Village of Woodridge Police Department Application Instructions

Similar documents
IOS - Recruitment and Testing Services

EMPLOYMENT APPLICATION

AMHERST COUNTY SHERIFF'S OFFICE An equal opportunity employer Women and Minorities are encouraged to apply.

WHITMAN COUNTY CIVIL SERVICE COMMISSION

Washington County Tennessee Sheriff s Office. Ed Graybeal, Sheriff. Employment Application Packet

Candidates failing to include ALL required documentation will be disqualified.

Application For Employment

Applicant Information

GENERAL APPLICATION FOR EMPLOYMENT Human Resources City of New Smyrna Beach 210 Sams Avenue New Smyrna Beach, Florida 32168

Education and Training

Name: The Town of East Haven. Application for Employment. Position: Secretary II, Grade Level 10

Albuquerque Police Department Applicant Additional Documents. Name: Page 1 of 9

EQUAL EMPLOYMENT OPPORTUNITY DATA FORM Please Return to: City of Geneva Human Resources 22 South First Street Geneva, IL 60134

Employment Application

APPLICATION

FIRE RECRUIT CIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS MINIMUM QUALIFICATIONS

Crandall Fire Department

Juvenile Services Officer Application Information

CITY OF BRANDON POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT. ALL applicants MUST attach items 1, 2, 3, 4 I. PERSONAL HISTORY

APPLICATION FOR EMPLOYMENT

GENERAL APPLICATION FOR EMPLOYMENT

Carlisle Police Department Employment Application

Please print clearly as you fill out the application. Social Security #: Are you known by other names while previously employed?

St. Vincent Apartments 1521 Las Vegas Blvd. North Las Vegas, NV 89101

APPLICATION FOR EMPLOYMENT

Department of Police APPLICATION DEADLINE: OCTOBER 15, :00PM

APPLICATION FOR EMPLOYMENT

Filer Police Department 300 Main Street Office: P.O. Box 140 Dispatch: Filer, Idaho Fax:

Complete the Attached Addendum

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL

Dallas County Master Wellness Volunteer Program

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL

EMPLOYMENT APPLICATION

MONROE COUNTY SHERIFF S OFFICE APPLICANT INFORMATION SUMMARY

Town of Southampton Police Department

Industrial Federal Credit Union


Application Instructions for: Police Officer

Crothall Services Group Environmental Services / Housekeeping

Employment Application

Legislative Administration Office Only. Last First Middle Are you known by other names while previously employed? YES NO.

MIDLAND JUDICIAL DISTRICT COMMUNITY SUPERVISION AND CORRECTIONS DEPARTMENT 200 N. Main P.O. Box 3038 Midland, TX Fax:

CPRS Application. Certified Peer Recovery Specialist. VCB CPRS Application Revised February

Application. Employment. for Contact our Human Resources Department at. ONE CALL GETS US ALL

CODAC BEHAVIORAL HEALTH SERVICES, INC.

(City) (State) (Zip Code) (Evening) Are you legally authorized to work in the United States? Yes. No If yes, who? EMPLOYMENT DESIRED

CITY OF PLANT CITY 302 W. REYNOLDS STREET P. O. BOX C PLANT CITY, FLORIDA PHONE (813)

Sentinel Transportation, LLC

EMPLOYMENT APPLICATION

APPLICATION FOR EMPLOYMENT

Columbia College Director of Teacher Education and Accreditation

Application for Employment An Equal Opportunity / Affirmative Action Employer

PLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date:

Fort Bend County M A S T E R G A R D E N E R A P P L I C A T I O N

VERMILLION COUNTY SHERIFF'S OFFICE

EMPLOYMENT PRE-SCREEN QUESTIONNAIRE

SHERIFF OF GARFIELD COUNTY LOU VALLARIO

Volunteer Application

APPLICATION FOR EMPLOYMENT

NJ TRANSIT POLICE 1 Penn Plaza East 7 th Floor Newark, NJ ATTN: TRAINING UNIT

AMERICAN AMBULANCE SERVICE, INC.

NOTICE DEPUTY SHERIFF APPLICANTS

POLICE RECRUIT MINIMUM QUALIFICATIONS CIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS

GLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER

Volunteer Application

VOLUNTEER APPLICATION

City of Pigeon Forge Police Department. Position: The City of Pigeon Forge Police Department is accepting applications for Communications Officer.

Teton County Sheriff s Office Jim Whalen Sheriff

NASSAU COUNTY BOARD OF COUNTY COMMISSIONERS OFFICE OF HUMAN RESOURCES Nassau Place, Suite 5, Yulee, Florida 32097

DOL H1B-Gulf Coast Ready To Work Petrochem Grant

Wyoming County Employment Application

Civil Service Commission Macomb County Sheriff s Office 120 North Main Street Mount Clemens, MI 48043

STATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS

EAGLE COUNTY SHERIFF S OFFICE APPLICATION FOR EMPLOYMENT JAMES VAN BEEK SHERIFF

Criminal Justice Selection Center

Matlacha/Pine Island Fire Control District 5700 Pine Island Road Bokeelia, FL APPLICATION FOR EMPLOYMENT

SACRED HEART PARISH LA GRANGE, TEXAS

Thank you for your interest in employment with Black Hills Surgical Hospital and Black Hills Urgent Care.

SOUTH KINGSTOWN POLICE DEPARTMENT

Instructions Please Follow Carefully! Affidavit & Release Form and Certification of Identification Form

Public Safety Telecommunicator Class REGISTRATION FORM

Rutherford Co. Rescue

NORTH SMITHFIELD POLICE DEPARTMENT

2018 City of Pompano Beach. Blanche Ely Scholarship Program

Wayzata Fire Department 600 East Rice Street Wayzata, Minnesota (952)

DOL H1B-Gulf Coast Ready To Work Petrochem Grant

Professional Nursing Program LPN to RN Bridge Track

STATE CERTIFICATION APPLICATION

YATES COUNTY PERSONNEL DEPARTMENT

Employment Application

EMPLOYMENT PRE-SCREEN QUESTIONNAIRE

APPLICATION FOR EMPLOYMENT

The Arc of Vigo County 11 Cherry St. Terre Haute, IN (812) EOE Provider Application

APPLICATION FOR EMPLOYMENT CLARK COUNTY SHERIFF S OFFICE

CITY OF CRANSTON DEPARTMENT OF PERSONNEL ANNOUNCES AN OPEN COMPETITIVE CIVIL SERVICE EXAMINATION FOR POLICE OFFICER

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT. Directions: Fill out this application in its entirety using blue or black ink.

American Foods Group, LLC APPLICATION FOR EMPLOYMENT General Labor and Production Support NOTICE TO APPLICANTS

Admission Requirements

CITY OF HOLLY HILL EMPLOYMENT APPLICATION 1065 Ridgewood Avenue Holly Hill, Florida An Equal Opportunity Employer

Transcription:

Village of Woodridge Police Department Application Instructions Thank you for your interest in the Village of Woodridge Police Department. Please read this document carefully, paying particular attention to deadlines and required documents: 1) Visit www.publicsafetyrecruitment.com to complete the online application for the position of Police Officer. 2) Return signed release forms and requested documents (see checklist) to Public Safety Recruitment, Attn.: Woodridge PD, 1127 S. Mannheim Rd., Ste. 203, Westchester, IL 60154, BEFORE 12 noon on Friday, June 26, 2009. Applications received AFTER 12 noon on Friday, June 26, 2009 will not be accepted. Faxed release forms and postmarks will NOT be accepted. Sending release forms and other required documents via traceable carrier (i.e. FedEx, UPS, Certified Mail, etc.) is suggested to ensure timely delivery. Documents may also be delivered by hand to Public Safety Recruitment during business hours. Public Safety Recruitment is not responsible for late or lost documents. It is the responsibility of the candidate to ensure all paper work is submitted properly by the deadline date. 3) Applicants must submit proof that they have passed the Illinois Peace Officer Wellness Evaluation Report (POWER) Test at the Northeastern Illinois Public Safety Training Academy (NIPSTA) within the past year (as of June 26, 2009). POWER test registration MUST be completed at least one week prior to the selected POWER Test session date. For more information, contact NIPSTA at (847)998-8090 or visit www.nipsta.org. 4) Attend Orientation & Written Exam on Saturday, July 11, 2009 at: Ashton Place 341 75 th Street Willowbrook, IL 60527 Orientation begins at 9 AM and testing will immediately follow. Arrive by 8:15 AM with photo identification to sign in. Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL 60154 1-800-343-HIRE TUwww.publicsafetyrecruitment.comUT A downloadable version of the Standard National Criminal Justice Selection Inventory Study Guide is available to all Woodridge Police Officer applicants at no charge as part of the online application process (included within STEP 4). If you have trouble downloading the study guide, send an email to info@publicsafetyrecruitment.com or call 800.343.HIRE. All portions of the testing process are mandatory. Failure to attend and complete any portion of the process will result in elimination from employment consideration. Call 800.343.HIRE with any questions. Good Luck!

Village of Woodridge Police Department Police Officer Minimum Requirements U.S. Citizen. No felony convictions. High school diploma or G.E.D. certificate. Preference points are available for college credit (60 semester hours or more), military service and prior law enforcement officer experience. 21 to 34 years of age on June 26, 2009 or as otherwise exempt from age limitation by statute. Must have binocular vision corrective to 20/30, must be free of significant vision problems such as impaired vision at night or under dim lighting conditions, sensitivity to glare, starbursts experience around light sources such as street lights or headlights, progressive regression of visual acuity, daily changes in visual acuity or other conditions. Must be able to make color distinctions, have normal depth perception and normal hearing ability. For acoustical reasons, audiograms must be done without hearing aids in place. Residency Requirement: Within six (6) months of the date of hire, appointees must live within 30 miles of the corporate limits of the Village. Good moral character and meeting of all the requirements of the Board of Police Commissioners and the State of Illinois. Must submit a current copy of POWER Test card issued from NIPSTA within the past year (as of June 26, 2009). Must attend orientation session (no exceptions) and pass all phases of testing process. $20.00 non-refundable application fee. The Village of Woodridge, Illinois (population 33,000) a progressive and growing community 30 miles west of Chicago, is seeking individuals to participate in a competitive process to establish an eligibility register for the position of Police Officer. We offer a wide range of benefits including health, dental, life and accidental death and dismemberment insurance, tuition reimbursement, computer purchase loan program (interest free), police pension, deferred compensation, uniform allowance, 8 Village Holidays, 4 Personal Holidays, 10 Vacation days after one year, one sick day per month. Patrol Officers work rotating, 12-Hour shifts. Current Starting Salary: $53,580.80 o Online Application and Required Documents deadline is 12 noon on Friday, June 26, 2009. o Orientation and Written Exam are at 9 AM on Saturday, July 11, 2009. Arrive by 8:15 AM. Please visit our website to pay the application fee and complete the online application at www.publicsafetyrecruitment.com. If you have any questions, please contact Public Safety Recruitment 1-800-343-HIRE ~ e-mail: TUinfo@publicsafetyrecruitment.com UT 9 am 5 pm Monday through Thursday and 9 am 3 pm on Friday

DIRECTIONS TO ORIENTATION & WRITTEN EXAMINATION: Ashton Place 341 75 th Street Willowbrook, IL 60527 (630) 789-3337 From Downtown Interstate 55 (I-55) to exit 274, IL Rt. 83/Kingery Hwy north to 75 th Street left (west) on 75 th Street, one block to Ashton Place. From the South IL Rt. 83/Kingery Hwy north to 75 th Street left (west) on 75 th Street, one block to Ashton Place. From the West 75 th Street, ½ mile east of Plainfield Road. From the North IL Rt. 83/Kingery Hwy south to 75 th Street right (west) on 75 th Street, one block to Ashton Place.

CHECK LIST of REQUIRED DOCUMENTS Village of Woodridge Police Department Application: Deadline: NOON on 6/26/2009 Confirmed online WRITE YOUR CONFIRMATION NUMBER HERE: (The confirmation page immediately follows the references section of the online application) Release Forms & EEO Form: (Pages 1-11) *No photocopies or fax copies will be accepted. You must submit the ORIGINAL DOCUMENTS WITH ORIGINAL SIGNATURES. Acceptable witness signatures include adult family members and friends. Personal Information Release to Municipality* Village of Woodridge EEO Form* Authorization to Release Information* Deadline: NOON on 6/26/2009 Background and Credit History* Written Examination* Village of Woodridge Consumer Reports* Affidavit of Application* Waiver/Release of Liability* Village of Woodridge Essay Question* Other required documents: Deadline: NOON on 6/26/2009 COPY of POWER Test Card Issued from NIPSTA within the past year as of June 26, 2009 COPY High School Diploma or GED (Copy of High School Transcripts with Graduation Date, Dated GED, or Signed Letter on High School letterhead is acceptable, COLLEGE DIPLOMA/TRANSCRIPTS NOT ACCEPTABLE ) COPY valid Driver s License (copy of front and back if you received a renewal sticker) COPY Birth Record READ CAREFULLY: Must contain the applicant s full name and date of birth and must be verifiable. To be verifiable, it must be possible to contact the regulatory authority to confirm the authenticity of the document. ONE OF THE FOLLOWING IS ACCEPTABLE AND REQUIRED TO FULFILL THE BIRTH RECORD REQUIREMENT: Copy of US Birth certificate (Copy of original or certified by a Board of Health or Bureau of Vital statistics within the U.S. State Department or U.S. territories. Hospital copy NOT accepted.) OR Copy of Valid U.S. Passport OR Copy of Naturalization Papers Optional documents REQUIRED BY June 26, 2009 FOR POINTS: Request of Preference Point form Official College Transcripts reflecting completion of 60 semester hours or more as of June 26, 2009 A copy of your Military Discharge Form DD-214, if you served in the Military If you are a certified Patrol Officer, please provide proof of employment (original letter from employer) or a copy of your State Certification. Copy of other job related certifications (if applicable). Include Police Academy Certification if obtained. Applications will not be verified until after the deadline has passed. Candidates who submit applications lacking proper documentation as indicated above will not be admitted to orientation or testing and you will be eliminated from employment consideration. I/O Solutions, d.b.a. Public Safety Recruitment, is not responsible for late, misdirected or incomplete application submissions. You must submit all required documents and have successfully CONFIRMED your online application by the deadline in order to be eligible to attend any portion of testing. You may drop your application documents off in person or by mail; however, all documents including your online application are due by the deadline by June 26, 2009 at 12 noon. DO NOT SUBMIT REQUIRED DOCUMENTS TO THE VILLAGE THE POLICE DEPARTMENT. PLEASE SUBMIT RELEASE FORMS & OTHER REQUIRED DOCUMENTS TO: PUBLIC SAFETY RECRUITMENT ATTN: WOODRIDGE PD 1127 S. MANNHEIM RD., SUITE 203 WESTCHESTER, IL 60154.

LAST NAME. FIRST NAME..... SSN.. PERSONAL INFORMATION RELEASE TO MUNICIPALITY DISCLOSURE This is to inform you that in processing your application an investigation has been made whereby information is obtained concerning you. This information can include a record of all personal information, required by statute to be collected and maintained by government agencies. RELEASE I understand that release of the results of the historical investigation profile will result in the disclosure of information regarding me to third parties. I hereby acknowledge the results of the investigation will be released to authorized representatives of the Village of Woodridge or to I/O Solutions, Inc., for appropriate review and dissemination to this municipality and/or Police/Fire departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the Village of Woodridge, the Village of Woodridge Board of Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the investigation and the disclosure of any of that information. Agreed to: Applicant Name, printed Applicant Signature Witness Name, printed Witness Signature Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 1 of 11

VILLAGE OF WOODRIDGE AFFIRMATIVE ACTION EQUAL EMPLOYMENT OPPORTUNITY INFORMATION To All Applicants: The Village is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the Village invites applicants to voluntarily selfidentify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. Mr. 1. Mrs. Ms. (Last Name) (First Name) 2. Job Applied for: Police Officer 3. Social Security Number: 4. Birth Date: 5. Sex: Male: Female: 6. Of the following, which racial/ethnic group do you consider yourself to belong? White Black or African American Hispanic or Latino Two or More Races Native Hawaiian or Pacific Islander Asian American Indian or Alaska Native 7. What level of education have you completed? Some High School 2-Year College Masters Degree Other: High School/GED 4-Year College PHD 8. How did you learn about the job? (Specify the name of the newspaper or magazine if applicable.) Blue Line Employee Referral WCTV Channel 6 Village Website Municipal Job Posting Village Marquee Walk-In Newspaper ( ) Other: 9. Date: Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 2 of 11

BOARD OF POLICE COMMISSIONERS VILLAGE OF WOODRIDGE, ILLINOIS AUTHORIZATION TO RELEASE INFORMATION CONCERNING BACKGROUND, ECONOMIC STATUS AND PHYSICAL AND EMOTIONAL STABILITY The undersigned is an applicant for employment with the Village of Woodridge, Illinois, and agrees that a candidate for employment must possess good moral background, be considered a stable and respectable citizen of his or her community, be of high moral character, meet his or her other just obligations and be both physically and emotionally stable. To determine whether the undersigned possesses these characteristics, I authorize the Woodridge Board of Police Commissioners and other persons and agencies to conduct background investigations, credit investigations and inquiries, and I agree that I will take a written test, psychological assessment, polygraph test, submit to oral interviews, physical examinations, and drug and alcohol substance abuse screening on any phase of my application, prior background, or other matters deemed by the Woodridge Board of Police Commissioners to be a legitimate matter of inquiry. This authorization to release information concerning my background, family relationship, education, employment, credit standing and history, physical characteristics, specific and general conditions of my past and present health, emotional stability, psychological evaluations, polygraph tests, and the results of any other matter legitimately included within any of these categories, is directed to any person who may have information concerning any of these subject matters and is an unqualified authorization to release such information, facts, opinions to the Board of Police Commissioners, Village of Woodridge, and employees or servants and/or any other agent or representative of the Woodridge Board of Police Commissioners. The original copy of this authorization is on file with the Board of Police Commissioners and shall be valid for a period of three years from the date subscribed below. I specifically authorize the RELEASE OF ANY INFORMATION REQUESTED and agree that a photocopy of this RELEASE shall have the same validity as an original copy. Dated this day of, 2009. Applicant Signature: Applicant Name, printed: Street Address: City, State, Zip: Witness Signature: Witness Name, printed: Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 3 of 11

ACKNOWLEDGMENT/CONSENT BACKGROUND AND CREDIT HISTORY As part of the application process for employment as a Police Officer with the Police Department of the Village of Woodridge, Illinois, the undersigned applicant has been informed and understands that an investigation may be made whereby information is obtained through personal interviews with the applicant s neighbors, friends, or others with whom the applicant is associated or acquainted. This inquiry includes, as appropriate, information as to the applicant s character, general reputation, personal characteristics, and mode of living. The applicant has the right, within a reasonable period of time, to make a request in writing to receive additional, detailed information about the nature and scope of this investigation. In addition, the undersigned has been informed that part of the background investigation contemplated herein may include the employment of a credit reporting service to obtain information related to the applicant s credit history. Furthermore, the applicant acknowledges that he consents and authorizes the Village of Woodridge, its agents and or assigns, to request a report of his or her credit history. The applicant also acknowledges that said applicant has been advised of his or her creditor s rights, as follows: Applicant has the right under federal law, on request and the presentation of proper identification, to obtain from the village utilized consumer reporting agency the following disclosures: (1) The nature and substance of all information in its files (except medical information) on you at the time of the request. (2) The sources of the information. (3) The creditors to whom the consumer reporting agency has furnished reports within the six month period preceding the request. The reporting agency is required by law to provide trained personnel to explain any information furnished to you, and you may be accompanied by one other person of your choosing when you visit the agency. If you are accompanied by another person, he or she must furnish reasonable identification, and the agency may require you to furnish a written statement granting permission to the agency s personnel to discuss your file in the other person s presence. Federal Law provides three methods by which you may obtain these disclosures from the consumer reporting agency: (1) You may appear in person at the agency during normal business hours and on reasonable notice to the agency, provided you furnish reasonable identification. (2) You may receive the information by telephone, provided you have first made written request of the agency to obtain disclosures by this means. You must pay any toll charge involved, and may be required to provide proper identification. (3) If the consumer credit reporting agency was responsible in any way for the denial of credit to you, you may obtain from the agency an explanation in writing free of charge. The undersigned agrees and consents to the release of such information to the Board of Police Commissioners of the Village of Woodridge, as the applicant s prospective employer. Signed and Sealed at, Illinois, on the day of, 2009. (City) (Day) (Month) Applicant Name, printed Applicant Signature Witness Name, printed Witness Signature Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 4 of 11

WRITTEN EXAMINATION RELEASE By this written authorization I understand that release of the results of my Written Examination will result in disclosure of those test results to third parties. I hereby consent to the release of the results of my Written Examination for dissemination to the Village of Woodridge, Village of Woodridge Board of Police Commissioners and to those municipalities and/or Police departments to which I have made application for employment or to which I will make application for employment. By executing this form I release, discharge and hold harmless the Village of Woodridge, the Village of Woodridge Board of Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the Police Officer Examination or due to the disclosure of the test and survey results as authorized herein by me. In the event that I have a disability which will affect my ability to take any examination, I will so inform the I/O Solutions, Inc. prior to the administration of the examinations so that a reasonable accommodation can be made. I/O Solutions, Inc. reserves the right to require medical documentation concerning the need for the accommodation. Agreed to: Applicant Name, printed Applicant Signature Witness Name, printed Witness Signature Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 5 of 11

VILLAGE OF WOODRIDGE, ILLINOIS CONSUMER REPORTS AUTHORIZATION FORM In connection with my application for employment (including contract for services), promotion, reassignment or retention as an employee, I understand that investigative reports or consumer reports which may contain public information may be requested or made on me including consumer credit, criminal records, driving record, education, present and prior employment verification, and others. These reports will include experience, salary history, job performance, and reasons for termination of past employment. Further, I understand that the Village of Woodridge will be requesting information from various Federal, State, local, and other agencies, which contain my past activities. I hereby authorize without reservation, any party or agency contacted by the Village of Woodridge to furnish the above-mentioned information. I further authorize ongoing procurement of the above-mentioned reports at any time during my employment or contract. NAME (please print) STREET ADDRESS CITY STATE ZIP CODE ( ) TELEPHONE NUMBER EMAIL ADDRESS (optional) DRIVER S LICENSE STATE AND NUMBER EXPIRATION DATE SOCIAL SECURITY NUMBER FOR IDENTIFICATION PURPOSES ONLY: DATE of BIRTH RACE GENDER OTHER or FORMER NAMES PROFESSIONAL LICENSES, INCLUDING STATE, TYPE, AND THE NUMBER SIGNATURE DATE Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 6 of 11

State of Illinois County of DuPage To: Board of Police Commissioners Woodridge, Illinois AFFIDAVIT OF APPLICATION The undersigned being duly sworn on oath deposes and says that the undersigned has read the application and additional documents dated of the undersigned for employment with the Village of Woodridge for the position of Police Officer, that said application is in the hand-writing of undersigned only, and that the facts, statements and representations therein are true. Applicant Name, Printed Applicant Signature Witness Name, printed Witness Signature Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 7 of 11

WAIVER/RELEASE OF LIABILITY APPLICANT FOR PUBLIC EMPLOYMENT Agreement made this day of, 2009, between, an applicant for employment as a Police Officer with the Woodridge Police Department of the Village of Woodridge, Illinois, (the Applicant ) and the Village of Woodridge, Illinois; its Board of Police Commissioners; the Village s and the Board of Police Commissioners employees, agents, representatives and assigns (specifically any testing agency employed by the Village or its Board of Police Commissioners) (hereinafter collectively referred to as the Village ), witness: Whereas, Applicant has applied to the Village for employment as a Police Officer; and, Whereas, the Village is required to subject the Applicant to a competitive testing process; and, Whereas, the Applicant has agreed to submit to a variety of examinations including a written examination, physical ability, oral interviews, medical examinations and such other examinations, and to undergo a thorough background investigation, as deemed appropriate by the Village; and, Whereas, the Village has agreed to administer said exams, on an as needed basis and as provided by the rules and regulations of the Village s Board of Police Commissioners, without expense to the Applicant; and, Whereas, both parties hereto agree that the examination process is conducted for the purpose of obtaining wellqualified individuals to fill the position sought by the Applicant, the parties hereto agree as follows: Applicant, in consideration of the payment, by the Village, of the fees associated with the conduct of examinations to be taken by the Applicant, hereby agrees to waive any claims the applicant may now have or may have in the future (specifically including any claim as to personal injury and/or damages) arising from Applicant s participation in any examination or background investigation conducted by or for the Village as part of its pre-employment screening process for the position of Police Officer. The Applicant further states that this waiver is given voluntarily and with the knowledge that the Applicant is waiving any and all liability the Village may incur as to the Applicant resulting from the Applicant s participation in the pre-employment screening process. The Applicant specifically waives the right to written notice required of any former employer pursuant to the Personnel Records Review Act, 820 ILCS, 40/7(1). The Applicant also acknowledges that the Applicant had the opportunity to discuss the import of this Waiver with legal counsel of Applicant s own choosing. Witness our hands and seals the day and year above written. APPLICANT: Applicant Signature Applicant Name, printed Witness Name, printed Witness Signature FOR USE BY THE VILLAGE OF WOODRIDGE, ILLINOIS BOARD OF POLICE COMMISSIONERS By: _ Board Chairman Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 8 of 11

VILLAGE OF WOODRIDGE REQUEST FOR PREFERENCE POINTS Board of Police Commissioners Village of Woodridge 5 Plaza Drive Woodridge, IL 60517 Dear Commissioners, I hereby indicate my intention to claim preference consideration if, following the written examination and oral interview process, my name appears on the Board s INITIAL ELIGIBLITY LIST for the position of Patrol Officer on the following basis (check one below): 1. Educational credit 2. Military service 3. Employment as a sworn state certified law enforcement officer 4. I am not entitled to preference consideration under the Board s rules. Or, 5. I am entitled to preference consideration under the Board s rules, but do not wish to claim said consideration. Signature of Applicant Printed Name Date Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 9 of 11

VILLAGE OF WOODRIDGE POLICE DEPARTMENT ESSAY QUESTION ESSAY MUST BE IN YOUR OWN HANDWRITING, NOT TYPE WRITTEN. Please tell us in 100 words or less, why you want to be a Woodridge Police Officer. Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 10 of 11

Essay Question Continuation Page ESSAY MUST BE IN YOUR OWN HANDWRITING, NOT TYPE WRITTEN. Copyright 2009 by I/O Solutions, Inc. d.b.a. Public Safety Recruitment REQUIRED RELEASE DOCUMENT: 11 of 11