Police Department Employment Application

This application is intended for use of the Middlefield Police Department. You must be truthful and complete all answers requested on this form. All information contained herein will be subject to verification, i.e., source documentation, voice stress analyzer, polygraph, interviews, and other screening procedures. Information contained herein will be considered confidential and will not be disclosed to any unauthorized person(s).

The answers to questions contained must be printed legibly in your own handwriting with black ink. Each question must be answered; there can be no blanks. If a question does not apply to your particular circumstance; insert “DNA” in that blank or area for “Does Not Apply”. When answering questions that require dates, insert the full date; partial month-year responses are not acceptable. You must provide complete address information when requested; partial address responses are unacceptable.

It is my understanding the Middlefield Police Department will conduct a thorough investigation of my entire work history and may verify all data provided by me in this application, related papers or oral interviews. I authorize such investigation and the giving and receiving of any information requested by the Middlefield Police Department, and I release from liability any person giving or receiving such information. Upon my receiving a conditional offer of employment, I authorize any physician, psychologist, or medical facility to release information that may be necessary to determine my ability to perform the duties and essential functions of the job for which I am being considered.

I consent to take a truth verification examination (polygraph or voice-stress analyzer), medical, and/or psychological examination by qualified professionals at the discretion of the Chief of Police.

I understand falsification of data so given or other information which is unacceptable to the Middlefield Police Department which is discovered as a result of this investigation may prevent my being hired, or if hired, may subject me to progressive discipline up to and including termination.

I understand the police department may at times make the following conditions mandatory: overtime, shift work, work on holidays, a rotating work schedule, or a work schedule other than Monday through Friday, and I accept these as conditions of my continuing employment.