North Carolina APPLICATION INFORMATION AND INSTRUCTIONS. (Read Carefully Before Starting)

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1 Human Resources & Risk Services Department PHONE: (252) City of Wilson North Carolina APPLICATION INFORMATION AND INSTRUCTIONS (Read Carefully Before Starting) General Information: Incorporated in 1849, Wilson, North Carolina, is ideally situated in Eastern North Carolina, only 50 miles east of Raleigh, the State s Capital, and 100 miles west of Atlantic Ocean. Though a small City of only 18.9 square miles and 50,651 people, Wilson is a giant in the world of business. Once a Tobacco Town, this City, affectionately know by her citizens as the City of Beautiful Trees, has emerged as a wonderfully harmonious blend of agriculture and industry. In addition to being American s largest tobacco market and home to the largest antique dealership in the United States, Wilson is also North Carolina s largest farm market center and is an All-America City. This exceptional balance between agriculture, business, industry, education, recreation, and government can be matched only by the friendliness of the people. An Equal Opportunity Employer, the City is firmly committed to the principles of Equal Employment Opportunity for all. The City selects and makes all personnel decisions based upon merit and individual qualifications without regard to sex, race, color, religion, national origin, age, or disability. If at any point in the selection process you believe discrimination has occurred, we ask that you contact the City s Human Resources & Risk Services Manager. Upon receipt or notification from any applicant (either internal or external) of alleged discrimination, the Human Resources & Risk Services Manager will conduct a formal investigation into the complaint. Applicants also have the right to contact the Equal Employment Opportunity Commission within 180 days after they feel discrimination has occurred, if they feel all other efforts have been exhausted. Six Steps to a Career: 1. Check our Job Opportunities Listing for any position which fits your educational background, professional interests, and experience. Listings are located in the Human Resources & Risk Services office and posted with some community and church organizations. Our Job Hotline number is (252) Once you locate a position which interests you, contact the Human Resources & Risk Services Department. You must complete an Employment Application and return it before the indicated deadline. 3. All applications received are evaluated based on skills, knowledge, and abilities required for the job. 4. After evaluations are completed, the most qualified applicants are notified for a personal interview. 5. After all interviews are completed, a recommendation for hire is forwarded to the Human Resources & Risk Services Department. 6. All applicants not chosen for the particular position will be notified by letter. Instructions: The City of Wilson receives several thousand applications each year for vacant positions. Due to the large volume of applications received, it is imperative that you fill out the application completely, and attach any additional information you feel may be useful. Resumes are not accepted in place of applications and incomplete applications will not be considered. Please print in ink clearly or type all information. Job applications should be forwarded to: City of Wilson Human Resources & Risk Services Department P.O. Box 10 Wilson, NC Phone (252) Fax (252) Please complete all pages of this application. We at the City of Wilson thank you for your interest in employment and wish you success during the selection process. Go to Page 2

2 APPLICATION INFORMATION FORM In order to comply with the United States Government Equal Opportunity Employment Requirements, all applicants for employment are requested to complete this form. Data will be used to measure the effectiveness of recruitment efforts and selection procedures. This information is requested on a voluntary basis, will be kept confidential, and is not available to hiring authorities. The City of Wilson is an Equal Opportunity Employer. The City does not discriminate on the basis of race, creed, sex, national origin, age, or disability. DATE: MM/DD/YYYY NAME: Last First Middle ADDRESS: St. & No., RFD, or PO Box City State Zip County DATE OF BIRTH: MM/DD/YYYY SEX Male Female VETERAN STATUS Yes (Vietnam) Yes (Other) No RACE White Black Asian American Indian Hispanic Other THIS APPLICATION IS IN RESPONSE TO: (Please check block and name particular source) Newspaper: Professional magazine or newsletter: 24 Hours Job Hotline: Job Opportunities Listing (Specify): TV: Personal Referral: College Recruitment: Radio: Other (Specify): POSITIONS APPLIED FOR:

3 APPLICATION FOR EMPLOYMENT Current Information City of Wilson HUMAN RESOURCES & RISK SERVICES DEPARTMENT P.O. BOX HERRING AVENUE WILSON, NC (252) An Equal Opportunity Employer INSTRUCTIONS: It is important that you fill out all sections of this application completely and to the best of your ability. Your application will be used as part of the examination process and, therefore, should represent your best effort. IN ORDER TO BE PROCESSED, THE APPLICATION MUST BE COMPLETED IN INK (OR TYPED) AND SIGNED. DATE: MM/DD/YYYY NAME: ADDRESS: Last First Middle St. & No., RFD, or PO Box City State Zip MAILING ADDRESS: (If different from above) St. & No., RFD, or PO Box City State Zip TELEPHONE: ( ) - ( ) - Home Business ( ) - If neither, where can you be reached? ADDRESS: Enter below the specific job titles for which you are applying When will you be available for employment? General Information (Attach additional sheet if needed) a. Have you ever been employed with the City of Wilson? If yes, what department and when? Yes No b. Will you accept employment requiring occasional night work or weekend work? Comments Yes No c. Will you accept employment requiring regular night work or weekend work? Yes No d. Are you related by blood or marriage to any City Employee? If yes, give name, relationship, and department Yes No e. Do you have a valid Driver s License? If so, complete the following: License No. State Date of Issue Is this a Commercial Driver s License (CDL)? If so, please check which type. A B C Yes No f. Have you ever been convicted of a Felony or Misdemeanor requiring imprisonment or a fine in excess of $50.00? If yes, please explain Yes No 3

4 Education Give your complete educational history below. Check highest school year completed High School: / Name City State Month/Year (last attended) Have you received a high school diploma or equivalent? Yes No If yes, when? / Education Beyond High School Education Beyond High School Name / - / Attended MM/YYYY-MM/YYYY Credit Hours Degree or Diploma Location Year Rec d Major Subject Graduate, Professional or Other Name / - / Attended MM/YYYY-MM/YYYY Skills, Certifications Please list any skills, special certifications, licenses, special training, or courses you have had that you feel are applicable to the position for which you are applying. Include skills and equipment or machinery that you operate. If you wish consideration for an administrative support position, indicate typing, and shorthand speeds. a. f. b. g. c. h. d. i. e. j. Employment Record your complete work history in the spaces below. Begin with your current or most recent employer first. Attach as many sheets as is necessary to account for your full record. Be sure to account for gaps in your employment history. Related volunteer experience should also be listed. A. CURRENT OR MOST RECENT EMPLOYMENT (Or explain gap in employment) Job Title: Credit Hours Degree or Diploma Starting Salary: $ Location Year Rec d Major Subject Ending Salary: $ Name and title of supervisor: # Supervised by you: Employer or company: Telephone #: ( ) - Address: Date Employed: Date Separated: / / Duties: Full-time for: Part-time for: Years Years Months Months If part-time, number of hours worked per week: Reason for leaving: If you are currently employed, may we inquire of this employer about your qualifications and character? Yes No Comments: 4

5 Employment (continued) B. NEXT EMPLOYMENT (Or explain gap in employment) Job Title: Name and title of supervisor: Starting Salary: $ Ending Salary: $ # Supervised by you: Employer or company: Telephone #: ( ) - Address: Date Employed: Date Separated: / / Duties: Full-time for: Part-time for: Years Years Months Months If part-time, number of hours worked per week: Reason for leaving: C. NEXT EMPLOYMENT (Or explain gap in employment) Job Title: Name and title of supervisor: Starting Salary: $ Ending Salary: $ # Supervised by you: Employer or company: Telephone #: ( ) - Address: Date Employed: Date Separated: / / Duties: Full-time for: Part-time for: Years Years Months Months If part-time, number of hours worked per week: Reason for leaving: D. NEXT EMPLOYMENT (Or explain gap in employment) Job Title: Name and title of supervisor: Starting Salary: $ Ending Salary: $ # Supervised by you: Employer or company: Telephone #: ( ) - Address: Date Employed: Date Separated: / / Duties: Full-time for: Part-time for: Years Years Months Months If part-time, number of hours worked per week: Reason for leaving: 5

6 Employment (continued) E. NEXT EMPLOYMENT (Or explain gap in employment) Job Title: Name and title of supervisor: Starting Salary: $ Ending Salary: $ # Supervised by you: Employer or company: Telephone #: ( ) - Address: Date Employed: Date Separated: / / Duties: Full-time for: Part-time for: Years Years Months Months If part-time, number of hours worked per week: Reason for leaving: (Attach additional sheets if this does not account for your full record.) Military Service (Applicable Only to Veterans) Please list any relevant military training or services which you may have obtained. Also list your service dates, present military status, etc. in the spaces provided. a) b) c) d) e) Date of Entry: MM/YYYY Date of Separation: Service Number: Service Branch: Special skills or training: Type of discharge: Military occupation: NOTICE! All applicants who are selected for a permanent position with the City of Wilson will be required to have a physical examination prior to employment. Included in the examination will be a drug screening test. THIS APPLICATION MUST BE SIGNED. Unsigned applications will not be processed. **Submitting an electronic version of this application: If selected to continue in the selection process a signature will be required at that time. I certify that, to the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly misrepresented or falsified any of the application information, I may be disqualified for employment consideration or dismissed from employment with the City. I authorize my current and former employers to give any information regarding my employment, together with any information regarding me whether or not it is in their records. I hereby release them from any damage whatsoever for issuing same. I also permit the City of Wilson to conduct a police and courts records investigation of my background. I also authorize schools and other educational institutions which I may have attended to reveal my scholastic ratings to the City of Wilson representatives who are investigating my educational background. I understand that North Carolina State Law requires male applicants for employment, 18-25, to register for military service. By signing below, I certify that I am in compliance with state law. Signature Date THANK YOU FOR APPLYING WITH THE CITY OF WILSON 6

7 Wilson Police Department CITY OF WILSON North Carolina INCORPORATED January 03, 2014 Dear Applicant: Thank you for your interest in obtaining employment with the Wilson Police Department. The duration of the selection process is approximately eight to twelve weeks from the time of orientation. This time may vary due to the difficulty of scheduling polygraph examinations, psychological examinations, and physical examinations. The employment process consists of the following items: 1. Complete City of Wilson/Police Department Employment Packet. All items listed in the employment packet must be submitted. Failure to submit the required documents may be grounds for exclusion. Submit by mail: Wilson Police Department Post Office Box 10 Wilson, NC ATTN: SPO AM Jones Submit in person: City of Wilson Human Resources 1800 Herring Ave Wilson, NC NOTE: Items from other states may take longer to arrive. Applicants are encouraged to obtain these documents as early as possible. 2. Review of Employment Packet- packets will be reviewed for disqualifiers and applicants will be selected to continue in our process. Disqualifiers will not be disclosed to ensure the integrity of the background investigation. 3. Applicant Orientation Session / POST (National Police Officer Selection Test)- applicants will be contacted by or phone, and informed of the date, time, and location. 4. Oral Interview Board must receive consensus recommendation from Oral Board. Applicants are encouraged to prepare for the oral board by familiarizing themselves with the various aspects of service, and community involvement at the Wilson Police Department. 5. Intensive Background Interview/Investigation must meet standards of Wilson Police Department, City of Wilson, and North Carolina Criminal Justice P.O. Box 10 Wilson, North Carolina Telephone (252) Equal Opportunity / Affirmative Action Employer

8 Wilson Police Department CITY OF WILSON North Carolina INCORPORATED Justice Standards Commission. Disqualifiers will not be disclosed to ensure the integrity of the background investigation. 6. Polygraph Examination must complete a polygraph exam 7. Applicants who have successfully completed the preceding steps will be placed in a candidate pool. Only highly qualified candidates will be selected to continue in the process. 8. Conditional Offer of Employment/Interview with Chief 9. Drug Screen must test negative for all controlled substances 10. Psychological Examination must be recommended by a Police Psychologist 11. Physical Examination must be recommended by City Physician as fit for duty. If not selected for one of the available positions, you may re-apply at any time for future openings within the Wilson Police Department. With exception to the application, each phase of the process that you successfully complete is valid for one calendar year. If you have any questions, please call me at (252) Sincerely, SPO AM Jones Hiring Coordinator P.O. Box 10 Wilson, North Carolina Telephone (252) Equal Opportunity / Affirmative Action Employer

9 Authorization for Release of Personal Information To Law Enforcement Agencies for Certification/Employment Purposes To Whom It May Concern: I am an applicant for a position with the (Police Department) (Sheriff s Office). In order to determine my suitability for employment, I understand that the (Police Department) (Sheriff s Office) (City) (County) of, North Carolina must make a thorough investigation of my personal records and personal background. It is in the public s interest that all relevant information concerning my personal and employment history be disclosed to the above agency. Therefore, I DOB,, Operators License #, do hereby request and authorize any bank, credit union, lending or financial institution, credit bureau, consumer report agency, retail business establishment, former and present employer, educational institution, doctor or other health care professional including mental health, alcohol treatment center, hospital or other repository of medical records, insurance company, governmental agency, criminal and civil courts, certification/licensing commission, military organization, and any other individual agency to produce and provide copies of any and all information to the authorize agent of the (Police Department)(Sheriff s Office) (City) (County) of, North Carolina regarding me whether of privileged or confidential nature. Moreover, I hereby release the (Police Department) (Sheriff s Office) (City) (County) of, North Carolina from any civil or criminal liability whatsoever for seeking such requested information and for evaluating such information as it relates to my employment with the (City) (County) of. And I hereby release the issuing agency and its agents and employees, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result because of compliance with this authorization and request. I further waive all right to inspect or review any information compiled in reference to my application for employment as allowed by law. I do further authorize the (Police Department) (Sheriff s Office) its agents and employees, to release copies of any and all information to any agency or entity regulating the certification, authority or conduct of law enforcement officers. This is to include, but not limited to: North Carolina Criminal Justice Education & Training Standards Commission, North Carolina Sheriffs Education and Training Standards Commission, North Carolina Attorney General s Office, agencies, of other states and the federal government, and the applicant s/officer s employing agency. I hereby acknowledge that this authorization is valid for one (1) year or until the employment application or investigation process has been completed, whichever is later. Rev 2/15/2005 WPD 116

10 A copy of this document is considered valid, just as the original. I have read and fully understand the above statements. STATE OF NORTH CAROLINA COUNTY OF Subscribed and sworn to before me, This is the day of,. Notary Public & Seal My Commission Expires: Applicant/Officer Signature Printed Name Address Phone Number Rev 2/15/2005 WPD 116

11 F-3(LE) Rev NORTH CAROLINA CRIMINAL JUSTICE EDUCATION AND TRAINING STANDARDS COMMISSION CRIMINAL JUSTICE STANDARDS DIVISION It is the determination of the Commission that these questions are necessary in order to fully and adequately evaluate applicants for law enforcement and criminal justice certification. These questions are designed to ascertain whether the applicant meets the minimum standards for certification and serve no other purpose. PERSONAL HISTORY STATEMENT NOTE: This form is not designed for use as an initial application for employment and must not be used for that purpose. Rather, the applicant for a CERTIFIED position should complete this form prior to beginning his/her background investigation. This form should only be completed by applicants for a Commission-certified position.

12 NORTH CAROLINA CRIMINAL JUSTICE EDUCATION AND TRAINING STANDARDS COMMISSION PERSONAL HISTORY STATEMENT INSTRUCTIONS: Using the online form or legibly printing in ink fill out this form completely and accurately. If you need extra space, add additional pages and identify the information by item number. If an item does not apply to you, indicate by entering N/A in the blank. NOTE: All statements are subject to verification and any incorrect statements or omissions may bar or remove you from certification. Truthful statements to any item requested will not necessarily exclude you from consideration. THIS FORM MUST BE NOTARIZED UPON COMPLETION. NOTE: The Social Security Number is used to make positive identification of applicant and/or law enforcement personnel. DISCLOSURE IS VOLUNTARY. However, failure to provide this information may result in a delay in the processing of application materials and may result in inaccurate records being assigned to you. Position(s) applied for: Agency: Month: Day: Year: PERSONAL 1. Name: 2. Social Security Number: First Middle Last Maiden Name: Other Previous Last Names: Nicknames or Aliases: Has your name been legally changed after age 12? Yes No If yes, submit documentation with date and attach to this form. 3. Present Mailing Address: Street & Number City County State Zip Code Permanent Mailing Address: Street & Number City County State Zip Code Telephone Number: (Include Area Code) Home Work Cell Phone: Address: 4. Date of Birth: 5. Place of Birth: 6. Citizenship: U.S. Born U.S. Naturalized Other Specify F-3(LE) Rev

13 NOTE: Data solicited in this box will be used for Equal Employment statistical purposes only. 7. Ethnic Background American Indian Spanish American Asian American White Black Other 8. Sex Male Female 9. Have you previously submitted an application for employment with this agency? Yes No Approximate Date: EDUCATIONAL 10. Indicate below the schools you have attended. (Include incomplete courses) Indicate the type of High School you attended: Traditional Home School Distance Learning Did not attend high school Other: Name Address (City & State) No. Full Yrs Work Completed When Attended Graduated (Yes/No) Degree Awarded Major Field High Schools Universities or Colleges Extension or Correspondence Courses 11. If you did not graduate from high school, have you passed the General Educational Development (GED) Test? Yes No If yes, when and where did you complete the GED? NOTE: Questions included in the next section are intended to assist in the conducting of a background investigation and are not intended for use by the employing agency as disqualifying factors for employment as a criminal justice officer. MARITAL 12. Marital Status (check one) Single Married Divorced Engaged Separated Widowed F-3(LE) Rev

14 13. Name of Spouse: Name of Former Spouse(s): 14. List all of your children, including any adopted or stepchildren. Name Birth Date Relationship Address Phone Number (1). (2). (3). (4). (5). (6). FAMILY HISTORY 15. Are you related by blood or marriage to any person(s) now employed by this agency? Yes No If yes, give name(s) and details: 16. Is any member(s) of your immediate family now in prison or on either probation or parole? Yes No If yes, give name(s) and details: RESIDENCES 17. List every city/county in which you have lived since attaining the age of 16, with present address at top: From Mo/Yr To Mo/Yr Address of Residence City County State Landlord F-3(LE) Rev

15 FINANCIAL 18. What income other than salary do you have at present? 19. List all businesses you currently own or have financial interest in (do not list any stocks and bonds): 20. Are you now supporting all children born to you, adopted by you and stepchildren? Yes No If not, give details: 21. Are there persons, other than your spouse and listed children, who are presently dependent upon you for support? Yes No If yes, give name and details: 22. Have you ever been sued with a civil judgment being rendered against you? Please note this includes repossessions, evictions, executions, failure to pay child support, etc. (Do not include divorce) Yes No Not sure (explain) If yes, give details: 23. What is the total amount of all your debts at present? $ 24. What is the average monthly total of all of your bills, payments, and current living expenses? $ 25. List credit references, including creditors to which you make monthly payments: A. Amount Owing $ Name of Business Street Address City and State B. Amount Owing $ Name of Business Street Address City and State C. Amount Owing $ Name of Business Street Address City and State F-3(LE) Rev

16 D. Amount Owing $ Name of Business Street Address City and State E. Amount Owing $ Name of Business Street Address City and State F. Amount Owing $ Name of Business WORK HISTORY Street Address City and State 26. Have you ever been denied employment by a law enforcement agency, corrections agency, or security agency which required certification or licensure from any Commission, Board or Agency after a conditional offer of employment was made? Yes No If yes, list agency name and give details: 27. Have you ever held a position in any capacity which required certification or licensure from any Commission, Board or Agency established to certify or license that position? (Note: List any such Commission, Board, or Agency, whether in or out of North Carolina.) Yes No 27a. If yes, was such certification or license ever suspended, revoked, or any sanctions taken against it by the issuing authority? Yes No 27b. If such certification or license was ever suspended, revoked, or any sanctions taken against it by the issuing authority, please list the agency s name taking the action against the certification or license, date of the action, reason for the action, and the period of time for the suspension, revocation, or sanction. F-3(LE) Rev

17 28. Have you ever been discharged, requested to resign, or allowed to resign in lieu of termination, from any position because of criminal or personal misconduct or rules violations? Yes No If yes, list organization name and give details: 29. Do you object to wearing a uniform? Yes No 30. Do you object to working nights? Yes No 31. Do you object to working rotating shifts? Yes No 32. Do you object to occasionally being away from home overnight and for other periods of time attending meetings, acquiring training and otherwise performing official duties? Yes No 33. List ALL jobs, positions or appointments you have held in the last ten years to include temporary, part-time, paid or not paid employment, active or inactive reserve, and internships. Put your present or most recent job first. List a Reason for Leaving for each job. Include military service in proper time sequence and temporary part-time jobs. If there are gaps in your employment please provide an explanation for each period of unemployment. A. Title of present or last position Employer Address and Phone Number Name Phone Number Street City State Zip Code Date Employed Starting Salary Last Salary Date Separated Name/Title of Supervisor Full Time Yrs Mos Part Time Yrs Mos If part time, number of hours worked per week No. employees supervised by you Duties: F-3(LE) Rev

18 Reason for leaving: B. Title of present or last position Employer Address and Phone Number Name Phone Number Street City State Zip Code Date Employed Starting Salary Last Salary Date Separated Name/Title of Supervisor Full Time Yrs Mos Part Time Yrs Mos If part time, number of hours worked per week No. employees supervised by you Duties: Reason for leaving: C. Title of present or last position Employer Address and Phone Number Name Phone Number Street City State Zip Code Date Employed Starting Salary Last Salary Date Separated Name/Title of Supervisor Full Time Yrs Mos Part Time Yrs Mos If part time, number of hours worked per week No. employees supervised by you Duties: F-3(LE) Rev

19 Reason for leaving: D. Title of present or last position Employer Address and Phone Number Name Phone Number Street City State Zip Code Date Employed Starting Salary Last Salary Date Separated Name/Title of Supervisor Full Time Yrs Mos Part Time Yrs Mos If part time, number of hours worked per week No. employees supervised by you Duties: Reason for leaving: E. Title of present or last position Employer Address and Phone Number Name Phone Number Street City State Zip Code Date Employed Starting Salary Last Salary Date Separated Name/Title of Supervisor Full Time Yrs Mos Part Time Yrs Mos If part time, number of hours worked per week No. employees supervised by you Duties: Reason for leaving: F-3(LE) Rev

20 F. Title of present or last position Employer Address and Phone Number Name Phone Number Street City State Zip Code Date Employed Starting Salary Last Salary Date Separated Name/Title of Supervisor Full Time Yrs Mos Part Time Yrs Mos If part time, number of hours worked per week No. employees supervised by you Duties: Reason for leaving: G. Explain Periods of unemployment of three months or more. MILITARY SERVICE 34. Were you ever in the U.S. Military Service or any other military organization? Yes No Were you ever denied entrance into the military? Yes No If yes, why? QUESTIONS 35 THROUGH 43 ARE APPLICABLE ONLY TO VETERANS 35. What is your service number? 36. What was the highest rank that you held? 37. What was the last rank that you held? 38. What was the date and location of your first enlistment or commission? Date: F-3(LE) Rev

21 39. List each tour of active duty where a DD-214 was issued: Branch Unit (Company or Ship) Location From Mo./Yr. To Mo./Yr. 40. List all duty stations: Branch Unit (Company or Ship) Location From Mo./Yr. To Mo./Yr. 41. Have you ever received any of the following types of discharge: Uncharacterized Yes No Honorable Yes No General (Under honorable conditions) Yes No Under other than honorable conditions Yes No Bad Conduct Discharge Yes No Dishonorable Discharge Yes No Dismissal Yes No 42. Were you ever court-martialed, tried on charges, or the subject of a summary court, deck court, nonjudicial punishment, captain s mast, company punishment, article 15, and/or any other disciplinary action while a member of the military, national guard or reserve unit? Yes No If yes, explain what occurred and what type of punishment you received: 43. List all medals and decorations awarded you during your military service: F-3(LE) Rev

22 44. If you are presently a member of the National Guard or any military reserve, give the unit, location, and describe your obligation: USE OF ALCOHOL OR DRUGS 45. Do you drink alcoholic beverages? Yes No NOTE: In questions 46, and 47, the word used means one time or more, including experimentation. If any answer is yes, give full and complete details. (Attach extra sheets if necessary.) 46. Have you ever used, to include tasting, any illegal drugs including but not limited to, marijuana, steroids, opiates, pills, heroin, cocaine, crack, LSD, designer or synthetic drugs, etc., to include even one-time use or experimentation? Yes No I don t know (explain below) If yes, what were the circumstances, drugs used, and when did the usage last occur? When was the last time? 47. Have you ever used prescription drugs other than under the supervision of, or as prescribed by, a physician? Yes No I don t know (explain below) If yes, what were the circumstances, drug(s) used, and when did the usage last occur? 48. Have you ever purchased, possessed, manufactured, grown, delivered or sold any amount of illegal drugs or controlled substances for which you did not have a valid prescription? Yes No I don t know (explain below) If yes, identify the drug(s) and provide details concerning the purchase, possession, manufacture, growth, delivery, or sale. CRIMINAL OFFENSE RECORD AND DISCIPLINARY ACTIONS NOTE: Answer all of the following questions completely and accurately. Any falsifications or misstatements of fact may be sufficient to disqualify you. If any doubt exists in your mind as to whether or not you were arrested or charged with a criminal offense at some point in your life or whether an offense remains on your record, you should answer Yes. You must list any and all criminal charges regardless of the date of offense and the disposition (to include dismissals, not guilty, nol pros, PJC, or any other disposition where you entered a plea of guilty). Juvenile charges or arrests should also be listed. Include all offenses other than minor traffic offenses. Specifically include DWI, DUI, driving while under the influence of drugs, driving while license permanently revoked, speeding to elude arrest, or duty to stop in event of accident. Attached to this form is an additional list of North Carolina traffic offenses which must be listed. F-3(LE) Rev

23 You must include any and all convictions regardless of whether or not the convictions were expunged pursuant to NCGS 15A and 15A If you list a charge(s), please attach certified and true copies of warrant(s) and judgment(s) for each offense, even if documentation and charges have previously been reported to this agency. 49. Have you ever been arrested by a law enforcement officer or otherwise charged with a criminal offense? (The term charged as used in this question includes being issued a criminal citation or summons.) Yes No If yes, give details below: A. Offense Charged Law Enforcement Agency Date Disposition of Case B. Offense Charged Law Enforcement Agency Date Disposition of Case C. Offense Charged Law Enforcement Agency Date Disposition of Case (ATTACH EXTRA SHEETS, IF NECESSARY) 50. Have you ever had a Domestic Violence Protection Order issued against you? (Include both ex-parte Domestic Violence Protective Orders and those entered subsequent to a hearing.) Yes No Date of Issuance: County of Issuance: Name of Plaintiff: Date of expiration: 51. Under federal law you may be disqualified to receive or possess a firearm if you meet any of the following conditions: (a) currently under Indictment or Information in any court for a crime punishable by imprisonment for a term exceeding one year. (b) have been convicted in any court of a crime punishable by imprisonment for a term exceeding one year. A person would not be ineligible under this criteria if the person has been pardoned for the crime or conviction, the crime or conviction has been expunged or set aside, or the person has had his/her civil rights restored, and under law where the conviction occurred the person is not prohibited from receiving or possessing any firearm. (c) are a fugitive from justice. (d) are an unlawful user of, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance. (e) have been adjudicated mentally defective or have been involuntarily committed to a mental institution. (f) have been discharged from the Armed Forces under dishonorable conditions. (g) are illegally in the United States. (h) have renounced your citizenship, having previously been a citizen of the United States. NOTE: A crime punishable by imprisonment for a term exceeding one year as discussed in (a) and (b) above is defined in federal law so as to exclude most misdemeanors in North Carolina. If any of the above (a through h) apply, please note below and submit an explanation on a separate sheet of paper which accompanies this form. Your signature on the attestation found on page 15 of this document indicates you have read this section and understand each of the disqualifiers. F-3(LE) Rev

24 52. Have you been convicted of a misdemeanor under federal or state law which has, as an element, the use or attempted use of physical force or threatened use of a deadly weapon? Yes No I don t know (explain below) If so, did you commit the act(s) against a current or former spouse, parent, or guardian or against a person with whom you were or are cohabiting with or a person similarly situated to a spouse, parent, or guardian of the victim (Domestic Violence Offense)? Yes No Offense Charged: Law Enforcement Agency Date: Disposition 53. Have you ever been charged with a felony? (including any charges expunged pursuant to NCGS 15A and 15A ) Yes No If yes, give details: 54. Have you ever been placed on probation? Yes No If yes, give details: 55. Do you possess a valid driver s license from the State of North Carolina? Yes No Driver s License Number Year Issued 56. Do you now possess, or have you ever possessed a driver s license issued by any state other than North Carolina? Yes No If yes, give state and number 57. Was your driver s license ever suspended or revoked? Yes No If yes, state which and give reasons: 58. Was your driver s license ever restored? Yes No When? 59. Have your driving privileges ever been restricted? Yes No If yes, give details: CAREER OBJECTIVES 60. Briefly explain your reasons for applying for this position: F-3(LE) Rev

25 61. List special skills, training, fields of work for which you are licensed, registered, or certified, and hobbies which may be useful in the performance of the duties of the position for which you have applied: 62. What are your feelings about the use of deadly force it if became necessary in the performance of official duties? REFERENCES 63. Give the names of five responsible persons, other than relatives or past employers, who could provide information about your character, ability, experience, personality, and other qualities. A. B. C. D. E. Name Address Telephone STATE OF NORTH CAROLINA COUNTY OF I hereby certify that each and every statement made on this form is true and complete and understand that any misstatement or omission of information will subject me to disqualification or dismissal. I also acknowledge that I have a continuing duty to update all information contained in this document. I will report to the employing agency and forward to the NC Criminal Justice Education and Training Standards Commission any additional information which occurs after the signing of this document. This the day of, 20 (Signature in Full) Subscribed and sworn before me, this the day of, 20 Notary Public (Official Seal) My Commission Expires:, 20 F-3(LE) Rev

26 Pay, Incentives and Work Schedule Wilson Police Department Recruiting Information 2014 Base 35, % probationary increase 37, % 37, % probationary increase 39, % 38, % probationary increase 40, % 40, % probationary increase 42, % 42, % probationary increase 44, These figures do not include annual merit raises. Merit raises are normally given annually and are based on the individual officer s performance, not across-the-board. Ratings: Needs Improvement ; Meets Expectations ; Exceeds Expectations ; Superior. Educational incentives may be awarded at any time during the officer s career. The awarding of an educational incentive is in addition to any promotional increase and/or merit increases. You are never limited or capped on the amount of money you can make in any given year. The city offers $ in educational assistance, annually. Incentives: 5% Current NC BLET Certification 5% AAS or 60 Semester Hours 10% BS/BA 15% MS/MA 5% Demonstrated fluency in a second language Operations Division Work Schedule Week One: Work M-Tu; Off W-Th; Work F-Su (work 5 days) Week Two: Off M-Tu; Work W-Th; Off F-Su (work 2 days) Day Shift; Night Shift. Rotate after two weeks. Other incentives:

27 CALEA Meritorious and Flagship designated Agency - 2 nd in NC (1987), 47 th in the Nation accredited NC Local Government Law Enforcement Retirement Pay NC Municipality Funded Supplemental Retirement Pay 401K (5% paid by the city, plus elective employee contribution) Individual health insurance premiums paid by the city as long as you meet your Wellness Program goals. Family plans available at group coverage cost. Complete medical exam paid for by the City annually, and Wellness Program Dental and Optical Insurance Plans paid by the City Life Insurance equal to base pay paid by the City (you can elect to buy more at group coverage rates) Individually assigned patrol vehicles (take-home if you live within the ETJ) MDT s and In-car camera systems in each vehicle OSSI Mobile Reporting and Database Software All Uniforms and Equipment paid by the City Sig P226, 229 and 239 service weapons in.357 Sig, with Safariland Raptor holsters Individually assigned TASER Shotguns and patrol rifles are issued by seniority and demonstrated skill. Officers may carry a personally owned AR15 rifle after 2 years of service and completing departmental rifle training and qualification. Personally owned secondary handguns are permitted after the completion of Field Training Johnson 800MHZ Digital vehicle and handheld radio systems (VIPER accessible). Handheld radios are take home 12 Sick Days per year (unlimited accumulation) 12 Paid Holidays Family Leave, Military Leave, Funeral Leave and Medical Appointments District Court scheduled on-duty during day shift You do not have to appear in Grand Jury, Investigators handle this for you 80 hours vacation years 1-5; 96 hours vacation years 6-10; 120 hrs vacation years 11-15; 160 hrs vacation years 16+ Vacation hours are limited to 240 hours annual carry over, however any additional hours will be credited to sick time without reduction Barton College and WTCC have local CJ programs, NC Wesleyan has a program 25 minutes away. ECU and NC State have Masters Programs and are within a minute commute. Supervisors attempt to give you three hours a week to attend class on-duty. Promotion System Your first two promotions are non-competitive and unlimited. You are eligible for your first promotion to Police Officer II after completing: semester hours of college 2. 2 years sworn experience with Wilson PD 3. Passing a written exam and assessment center

28 4. Completed core training courses for POII (all promotional training is compensated) 5. Performance rated as Meets Expectations You are eligible for your second promotion to Senior Police Officer after completing: semester hours of college 2. 2 years sworn experience with Wilson PD as a POII 3. Passing a written exam and assessment center 4. Completed core and elective training courses for SPO (all promotional training is compensated) 5. Performance rated as Meets Expectations 6. Have been awarded the Intermediate Law Enforcement Certificate Promotions to supervisory ranks are competitive. Six years of service are required to be eligible for promotion to Sergeant, and 9 years of service are required to be eligible for promotion to Lieutenant. Training Program All officers complete annual state mandated courses online - through PCC All officers complete a minimum of two, 4-6 hour blocks of instruction in Firearms annually (Qualification, Precision Shooting, Tactical Shooting). Additional firearms training hours are allocated for Shotgun, Patrol Rifle and Off-Duty/Back-Up Handgun. Unarmed Self Defense (including force-on-force Redman) and Less Lethal Weapons training is conducted annually (ASP, OC, TASER, Less Lethal Munitions) Driver s training is conducted annually (high speed pursuit training and Precision driving on alternating years) Rapid Deployment/Force-on-Force (Simunitions) tactical training conducted annually. Roll call training and online training are used extensively so that available training dates can be utilized for tactical skills training. The Department employs 25 general instructors and 13 specialized (Firearms, Driving, PT, SCAT, and HazMat) instructors. We have the ability and resources to teach practically any training internally. We have two training facilities (air conditioned) and a first class firearms range with a Blackwater BEAR target system and a Ballistic Technologies Shoot House. A large, fully stocked gym is accessible at all times.

29 Specialized Positions Most specialized positions require 2 years of sworn service and a recommendation from your Chain of Command. There may be additional requirements depending on the assignment. Burglary Investigator Major Case Investigator Financial Crimes Investigator Juvenile Investigator Narcotics Investigator DEA Task Force ATF Liaison Investigator USMS (Marshal) Task Force Street Crimes Unit K-9 Officer Housing Officer Gang Officer Domestic Violence Officer Traffic Unit Administrative Officer (Recruitment and Training) Special Reaction Team Operator* Hostage Negotiations* Public Information Officer * Not a full time position