Application Packet Page: 1. Instructions:

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1 Application Packet Page: 1 Instructions: This application packet, all 35 pages, must be printed and then filled out. Please read ALL of the instructions and fill the packet out COMPLETELY. Be sure that all supporting documents are included with this packet at the time that it is submitted. Certain documents require notarization prior to turning the packet in. Be sure that this is completed as non-notarized packets will not be considered. This packet may not be submitted electronically. It must be post marked or dropped off at the Hamilton Police Department, along with the supporting documents, by October 9 th, Late submissions will NOT be accepted or considered.

2 Application Packet Page: 2 Hamilton Police Department 223 South 2 nd Street Hamilton, MT Phone: September 22 nd, 2015 Thank you for your interest in the Hamilton Police Department. At the present time, we are beginning our applicant screening process. The Hamilton Police Department wishes to employ only those individuals who have high integrity and the necessary skills to serve our community as a sworn Police Officer. Because of our high standards, we will be conducting a thorough applicant screening process to include written and physical testing, oral interviews, background checks, etc. Enclosed in this application packet is a description of our entire screening process. Please take some time and read this information. I hope you will find it useful as you complete your packet. For those individuals who are P.O.S.T. certified in Montana or another state, you must include a copy of your P.O.S.T. certificate with your completed application packet. If you have any questions about our screening process please contact Lieutenant Steve Snavely or Sergeant Bob Liercke at (406) Again, thank you for your interest in the Hamilton Police Department. Sincerely, Ryan L. Oster Chief of Police

3 Application Packet Page: 3 TENTATIVE PROJECTED TIMELINE This is not a definitive timeline; it is a general timeline that we hope to accomplish each phase of our screening process. The applicant will be notified of dates and times for each phase of screening. Accepting application packets September 22 nd, 2015 to October 9 th, 2015 Written and physical testing October 17 th, 2015 Candidate interviews Background investigation Following testing Following candidate interviews If you have any questions throughout the screening process please contact Lieutenant Steve Snavely or Sergeant Bob Liercke at the Hamilton Police Department (406)

4 Application Packet Page: 4 IMPORTANT PLEASE READ All information provided herein, is accurate at this time. Information is subject to change at any time. IMPORTANT the following items must be included in application packet: Applications that do not include all documents required will be considered incomplete and will be ineligible for consideration. Photocopy of applicant s birth certificate; Photocopy of applicant s high school transcripts and/or college transcripts if applicable; Photocopy of applicants current driver s license Photocopy of DD 214 if a veteran; Veteran s preference form, if applicable Completed personal history statement; (supplied with application packet) All waivers and releases must be Notarized. MINIMUM REQUIREMENTS 1. Eighteen (18) years of age at time of appointment; 2. Posses a high school diploma or equivalent; 3. Ability to perform the various requirements demanded by the nature of police work; 4. Be a citizen of the United States of America; 5. Be of good moral character, as determined by a thorough background investigation; 6. Posses a valid driver s license from their State of residency at time of application and have no restrictions or traffic infractions which would preclude obtaining a Montana driver s license immediately upon appointment. ************* Lateral transfers are not accepted. Those persons who are P.O.S.T. certified in another state should contact Montana P.O.S.T. to determine if that state s certification will be recognized by Montana P.O.S.T. Employment is not ensured as a result of successful completion of testing.

5 Application Packet Page: 5 1. FORMAL APPLICATION APPLICANT SCREENING PROCESS The completed application and all required documents must be postmarked no later than October 9 th, Incomplete or late applications will not be accepted. All forms must be signed and NOTARIZED. 2. APPLICATION EVALUATION AND SCREENING All applications are reviewed to ensure that the minimum qualifications are met and that the submitted application packet is complete. Successful applicants will proceed to the next step in the screening process. 3. WRITTEN AND PHYSICAL ABILITIES TESTING Candidates will be notified of the time and place where the Police Officer selection test and physical strength and ability tests will be conducted. A brief description of the physical abilities testing is enclosed in the application packet. 4. CANDIDATE INTERVIEWS Successful candidates will be notified of the time and location of their oral interviews. Hamilton City administration personnel and Hamilton Police Department personnel will conduct this interview. 5. BACKGROUND INTERVIEW After completing the candidate interviews, the candidate will meet with a background investigator who will conduct a background interview with the candidate. The background investigator will be a member of the Hamilton Police Department. The information received during the background interview will be used to conduct a thorough background investigation into the candidate s personal and work history, past criminal history, past educational history, credit history, moral character, etc. As part of the background interview, the candidate will be fingerprinted. 6. BACKGROUND INVESTIGATION The background investigator will conduct a thorough background investigation as previously explained. Results of the background investigation can be cause for removal of an applicant from the eligibility pool. 7. PSYCHOLOGICAL EVALUATION Upon being offered a position with the Hamilton Police Department (contingent on successful results of #1- #6 above) the applicant will be requested to submit to a psychological evaluation, at the expense of the Hamilton Police Department. The results of the psychological evaluation can result in the applicant s removal from the eligibility pool. Any applicant who refuses to submit to a psychological evaluation will be removed from the eligibility pool on the Chief s orders. 8. MEDICAL EXAMINATION Upon being offered a position with the Hamilton Police Department (contingent on successful results of #6 and #7 above) the applicant will undergo a medical examination conducted by a licensed physician at the departments expense. The results of the medical examination can result in the applicant s removal from the

6 Application Packet Page: 6 eligibility pool. Any applicant who refuses to submit to the medical examination will be removed from the eligibility pool on the Chief s orders. The medical examination will include screening for illicit drug usage. 9. PRIOR TO APPOINTMENT Prior to appointment the applicant must meet with and be certified by the Hamilton Police Commission for employment as a Sworn Police Officer and their appointment must be confirmed by the City Council. 10. APPOINTMENT Upon appointment with the Hamilton Police Department, the officer will be required to take the oath of office. Officers who are not P.O.S.T. certified will be required to attend the Montana Law Enforcement Academy within one year of appointment. All patrol officers of the Hamilton Police Department are represented by the Hamilton Police Association. 11. PROBATIONARY PERIOD All officers will be required to complete one (1) year of probationary employment with the Hamilton Police Department. Officers will undergo field training for a portion of this probationary year. BENEFITS 1. Hourly wage during the required one (1) year probationary period is $20.44 per hour. 2. Officers receive 1% pay increase per year as longevity pay. 3. Uniforms, duty gear, firearm and personal body armor are issued by the Department. 4. Officers receive $1,000 uniform allowance per year thereafter. 5. Officers earn eight (8) hours of sick leave per month, with no accumulation limit. 6. Officers are paid for overtime work at the rate of time and one-half. 7. Officers work four ten-hour workdays and are paid every two weeks. 8. Officers work various shift assignments with rotating shifts and variable days off. 9. Officers receive ten paid holidays per year. 10. Insurance premium paid for each employee. 11. Reimbursement for gym membership up to $40.00/month. VACATION: Earn 10 hours per month until completing 10 Th year of service Earn 12 hours per month until completing 15 TH year of service Earn 14 hours per month until completing 20 TH year of service Earn 16 hours per month after completion of 20 TH year of service May not accumulate more than twice the annual vacation earned as of the last day of any calendar year. Prior service with any Montana City, County or State agency can be qualified for vacation accrual credit. RETIREMENT: Municipal Peace Officers Retirement System (20 year retirement) City contribution to an annuity program

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12 Application Packet Page: 12 PERSONAL HISTORY STATEMENT OPENING STATEMENT: Please read completely the Opening Statement, Instructions And Confidentiality and Certification provision before Proceeding to answer any questions. The information you provide in this Personal History Statement will be used to assist the Hamilton Police Department in determining your suitability for employment as a Police Officer. A background investigation is conducted into the personal history of all applicants. Please keep in mind the following: 1. The completion of this Personal History Statement is mandatory according to Hamilton Police Department policy. 2. All statements made herein are subject to verification. 3. Deliberate inaccuracies, or incomplete statements, will remove you from any further consideration for employment. 4. All time periods in your background, unless otherwise specified, must be accounted for. 5. It is to your advantage to respond openly. Any negative factor in your background will be evaluated in terms of the circumstances surrounding it, and consideration will be given to the degree of relevance it has to employment with a law enforcement agency. If you withhold or deliberately distort any information provided by you during the background investigation, discovery of that fact will disqualify you from further consideration. If the discovery is made after the Hamilton Police Department has hired you, it is grounds for immediate termination. 6. Applicants who proceed to the secondary phase of the background will be interviewed by an investigator and given an opportunity to discuss any inconsistencies or adverse information apparent at that point in the investigation.

13 Application Packet Page: 13 INSTRUCTIONS: 1. Please print your responses to this questionnaire in ink. DO NOT TYPE on this form. 2. Please complete the responses yourself. DO NOT have another person fill in the blanks for you. 3. IF YOU NEED ADDITIONAL SPACE TO ANSWER A QUESTION, SUCH AS TO PROVIDE A COMPLETE LIST OF FAMILY MEMBERS, PAST EMPLOYERS, OR PAST RESIDENCES, USE A SEPARATE SHEET OF PAPER. DO NOT LEAVE OUT INFORMATION SIMPLY BECAUSE THERE ISN T ADEQUATE ROOM ON THE FORM. ALSO, MAKE SURE THAT ANY QUESTIONS ON ADDITIONAL SHEETS ARE CLEARLY IDENTIFIED AS TO QUESTION NUMBER. CONFIDENTIALITY: The contents of this Personal History Statement are considered Confidential and will be used by the Hamilton Police Department for the purpose of evaluating your suitability for employment as a Police Officer. However, if it is discovered that you are currently involved in criminal activity, or have committed an undiscovered felony, the contents of this Personal History Statement, as well as any other information from the background investigation, will be shared with the appropriate law enforcement agency or agencies. When completed, this Statement, along with all other supporting documents, should be returned to the Hamilton Police Department. If you have questions regarding this or any other aspect of the application process contact, Lieutenant Steve Snavely or Sergeant Bob Liercke (406) CERTIFICATION: I certify that I have read the opening statement and instructions for the Hamilton Police Department Personal History Statement and I accept the conditions of completeness, accuracy and confidentiality. Signature of Applicant Date

14 Application Packet Page: 14 PERSONAL INFORMATION The following information is required from you for verification and contact purposes: 1. Your name (please print in ink). Last First Middle List other names you have used or been known by. Include maiden names, married or adopted names, or nicknames. 2. Your current physical address: Number Street City State Zip Your mailing address (if different from your physical address): PO Box, or Number Street City State Zip 3. Phone numbers at which you can be reached: Home Work Page/Cell Message 4. Date of Birth: 5. Place of Birth (city and state, or country): You must be a U.S. citizen for this position. You must provide a certified copy of your birth certificate or copies of your naturalization papers. 6. Social Security Number: In accordance with the Federal Privacy Act of 1974, disclosure is voluntary. This information will be used for identification purposes and to ensure that proper records are obtained.

15 Application Packet Page: 15 RELATIVES, REFERENCES, ACQUAINTANCES. During the course of the background investigation, persons who know you will be asked to comment upon your suitability for the position for which you have applied. Inquiries will be confined to job-relevant matters. 7. Please supply the appropriate information in the spaces below. If a category is not applicable, write in N/A. IN BLOCKS MARKED OTHER, LIST FORMER SPOUSES, BROTHERS AND SISTERS, STEPPARENTS. Father Home Phone Work Phone Mother Home Phone Work Phone Spouse Home Phone Work Phone Father-in-law Home Phone Work Phone Mother-in-law Home Phone Work Phone Ex-Spouse Home Phone Work Phone Other Home Phone Work Phone Other Home Phone Work Phone Other Home Phone Work Phone Other Home Phone Work Phone Current Address Current Address Current Address Current Address Current Address Current Address Current Address Current Address Current Address Current Address

16 Application Packet Page: List as personal or professional references 3 to 5 individuals who have knowledge of you and your qualifications. Name Address Name Address Relationship Phone Relationship Phone Name Relationship Address Phone Name Relationship Address Phone Name Relationship Address Phone 9. List individuals with whom you have resided within the past ten (10) years. List no information prior to your 15 th birthday. Exclude family members. Use an additional sheet if necessary. Name Address Phone RESIDENTIAL HISTORY. 10. Please list all your residences during the last ten (10) years. Begin with your most current residence and proceed backward. If a residence was rented, give the landlord s name, address and telephone number. List no information prior to your 15 th birthday. Use an additional sheet if necessary. Address From To Reason for leaving Landlord information Address From To Reason for leaving Landlord information

17 Application Packet Page: 17 Address From To Reason for leaving Landlord information Address From To Reason for leaving Landlord information Address From To Reason for leaving Landlord information Address From To Reason for leaving Landlord information Address From To Reason for leaving Landlord information EDUCATION 11. Montana law requires peace officers to possess a high school diploma or it s equivalent. Please indicate your current status in this regard by checking the appropriate space(s). Possess a high school diploma. Passed the G.E.D. (General Education Development) test. Have the following higher education degree(s):

18 Application Packet Page: List all the schools you have attended, beginning with high school. During the background investigation persons who have known you in a learning environment may be contacted. A review of your school records may be made in conjunction with those contacts. Use an additional sheet if necessary. School City & State From To Highest Grade Teacher or Reference School City & State From To Highest Grade Teacher or Reference School City & State From To Highest Grade Teacher or Reference School City & State From To Highest Grade Teacher or Reference School City & State From To Highest Grade Teacher or Reference School City & State From To Highest Grade Teacher or Reference

19 Application Packet Page: Have you ever been suspended or expelled from any high school or post-secondary school? (Postsecondary schools include colleges and universities, graduate schools, business and vocational schools, any formal education beyond the high school level.) YES NO If Yes, please explain, including date, school and circumstances: PREVIOUS EMPLOYMENT. 14. Beginning with your most current employment, list all jobs you have held in the past ten (10) years. For purposes of the Personal History Statement, part-time, temporary and voluntary work should be included. Please list all periods of unemployment in chronological sequences in the spaces provided for you between employment listings. Should you need to list additional experience/employment information, please use an additional sheet of paper, and continue in the exact same format as below: Name and Address of Employer: Telephone Dates of Employment: From, To Full Time ; Part-Time ; Volunteer ; Military Service. Title or duties: Name you were known by: Name of Supervisor: Names of Co-Workers: (1) (2) (3) Reason for Leaving: Unemployed FROM TO

20 Name and Address of Employer: Application Packet Page: 20 Telephone Dates of Employment: From, To Full Time ; Part-Time ; Volunteer ; Military Service. Title or duties: Name you were known by: Name of Supervisor: Names of Co-Workers: (1) (2) (3) Reason for Leaving: Unemployed FROM TO Name and Address of Employer: Telephone Dates of Employment: From, To Full Time ; Part-Time ; Volunteer ; Military Service. Title or duties: Name you were known by: Name of Supervisor: Names of Co-Workers: (1) (2) (3) Reason for Leaving: Unemployed FROM TO Name and Address of Employer: Telephone Dates of Employment: From, To Full Time ; Part-Time ; Volunteer ; Military Service. Title or duties: Name you were known by: Name of Supervisor: Names of Co-Workers: (1) (2) (3) Reason for Leaving:

21 Application Packet Page: 21 Unemployed FROM TO Name and Address of Employer: Telephone Dates of Employment: From, To Full Time ; Part-Time ; Volunteer ; Military Service. Title or duties: Name you were known by: Name of Supervisor: Names of Co-Workers: (1) (2) (3) Reason for Leaving: Unemployed FROM TO Name and Address of Employer: Telephone Dates of Employment: From, To Full Time ; Part-Time ; Volunteer ; Military Service. Title or duties: Name you were known by: Name of Supervisor: Names of Co-Workers: (1) (2) (3) Reason for Leaving: Unemployed FROM TO 15. Would any problem result if your present employer was contacted during the course of the background investigation: Yes No If Yes, when should contact be made? 16. If you have had no previous employment, please explain here:

22 Application Packet Page: Have you ever been fired or asked to resign from any place of employment? YES NO. If Yes, please give details, including when, name of employer, and why. 18. Have you ever applied, either successfully or unsuccessfully, for another position with any law enforcement agency? YES NO If YES, please provide details, including name and location of department(s), date(s) of application, and how far you progressed through the hiring process. 19. Have you ever attended a law enforcement academy in Montana or any other state? YES NO If Yes, please provide details, including name of academy, dates of attendance and outcome. MILITARY SERVICE 20. Have you ever served in the Armed Forces, National Guard, or Military Reserves? YES NO If Yes, please supply the following information: Branch of Service Dates of Service: From to. Military specialty: Type of discharge: 21. Have you registered with the Selective Service? YES NO If YES, when? 22. If you were in the Military, National Guard or Military Reserves, were you ever the subject of judicial or non-judicial disciplinary action? Yes No. If Yes, please give details, including branch of service, where, when, charges, resolution, etc. 23. Past commanding officers and other military acquaintances are potential sources of relevant information pertaining to your background. Please list those individuals who know you well enough to provide accurate information about you. Name/Title Military Unit Telephone

23 Application Packet Page: 23 FINANCIAL 24. The management of personal finances is relevant to an individual s qualifications for a position with a law enforcement agency. Therefore, please fill in the financial statement as follows. The amount of indebtedness, in itself, will not be used in evaluating your qualifications. However, your behavior in meeting your financial obligations will be reviewed. A credit-reporting agency will be contacted for a report on your credit history. Use an additional sheet if necessary. Monthly Income Monthly Salary Spouse s Salary Other Monthly Income Monthly Expenses Monthly Mortgage/Rent Car payment(s) Other payments Total Monthly Income Total Monthly Expenses Current Assets Savings Checking Balance Real Estate Equity Stocks & Bonds Life Insurance (cash value) Automobile Equity Other assets (describe) Current Liabilities Mortgage(s) Balance(s) Car Loan(s) Charge accounts (total) Other Liabilities (describe) Total Assets Total Liabilities 25. Please supply the following information regarding financial institutions with which you have accounts or loans: Institution (bank, S&L, loan company) Account Number Type account

24 Application Packet Page: Please supply the following information about your charge accounts, credit cards, contracts or other financial liabilities: Name of Company Address Type of Account 27. Have you ever filed for or declared bankruptcy, or filed for the Wage Earner s Plan? YES NO. If YES, please give details, including when, where and why. 28. Within the last seven (7) years, have any of your bills ever been turned over to a collection agency? YES NO. If YES, please give details, including when, firms involved and circumstances. 29. Within the last seven (7) years, have your wages ever been garnished? YES NO. If YES, please give details, including when, where and why. 30. Within the last seven (7) years, have you ever had purchased goods repossessed? YES NO. If YES, please give detail, including when, firms involved and circumstances.

25 Application Packet Page: Have you ever been delinquent on child support, income tax, or other tax payments? YES NO. If YES, please give details, including when, where and why. LEGAL 32. If you have ever been arrested, taken into physical custody, been issued a misdemeanor citation (exclude traffic citations), been convicted of a crime, or have been the respondent of a restraining order, please give the following information: You should not include the following: 1. Incidents that occurred when you were a juvenile which have been sealed; 2. Offenses expunged from your record for which you have received a pardon, or; 3. Any other offense that is part of a record that has been sealed by a court. Agency Charge Date Disposition 33. As an adult, has any court ever placed you on probation? YES NO. If YES, please give details, including when, where and why. 34. Are you now, or have you ever been, involved as a defendant in any civil court action? YES NO. If YES, please give details, including when, where, name of court, and circumstances.

26 Application Packet Page: 26 MOTOR VEHICLE OPERATION 35. Operation of a motor vehicle is an integral part of the position for which you have applied. An investigation of your driving history will be made through a record check. Please supply the following information: Name as printed on Driver s License Driver s License Number State 36. Please list other states where you have been licensed to operate a motor vehicle: State Name under which licensed 37. Have you ever been refused a driver s license by any state? YES NO. If YES, please explain when, where and why. 38. Has your driver s license ever been suspended, revoked or placed on negligent operator s probation or restriction. YES NO. If YES, please give details including where, when and under what circumstances. 39. Please list all traffic citations you have received as an adult (after reaching the age of 18). Exclude parking citations. Use an extra sheet if necessary. Violation Location Date Disposition

27 Application Packet Page: Please list all motor vehicle accidents, which you have been involved in as a driver within the past seven (7) years. Use an extra sheet if necessary. Date Location Investigating Agency Injury/Non-injury 41. If there is anything you wish to discuss about your driving record, which has not already been covered in the preceding sections, please explain here. 42. Please list all motor vehicles registered to you and your spouse. Year Make Model License # State VIN 43. Montana law requires that owners of motor vehicles be covered by automobile liability insurance. Therefore, please list the company that insures each of the motor vehicles listed above. Vehicle Company Address Policy # Expiration Date 44. Have you ever been refused automobile insurance for any reason other than failure to pay a premium? YES NO. If YES, please explain, including the company, name, date and reason.

28 Application Packet Page: 28 GENERAL INFORMATION 45. Have you ever applied for a permit to carry a concealed firearm or other weapon? YES NO. If YES, was the permit granted? Date issued: Law Enforcement Agency Purpose of permit: 46. Are you willing to work all hours of the day, all days of the week, holidays, and overtime when assigned? YES NO 47. If the necessity arose in the course of your employment as a Police Officer to use deadly force on a human being, would you have any reluctance to do so? YES NO 48. Do you have anything in your background that may disqualify you from becoming a Police Officer in the State of Montana? YES NO. If YES, please explain. 49. Please answer the following questions in your own handwriting, and using no more than the lined space provided. You are not required to use all of the lined space. Why do you want this job? How do you think this job will benefit you?

29 Application Packet Page: 29 Signature: Date: PHS ( )

30 Application Packet Page: 30 LETTER OF UNDERSTANDING I am applying for the position of Police Officer with the Hamilton Police Department. I understand that there are certain requirements I must meet before I can be accepted into this position. I also understand that I must submit to and cooperate fully with an extensive background investigation, which consists of, but is not necessarily limited to, the following areas of concern: 1. Review of my completed Personal History Statement and investigation of the information contained therein. 2. Thorough criminal history checks. 3. Thorough examination of my prior employment. 4. Examination of my personal credit/financial report. 5. Thorough investigation of all those elements necessary to determine whether I meet the standards of high moral character required of a Police Officer. I understand that the background investigation will be conducted in accordance with procedures established by the Hamilton Police Department. The Chief of Police is responsible for all decisions regarding which Officer Candidates, if any, receive conditional offers of employment. Those decisions are based upon the Chief s assessment of the needs of the Hamilton Police Department, and the totality of my qualifications as those qualifications are reflected in all phases of the application process. I acknowledge and accept that if a conditional offer of employment is extended to me, the following conditions apply: 1. I must pass a physical examination conducted by a physician selected by and paid for by the Hamilton Police Department. 2. I must pass a psychological examination conducted by a licensed professional, selected by and paid by the Hamilton Police Department. 3. I must pass a drug screen conducted at the time of the physical examination. 4. I must successfully complete the Montana Law Enforcement Academy Basic School within one year of employment, unless my failure to do so is the result of scheduling problems beyond my control. 5. I must resolve any other issues that may arise as a result of the physical and psychological examinations, drug screen, and physical agility test, as well as any 6. other issues that are properly raised by the Hamilton Police Department, the City of Hamilton, or myself. All of the aforementioned tests and examinations will be administered in a manner selected by the Hamilton Police Department. I understand that the results of those tests are the property of the Hamilton Police Department and that their results are not available to me unless they reveal a health condition that is important to my well being. I understand that the Hamilton Police Department treats all documents, interviews, reports and any other information regarding all phases of the background as confidential information. As such, they will not be

31 Application Packet Page: 31 shared with anyone not directly involved in the hiring process. The Hamilton Police Department will also not share the information with me, except in response to a court order. I understand that my failure to cooperate fully in all facets of the background investigation will result in my immediate disqualification from further consideration for the position of Police Officer for the Hamilton Police Department. Signature of Applicant Date Subscribed and Sworn to before me this day of,. Notary Public in and for said County of, State of Notary Public Signature

32 Application Packet Page: 32 CHILD SUPPORT Please mark the appropriate response. Failure to mark one of the three statements will result in the denial of your application. I am not subject to a court order for the support of a child. I am subject to a court order for the support of one or more children and I am in compliance with the order; or I am in compliance with a plan approved by the County Attorney (or other public agency) enforcing the order for the repayment of the amount owed, pursuant to the order. I am subject to a court order for the support of one or more children and I am NOT in compliance with the order or plan approved by the County Attorney (or other public agency), enforcing the order for the repayment of the amount owed, pursuant to the order. Applicant s Social Security Number: Signature of Applicant Date Subscribed and Sworn to before me this day of,. Notary Public for said County of, State of Notary Public Signature

33 Application Packet Page: 33 AUTHORIZATION TO RELEASE INFORMATION Name of Applicant Date of Birth Social Security Number As an applicant for the position of Police Officer with the Hamilton Police Department I am required to undergo a background investigation for use in determining my qualifications and suitability to be a police officer. I realize that this Department will NOT release the information provided to them to any person, including myself. The information submitted to this Department is confidential and will be used only for investigation of my suitability for law enforcement employment. Toward this end, I authorize release to the Hamilton Police Department of any and all information that you may have concerning me, including information of a confidential or privileged nature. I hereby authorize all my previous employers, physicians, and professionals who may have examined or treated me, friends, acquaintances, credit reporting services, public agencies, and all others to furnish the Hamilton Police Department any and all information they may have concerning me. I hereby release you, your organization, or others, from liability or damage, which may result from furnishing the information requested. You may be contacted by mail, by a background investigator with the Hamilton Police Department, or both. I further authorize that a photocopy of this Authorization to Release Information form shall be for all intents and purposes, as valid as the original. I authorize you to retain a copy of this form for your files. This release is valid for a period of one (1) year of the date of my signature. Signature of Applicant Date Subscribed and Sworn to before me this day of, Notary Public in and for said County of, State of Notary Public Signature

34 Application Packet Page: 34 CERTIFICATION AND PENALTY I hereby declare that all statements and information provided by me to the Hamilton Police Department during all phases of my pre-employment background investigation, and in any other pre-employment screening process, are true and complete to the best of my knowledge and belief. I understand that any misstatement of material fact, willful omission of material fact, or willful deception, will be cause for disqualification and rejection as a candidate for employment, without appeal. I further understand that any misstatements, omissions, or deceptions made by me that may be discovered after such time as I may be employed by the Hamilton Police Department are grounds for disciplinary action up to and including termination. Signature of Applicant Date Subscribed and Sworn to before me this day of,. Notary Public in and for said County of, State of Notary Public Signature

35 Application Packet Page: 35 APPLICATION PACKET CHECKLIST All forms and documents listed below must be included in the application packet. All packets will be checked for completeness and proper signatures when they are received. Return this checklist with your application packet. APPLICANT CHECKLIST: AGENCY REMARKS: 1. All forms complete & signed with legal name 2. Photocopy of birth certificate enclosed 3. Photocopy of high school diploma 4. Photocopy of college transcripts (if applicable) 5. Photocopy of applicants driver s license 6. Photocopy of applicants DD 214 (if applicable) 7. Waiver signed and notarized 8. Personal history statement form completed/enclosed Date received Reviewed by