DELMAR, DELAWARE - MARYLAND POLICE DEPARTMENT

Transcription

1 DELMAR, DELAWARE - MARYLAND POLICE DEPARTMENT STATE OF DELAWARE P.O. BOX 11 DELMAR, DE IVAN E. BARKLEY SR Chief of Police FAX STATE OF MARYLAND 102 S. PENN. AVE. DELMAR, MD Dear Applicant: Thank you for your interest in applying for a position with the Delmar Police Department. Attached you will find the qualifications for employment, employee benefits and the application package. The applicant package includes a number of forms that you must complete and return with your application. These forms will become a permanent part of your testing folder and will be used as a tool by our investigators in conducting your background investigation. Please note that we require a copy of your birth certificate and high school diploma. These will not be returned to you, make sure they are copies. In addition, we also require a certified copy of your driving record and a recent photograph. Upon completing the attached forms, Please return them to the Delmar Police Department, Monday through Friday, from 8A.M. to 4P.M. Sincerely, Ivan E. Barkley Sr.; Chief Delmar Police Department

2 TESTING There will be three phases of preliminary testing. Those phases are: 1. Written Examination 2. Physical Ability Test 3. Oral Interview Board In addition, there will be two phases of testing that will be conducted once a conditional offer of employment has been made. Those phases are: 1. Physical Examination 2. Psychological Evaluation Written Examination: The written examination used is the National Police Officer Selection (POST) test. Physical Ability Test: At this phase, the applicant must participate and complete several areas of fitness related to exercise. Physical fitness is a candidate s body conditioning as measured by evaluation results, according to the persons sex and age. Such an evaluation may help identify qualified applicants and reduce the probability of work related disabilities. The Written Exam and Physical Ability tests are worth 100 points each. The ten best applicants with the highest combined scores will continue in the selection process. Oral Interview Board: Applicants who successfully complete the written examination any physical ability test with the required scores will be invited to the oral interview board. The Board will consist of three members of the Delmar Police Department, of varying rank. The Oral Board will be appraising such personal qualities as appearance, voice, ability to express himself/herself, ability to organize higher thoughts, poise, bearing and alertness. The ten candidates brought before the Oral Board will be reduced to five candidates. The remaining five candidates will continue on to the Chief s Interview. The Chief of Police will make the selections for offers of conditional employment from within this final group of candidates. 2

3 QUALIFICATIONS: Age: Each Police Officer applicant must have reached his/her 21 st birthday by the time of appointment to police officer (in all cases, applicant must reach his/her 21 st birthday prior to completion of the police academy). Education: All applicants must show proof of graduation from an accredited high school, or G.E.D., as approved/recognized by the Maryland or Delaware Department of Education. Residency: All Delmar Police Officers are restricted to live within a thirty minute response time to the Delmar Police Department. Physical Requirements: All applicants offered conditional employment must be able to pass a medical examination including a vision test. The medical examination will be conducted by a departmentally approved physician. The weight of each police officer applicant must be in proportion to height and build, as determined by the departmentally approved physician. Each police officer applicant must be complete a physical fitness evaluation. Additional Requirements: Each applicant must be a United States citizen. Each police officer applicant must possess a valid driver s license and must obtain a Maryland or Delaware driver s license within thirty days of appointment. Each police officer applicant must have at least three (3) years of driving experience at the time of appointment. Physical Examination: All applicants offered conditional employment must be able to pass a medical examination, based on medical standards as determined by the departmentally approved physician. The medical examination will include, but will not be limited to: 1. Eyesight, as determined by the examining physician, natural or correctable to 20/ General condition of sound physical health. Psychological Evaluation: All applicants offered conditional employment must be able to pass a written psychological test which he/she must pass. Such testing will be classified and withheld from public inspection. This test identifies abnormal personality traits which indicate maladjustments or mental illness. The tests results are analyzed by the Delmar Police Department s Psychologist. Based upon his/her analysis and written recommendations, an applicant may be rejected at this point. 3

4 PHYSICAL ABILITY TEST: The physical ability test (PAT) will consist of four parts: mile run 2. Sit-ups 3. Push-ups 4. Flex test 1.5 Mile Run This test is an excellent indication of the condition of the heart and lungs as it measures one s aerobic capacity or the ability of the heart and lungs to utilize oxygen. This test is worth 25 points and the breakdown for scoring is as follows: Age Group Fitness Score Males ales 20 to under 11:29 under 13: :30 to 12:09 13:4 o 15: :10 to 13:24 15:10 o 15: :25 to 14:29 15:55 o 17:54 5 over 14:30 over 17:55 30 to under 11:49 under 13: :50 to 12:54 13:55 o 15: :55 to 13:44 15:15 o 16: :45 to 14:44 16:05 o 18:24 5 over 14:45 over 18:25 40 to under 12:04 under 15: :05 to 13:24 15:10 o 16: :25 to 14:14 16:05 o 17: :15 to 15:19 17:55 o 19:29 5 over 15:20 over 19:30 50 to under 12:54 under 15: :55 to 14:04 15:45 o 17: :05 to 15:09 17:30 o 18: :10 to 16:04 18:55 o 20:29 5 over 16:05 over 20:29 The test will be performed on a flat surface. 4

5 Sit-ups This test measures muscular endurance in the abdominal muscle group, an area of great concern to the sedentary individual. Muscular endurance is the ability of the muscle(s) to contract repeatedly for a particular amount of time. Much evidence exists of the correlation between poor abdominal muscle development, excessive fat tissue and lower back problems. In this test, the applicant starts by lying on his/her back, fingers interlaced behind the head, knees bent, and the heels flat on the floor with a partner holding the feet secure. On the command GO the applicant performs as many correct sit-ups as possible in one minute. This test is worth 25 points. The breakdown for scoring is as follows: Age Group Fitness Score er of Sit-ups 20 to over o o o to to over o o o to to over o o o to to over o o o to 12 5

6 Push-ups This test also measures muscle endurance. A low level of muscle endurance indicates inefficiency in movement and a poor capacity to perform work. This test also measures mainly the muscles of both the chest and upper arm which are important in physical confrontations such as pushing, pulling, controlling, and handcuffing. The applicant starts from a front leaning/ rest position with only the toes and hands touching the floor. The applicant begins by lowering his/her body toward the floor so as to bring the shoulders even with or below the level of the elbow. He/she then pushes up so that the elbows lock out and immediately thereafter proceeds to repeat the exercise. The total number of correctly performed push-ups is recorded. This test is worth 25 points. The breakdown for scoring is as follows: Age Group Fitness Scores Males ales 20 to over 40 over o to o to o 26 9 to to 20 0 to 8 30 to over 37 over o to o to o 23 7 to to 17 0 to 6 40 to over 34 over o to o 25 9 to to 20 5 to to 14 0 to 5 50 to over 30 over o to to 23 6 to to 16 3 to to 10 over 2 6

7 Flexibility Flexibility may be defined as the possible range of motion in a single joint or in a group of muscles or joints. There is no known test that measures the flexibility of all the joints, but the sit and reach test will measure the all important flexibility of the lower back and hip areas. Additionally, the elastic ability of the muscles located in the back of the legs and the trunk is measured. After removing his/her shoes, the applicant sits on the floor with the legs extended forward, knees locked, the backs of the legs touching the floor, and leans forward at the waist as far as possible. This test is worth 25 points. The breakdown for scoring is as follows: Males Applicants flexible enough to extend their hands past their toes will receive 25 points. Applicants able to touch their toes will receive 20 points Applicants able to get within 1 of toes will receive 15 points Applicants able to get within 2 of toes will receive 10 points Applicants able to get within 3 of toes will receive 5 points Any applicant not able to get within 3 of toes will receive 0 points Females Applicants flexible enough to extend their hands plus 1 past their toes will receive 25 points. Applicants able to extend their hands past toes will receive 20 points Applicants able to touch their toes will receive 15 points Applicants able to get within 1 of toes will receive 10 points Applicants able to get within 2 of toes will receive 5 points Any applicant not able to get within 2 of toes will receive 0 points 7

8 BACKGROUND INVESTIGATION All applicants must submit to a personal investigation to verify his/her good character. The name and fingerprint classification of all candidates must be searched through the records of the Delmar Police Department, the Maryland State Police, the Delaware State Police, and the Federal Bureau of Investigation, and in other cities, including appropriate agencies located in states in which the candidate may have resided or worked. Background investigations using the personal history statement will verify candidates qualifying credentials in such areas as resident checks, employment, education, military experience, arrests, civil actions and gross negligence. On the application, the applicant is required to list three personal references, names of whom cannot be former employers or relatives. Candidates determined to be not eligible for employment with the Delmar Police Department will be informed by the Chief of Police, in writing within thirty calendar days of such decision. Candidates will be informed of the basis for their disqualification (e.g., background investigations, test scores, medical examination, etc.) A. Failure to meet the following state mandated requirements to become a police officer will also result in rejection: 1. At least 21 years of age at time of appointment 2. U.S. Citizen at time of appointment 3. High School Diploma, or G.E.D. Certificate recognized by the Maryland or Delaware Board of Education 4. Eligibility for or possession of a valid Maryland or Delaware Driver s License prior to appointment with three years driving experience. 5. Be of good moral character and reputation, as determined by a comprehensive background investigation which MUST, by law, include: a. Fingerprint search of local, state, and federal criminal record files. b. Check of military records (where applicable) c. Credit Agencies at places of residency over the past five (5) years d. School records e. Personal references f. Neighbors at places of residence over past ten (10) years g. Present and past employers and fellow employees ** Conviction for any state or federal crime MAY be grounds for rejection of applicant by the Maryland Police Training Commission or Delaware Council on Police Training. 8

9 B. Medical Examination. Those applicants offered Conditional employments who fail to pass the medical examination given by a licensed physician designated by the Delmar Police Department will be considered as rejected and will progress no further in the selection process. Reasons for rejection (failure to pass medical examination or meet minimum physical standards) shall include, but not be solely limited to the following: 1. Eyesight, as determined by the Police Department of the Town of Delmar, natural/correctable to 20/ Weight in proportion to applicant s height as determined by the examining physician for the Town of Delmar. 3. Recurring and limited physical injuries, conditions or illnesses which would prevent applicant from performing the essential functions of the position for which the applicant applied. C. Physical Stature. An applicant offered conditional employment may be rejected if his/her physical stature is not within the acceptable range of height and weight. This requirement will be waived in the event that the applicant provides a medical opinion from a licensed physician that his/her participation in the physical fitness evaluation will not have any adverse impact on the health status of the applicant. D. Background Investigation. The following may be cause for automatic rejection of applicant. 1. Military bad conduct or dishonorable discharge from any branch of the U.S. Military Service. 2. Documented evidence of three (3) or more instances of misconduct or disciplinary action in the military service (regardless of the type of discharges0. 3. Discharge from employment on two (2) or more occasions within the past five (5) years, or documented evidence of disciplinary action or discharge on three (3) or more occasions. 4. Conviction for any felony or serious crime 5. Conviction for a misdemeanor may be cause for rejection. 9

10 Delmar Police Department Drug Use Policy The purpose of this policy is to avoid arbitrary discrimination against those applicants, who during their formative years, experimented with certain substances of abuse and also protect the interests of the department and the community. Considering that inclusive and sometimes conflicting research as to the residual effects of various substances, legal obligations and the department s responsibilities, this policy will be a realistic approach to reducing the questions of risks associated with the employment of such individuals. Identification of present use and/or addiction to any illicit drug (cocaine, PCP, marijuana, LSD, etc.) by any applicant will be grounds for permanent rejection. Should the use of a substance identified be supported by the proper medical documentation, the completed investigation will be forwarded to the department designated physician for evaluation and recommendation. The purpose of this evaluation shall be to ensure the substance, although properly obtained, is not subject to abuse and/or the individual is medically fit to fill the assigned position. Evidence demonstrating repeated use of any drug or chemical substance, e.g. marijuana, alcohol, etc., with such frequency that it appears the individual has or had accepted the use and/or reliance upon the substance as part of a pattern or behavior, shall be reason for permanent rejection. Any applicant found to be involved (at anytime) in the illegal sale, manufacture, or distribution of any controlled dangerous substance will be permanently rejected. Any improper use of any narcotic/drug by any applicant after application will be grounds for permanent rejection. The following is a list of criteria formulating the Delmar Police Department Drug Use Policy: 1. Opiates There will be no exceptions for any use of heroin or opium. Opiates in this form have no medicinal use, are typically related to a criminal atmosphere and are not usually a drug of first choice. Other opiates, e.g. morphine, codeine, etc., having a medicinal value, may be considered in the context of their application. Where these drugs are abused, e.g. in experimentation situations, taken without proper authorization, illegally obtained, etc, the limits for experimentation are: 10

11 Opiates Continued 1. One time ingestion (lifetime) with no intravenous applications. 2. Three year period of abstinence prior to application. 3. Must submit to additional psychiatric/psychological evaluation. Depressants (barbiturates, benzodiazepines, methaqualone, etc.) Drugs of this class have a medical use and are readily available legally and illegally. Where these drugs are abused, the limits for experimentation are: 1. One time ingestion (lifetime) with no intravenous applications. 2. Three year period of abstinence prior to application. 3. May submit to additional psychiatric/psychological evaluation. Stimulants (amphetamines, methamphetamines, etc.) Cocaine 1. Two ingestions (lifetime) with no intravenous applications. 2. three year period of abstinence prior to application. 3. May be required to submit to additional psychiatric/psychological evaluation. Cocaine may be used medicinally as a local, topical anesthetic; however, the predominate use of cocaine is in abusive situations. Because of its rapid psychological addictive nature, experimentation limits are: 1. One ingestion (lifetime) for powder cocaine with no intravenous applications. 2. There will be NO exception for any use of crack cocaine. 3. Three year period of abstinence prior to application. 4. Must submit to additional psychiatric/psychological evaluation. Hallucinogens These drugs have no medical value. Because of the research concerning residual side effects from even small quantities of these drugs, no exemptions for experimentation are to be made for any use. Permanent rejection. 11

12 Inhalants- (solvents, glue, paint, aerosols, amyl nitrites) Inhalants have no medicinal value. Documented medical information identifies significant medical complications associated with the use of small quantities of inhalants. The limits for experimentation are: 1. two ingestions (lifetime) 2. three year period of abstinence prior to application 3. May be required to submit to additional psychiatric/psychological evaluation. Cannabis-Marijuana, Hashish, any substance containing THC Cannabis has no medicinal value. Prevailing attitudes, availability, and the lack of significant conclusive evidence supporting health or psychological evidence supporting health or psychological hazards contributes to the widespread use of this substance. Research found that marijuana has been used by individuals as early as age eleven. Twenty percent of those reporting used for at least a month sometime in their life. The limits for experimentation are: 1. fifteen ingestions (lifetime) 2. three year period of abstinence prior to application 3. May be required to submit to psychiatric/psychological evaluation. ***Note: Ingestion is a single application, e.g., one marijuana cigarette, one dosage of pills, liquid, etc. Indications of cross experimentation, while meeting individual drug exemption criteria, will require, in all cases, participation in psychiatric/psychological evaluation. All periods of abstinence must be positively verified by polygraph/voice stress analysis examination. Results of psychiatric/psychological evaluation must support a negative propensity toward drug abuse and a lack of residual side effects associated with drug use. Cross experimentation indicating experimentation with more than two controlled dangerous substances will result in permanent rejection. An applicant having been permanently rejected has no reapplication right. Applicants will further be required to submit to a urinalysis test for controlled dangerous substances during the application process. The time, location, and procedure will be designated by the department. 12

13 BENEFITS 1. Starting Salary Police Officer non-certified $35,500 Police Officer after MD & DE Certifications $36, All Uniforms and Equipment Issued (Except socks and underwear) 3. Medical Benefits Health Plan available with employee s membership paid for by Town of Delmar. 4. State Retirement Sworn employees accrue 2 ½% for each of their first 20 years of uninterrupted service and 3 ½% for each year thereafter not to exceed 100%. 5. Holiday Leave+ The employee receives ten (10) paid holidays per year. 6. Annual Leave Employee receives ½ day a month during the first two years of service. After the second year, the employee receives one day per month. After the tenth year, the employee receives a day and a half per month. 7. Sick Leave The employee receives one sick day per month. The employee may accumulate 720 hours of sick time. 8. Overtime Time and one half is paid for overtime. Employees scheduled to work on a recognized holiday receive pay at double time and one half. 13

14 DELMAR, DELAWARE - MARYLAND POLICE DEPARTMENT STATE OF DELAWARE P.O. BOX 11 DELMAR, DE IVAN E. BARKLEY SR Chief of Police FAX STATE OF MARYLAND 102 S. PENN. AVE. DELMAR, MD To All Applicants: 1. Upon Completion return: a. Completed Application and Personal History Statement b. Copies of Birth Certificate and Social Security Card c. Copies of High School Diploma or GED, along with any other degrees or diplomas. d. Signed and Notarized Forms including - Release of Medical Records Authorization - Release of Information - Waiver of Liability for Physical Agility Test - Statement of Truthfulness 2. In addition all applicants must provide: a. recent photograph of applicant b. certified copy of driving record (available from Motor Vehicle Admin. (for a small fee) *** INCOMPLETE APPLICATIONS MAY BE REJECTED 14

15 Application for position of: Date: General Instructions: Print an answer to every question. If a question does not apply to you Then write N/A. If space available is insufficient, use a sheet and precede Each answer with the number of the reference block. Do not mistake or omit material facts, since the statements made herein are Subject to verification to determine your qualification for employment. 1. Last Name First Name Middle Name 2. Alias (es) Maiden Name, Other changes in Name Social Security Number 3. Present Address Street or RFD/City or P.O./State Zip Code 4. Date of Birth (mo/day/yr.) Place of Birth (city, county) State 5. Phone Number Home: Business: 15

16 Height Weight Color of Eyes Color of Hair Scars & Marks U.S. Citizen Native Yes No Naturalized Certificate Number If Derived, Parents Certificate No. Date, Place & Court Marriage Status Name of Fiancée (if applicable) Single Engaged Married Separated Divorced Widowed Information Concerning Marriages: When: Where: Who Officiated: Spouse s Name Names and Present Address of Spouse (s) if Divorced or Separated: Name: Name: Address: Address: Name: Address: 9. Children and Dependents List All of Your Children, Including Step-Children Name Birth Date Birth Place Address 16

17 10. Military Status Have you served in the U.S. Armed Forces? Yes No Branch: From: To: A. While in the military service, were you ever arrested for an offense which resulted in a trial by Deck Court or by Summary, Special, or General Court-Martial? Yes No If yes, give date, place, law enforcing authority or type of court or court-martial, charge and action taken for each incident, using a separate sheet to record this information. B. Are you presently a member of the U.S. Reserve or National or State Guard organization? Yes Grade and Service No. NO If yes, complete the following: Service and Component Organization and station or unit and location: Indicate Reserve Obligation, if any: Active Inactive Standby 11. Vehicle Operator s License (Driver s, Chauffeur s, etc.) Give the following information concerning any vehicle operator s license you have held or now Hold. Class of License Place of Issue Date of Expiration Restrictions Have you ever been denied issuance or have you had a license suspended or revoked? Yes No If yes, operator s License No. Explain Fully: 17

18 Have you ever had automobile insurance withdrawn or revoked or have you ever been refused automobile insurance? Yes No If yes, give details, including reasons, names of companies, date, etc. Give name and address of the insurance company with whom you now have automobile insurance: Policy coverage: Policy Number: 12. Family List in order given, showing relationship, parents, guardians, step-parents, foster parents, parents-inlaw, brothers and sisters (even if deceased). Include any others you have resided with or with whom a close relationship existed or exists. Relationship Name Present Address, if living Father Mother-Maiden Name If any person listed above is not a U.S. Citizen by birth, give the date and place of his/her birth, the date and port of entry, alien registration number, naturalized certificate number, and place of issuance. 18

19 13. Have you ever been discharged, asked to resign, furloughed, or put on inactive status for a cause, Or subjected to disciplinary action while in any position (except military)? Yes No if yes, state circumstances: Have you ever resigned (quit) after being informed that your employer intended to discharge (fire) You for any reason? Yes No 14. Arrest, detention, and litigation (show all arrests including juvenile delinquent and traffic). Have you ever been arrested or detained by a law enforcement agency? Yes No If the answer to any of the above questions is yes, list below the date, place, and full details of each incident: 15. Residence: List all residences for the past 10 years. Month and Year From To Street and Number City State and County 19

20 16. Subversive Organizations Yes No Are you now or have you ever been a member of the Communist Party U.S.A. or any communist organization (s) anywhere? Are you now or have you ever been a member of a Fascist Organization? Are you now or have you ever been a member of any organization, association, movement, group or combination of persons which advocates the overthrow of our constitutional form of government, or which has adopted the policy of advocating or approaching the commission of acts of force or violence to deny other persons their rights under the constitution of the United States or which seeks to alter the form of government of the United States by unconstitutional means? Are you now or have you ever been affiliated or associated with any organization of the type described above? Are you now associating with, or have you associated with any individuals, including relatives, who you know or have reason to believe are or have been members of any of the organizations named above? Have you ever been engaged in any of the following activities of any organization of the type described above; contribution (s) to, attendance at or participation in any organizational, social, other activities of said organizations of any projects sponsored by them, the sale, gift, or distribution of any written, printed, or other matter, prepared, reproduced, or published by them or any of their agents or instrumentalities? If you answered YES to any of the questions above, describe the circumstances. Attach additional sheets for a full detailed statement. If associated with any of these organizations, specify nature and extent of association with each, including office or position held, also include names, places and credentials now or formerly held. If associations have been with individuals who are members of these organizations then list the individuals and the organizations with which they were or are affiliated. 17. Are there any incidents in your life not mentioned herein which may reflect upon your suitability to perform the duties which you may be called upon to take or which might require further Explanation? Yes No If yes, attached a separate sheet of paper(s). 18. Have you ever applied for a position with any other police, fire or protective agency? Yes No if yes, give details: 19. Do you have an application pending with any other employment? Yes No if yes, give details: 20

21 EDUCATION It is necessary for YOU to submit, or arrange for submission, a transcript of all records from accredited high schools, colleges, military and technical schools you may have attended. Schools or colleges should forward transcripts to: Chief Harold Saylor, Delmar Police Department, 400 S. Pennsylvania Avenue, Delmar, MD High School: 2. Dates attended, from to Date of Graduation 3. Have you ever taken a High School Equivalency Test? Date and Certificate Number: 4. Certificates or Diplomas issued by the U.S. Armed Forces: Name & Location of Dates Attended Credits Degree College(s) or Univ. (s) From/To Accumulated Received/Year 5. Major and minor courses: 6. List Graduate Studies: 7. List specialized schools and training. (Trade and Vocational, Business or Military). Give The name and location of school, dates attended, subjects studied, number of classroom hours, certificate received and other pertinent information. 8. Special skills and qualifications Indicate all types of special licenses such as pilot, Radio operator, etc. Show all licensing authority, where issued and date expiration. DO NOT list automobile operator s license here. 21

22 CREDIT INFORMATION 1. Give the names and addresses of all individuals, companies or others to whom you are indebted and the extent of your debt. Include loans on which you are a co-worker. Name and address of Account Number Highest Credit or Monthly Creditor Am ount Owed Payment 2. Have you ever been refused credit? Yes No (Explain yes) 3. If you attended college, were State and Federal Funds used for tuition? Yes No If yes, what was the amount of the loan or grant? Termination date of the obligation: 22

23 EMPLOYMENT EXPERIENCE Please list all your previous places of employment starting with your present or most recent employer and going backwards. If more space is needed then please continue on a separate sheet of paper. 1. Employer: Telephone: Address: Supervisor: Employed from to Reason for Leaving: Job Description: 2. Employer: Telephone: Address: Supervisor: Employed from to Reason for Leaving: Job Description: 3. Employer: Telephone: Address: Supervisor: Employed from to Reason for Leaving: Job Description: 4. Employer: Telephone: Address: Supervisor: Employed from to Reason for Leaving: Job Description: 23

24 Please list below any other law enforcement agencies to which you have applied: Please list three personal references, addresses and telephone numbers, none of which can be former employers or relatives:

25 APPLICANT DATA RECORD Qualified applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sec, national origin, age, marital or veteran status, medical condition or handicap. Solely to help us comply with government record keeping, reporting, and other legal requirements, please fill out the Data Record. This Data Record is for periodic government reporting and will be kept in a confidential file separate from the application for employment. Date of Application: Position (s) applied for (The designation of a specific position will not exclude you from being considered For any other position for which you are qualified.) Name: Last First Middle Address: Number Street City State Zip Phone: ( ) Social Security No. Referral Source: Advertisement State Employment Office Employm ent Agency Walk-In Personal Contact College Placement Service Other Government Agencies require periodic reports on the sex, ethnicity, disability, and veteran status of applicants. This data is for analysis only. Submission of information about a disability is voluntary. Check one: m ale female Check one of the following: white Black Hispanic Am erican Indian/Alaskan Native Asian/Pacific Islander Other Check if applicable: Veteran Disabled Veteran Disabled Individual 25

26 DELMAR, DELAWARE - MARYLAND POLICE DEPARTMENT STATE OF DELAWARE P.O. BOX 11 DELMAR, DE IVAN E. BARKLEY SR Chief of Police FAX STATE OF MARYLAND 102 S. PENN. AVE. DELMAR, MD Waiver of Liability In consideration of being permitted to take the physical test for the position of Police Officer, I agree that I shall not hold the Town of Delmar or any of its employees or agents responsible for any injury or damage that I may receive or cause to myself during or as a result of this physical agility test. Signature: Date: Subscribed and sworn to Before Me This day of, 20. Notary Public: My commission expires on:

27 DELMAR, DELAWARE - MARYLAND POLICE DEPARTMENT STATE OF DELAWARE P.O. BOX 11 DELMAR, DE IVAN E. BARKLEY SR STATE OF MARYLAND Chief of Police FAX S. PENN. AVE. DELMAR, MD Authorization for Release of Medical Records (Upon conditional offer of employment) I, do hereby authorize a review and full disclosure of all medical records or any part thereof, concerning my self, by and to a duly authorized agent of the Delmar Police Department, whether the said records are of a public, private, or confidential in nature. Name: Signature: Date of Birth: Social Security Number: Subscribed and Sworn to Before Me This day of, 20. Notary Public: My Commission Expires: Official seal must be affixed

28 DELMAR, DELAWARE - MARYLAND POLICE DEPARTMENT STATE OF DELAWARE P.O. BOX 11 DELMAR, DE IVAN E. BARKLEY SR Chief of Police FAX STATE OF MARYLAND 102 S. PENN. AVE. DELMAR, MD Authorization for Release of Information I do hereby authorize a review and full disclosure for all records, or any part thereof, concerning my self by/to any duly authorized agent of the Delmar Police Department, whether the said records are public or private, and including those which may be deemed to be of a privileged or confidential in nature. The intent of this authorization is to provide pertinent information which will be utilized for investigative information. I understand that this investigation will include, but not be limited to, records of educational institutions; financial or credit institutions along with records of commercial or retail mercantile establishments; all medical and psychiatric records of treatment or consultations; any and all work records including any previous background investigations, efficiency reports or evaluations, complaints or grievances filed by or against me; records of a civil nature involving complaints filed by or against me; and records of any violations of criminal or traffic laws. I also authorize further investigation into my personal life in order to facilitate any decision regarding my suitability for the position of Police Officer with the Delmar Police Department. A photocopy of this release form will be valid as an original hereof, even though through the photocopy does not contain an original writing of my signature. Applicant's Signature/Date Applicant's SSN Applicant's Printed Name Date of Birth On this day of, 20, before a Notary Public, the undersigned individual personally appeared, known to me (or satisfactorily proven) to be the person whose name is subscribed to herein and acknowledged that he/she executed the same in the capacity therein stated and for the purposes therein contained. In witness whereof, I here unto set my hand and official seal. Signature of Notary Public Official Seal must be affixed

29 DELMAR, DELAWARE - MARYLAND POLICE DEPARTMENT STATE OF DELAWARE P.O. BOX 11 DELMAR, DE IVAN E. BARKLEY SR STATE OF MARYLAND Chief of Police FAX S. PENN. AVE. DELMAR, MD I certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers, and that the entries made by myself are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I further agree and consent to being summarily discharged without cause or hearing if any of the above information contains any misrepresentations or falsification or if any material contains any information that has been omitted. Name of Applicant Signature of Applicant Date Subscribed and Sworn to Before Me This day of, 20. Notary Public: My commission expires: Official seal must be affixed