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    PERSONAL INFORMATION:

    Last Name (required)

    First Name (required)

    Age

    Date of Birth

    Home Address (required)

    City (required)

    Zip Code (required)

    Place of Birth

    Home Phone (required)

    Business Phone

    Email Address(required)

    Previous Address(s) Last Five Years


    CRIMINAL HISTORY AND DRIVING RECORD:

    Kentucky Drivers License Number:

    Has your license ever been suspended or revoked?:
    YesNo

    Has your ever been convicted of a crime?:
    YesNo

    If "Yes", please explain:

    Traffic citations and accidents for the past two years:


    REFERENCES:

    References: DO NOT USE FAMILY MEMBERS AS REFERENCES. List four(4) individuals you have know for at least 5 years. Please list names, complete address with Zip Code and Telephone Number)

    Reference 1:

    Reference 2:

    Reference 3:

    Reference 4:


    EDUCATION BACKGROUND AND MILITARY EXPERIENCE:

    Please check the highest level of education completed:
    Some High SchoolHigh School DiplomaSome College StudyCollege DegreeSome Graduate StudyGraduate Degree

    High School Attended:

    Collegel Attended:

    Military Service Branch:

    Rank:

    Time served:

    Date Discharged:

    Military Service Branch:

    Rank:

    Time served:

    Date Discharged:


    EMPLOYER HISTORY: (Please fill out completely) IF you are retired please not "Not Applicable"

    Current Employer:

    Occupation:

    From Date:

    To Date:

    Employment for the past 5 years (Please include firm name, address, supervisor, dates).

    1)

    2)

    3)

    4)


    TELL US A LITTLE ABOUT YOU...

    What are your hobbies and interests?

    Have you volunteered before? If so, what did you do and where?

    Do you prefer an office setting or more active role?

    Please briefly sate why you wish to volunteer your time to the Erlanger Police Department? This question is required.