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2. Application for Employment
4. Application Type*
   -- Select One --Police Officer - Entry LevelPolice Officer - Certified LateralMeter Enforcement OfficerAdministrative / CivilianCrossing Guard
6. Personal Information
8. First Name*
9. Middle Name*
10. Last Name*
12. Maiden Name (if applicable)
14. Address*
15. P.O. Box
17. City*
18. State*
19. Zip Code*
21. Phone Number*
22. Email Address*
24. Date of Birth*
    Date of Birth
25. Are you a U.S. Citizen? *
    -- Select One --YesNo
27. Place of Birth (City/State)*
28. Social Security Number*
30. Background Information
32. Have you ever been convicted of any violation of law, including motor vehicle violations?*
    -- Select One --YesNo
34. If YES to the above, state details and the disposition of the case(s):
36. List all residences you have lived at over the past 5 years (include dates):
38. Education
40. Education *

    1. GED
    2. High School Graduate
    3. Associates Degree
    4. Bachelors Degree
    5. Masters Degree
    6. Certified Police Officer - Maryland
    7. Certified Police Officer - Other
42. High School Attended
43. Graduation Year
45. High School Equivalency Certificate Number
46. State Issuing Certificate
48. College Attended
49. Dates Attended
51. Type of Diploma or Degree Awarded
52. Major
54. List any additional education or specialized training:
56. Languages Spoken or Read*
58. Military
60. Have you served as a member of the U.S. Military?*
    -- Select One --YesNo
62. Military Branch:
64. Begin Service Date:
    Begin Service Date:
65. End Service Date:
    End Service Date:
67. MOS (Specialty)
69. Honorable Discharge?*
    -- Select One --YesNoNot Applicable
70. Type of Discharge:
72. Rank at Time of Separation:
74. Employment History
76. Current Employer*
    ***If unemployed, type NONE
78. Employer Address
80. City
81. State
82. Zip Code
84. List your work history, starting with your present position working backward through your jobs. List any periods of unemployment.
    ***Include employment dates, name, phone,and address of employer, supervisor name, type of business, positions held, assigned duties, and reason for leaving.
86. May we contact your current employer?*
    -- Select One --YesNoNot Applicable
88. Have you ever been dismissed or asked to resign from any employment position?*
    -- Select One --YesNoNot Applicable
89. If yes, explain:
    explain or put n/a
91. If previously employed as a Police Officer, were you ever charged with a violation of departmental rules and/or regulations?*
    -- Select One --YesNo No Applicable
93. If yes to above, enter date(s), charge(s), and disposition(s):
95. Have you previously applied for a job with the Town of Easton?*
    -- Select One --YesNo
97. Date of Application(s) and Position(s) applied for:
99. Are you a current or former employee of the Town of Easton?*
    -- Select One --YesNo
101. Employment Dates and Positions Held:
103. References
105. Reference #1 Name*
106. Occupation*
108. Address
110. City
111. State
112. Zip Code
114. Phone Number*
116. Reference #2 Name*
117. Occupation*
119. Address
121. City
122. State
123. Zip Code
125. Phone Number*
127. Reference #3 Name*
128. Occupation*
130. Address
132. City
133. State
134. Zip Code
136. Phone Number*
138. Reference #4 Name*
139. Occupation*
141. Address
143. City
144. State
145. Zip Code
147. Phone Number*
149. Reference #5 Name*
150. Occupation*
152. Address
154. City
155. State
156. Zip Code
158. Phone Number*
160. Drug Screen Questionaire
162. Have you ever experimented with or used for personal consumption any of the following drugs (Check all that apply)?*

     1. Marijuana
     2. CBD Oil
     3. LSD
     4. PCP
     5. Methamphetamine
     6. Cocaine
     7. Crack Cocaine
     8. Heroin
     9. Psilocybin Mushrooms
     10. Hashish
     11. Steroids
     12. Ecstacy
     13. Inhalants
     14. Synthetic Drugs
     15. Abuse Prescription Drugs?
     16. Any other drug not mentioned?
     17. I certify that I have never sold, used for personal consumption, or experimented with any drugs.

     ***A check mark indicates a Yes response to the question above

164. If YES to any of the above, list the drug, number of times used, and date of last usage:
166. Have you ever sold any of the above listed drugs? Is so, explain:*
168. Verification / Certifications / Electronic Signatures
170. Online Form Electronic Signature
     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
172. I acknowledge and agree to the Electronic Signature instructions above*

     1. I agree
174. Electronic Signature*
175. Date*
     Date
177. Verification & Certification Statement
     By checking the "I agree" box below, I the undersigned, certify that I have read and understand this application in its entirety and that the information herein provided is true and complete to the best of my knowledge. I understand that should any statement made by me during the hiring process prove false, misleading or erroneous, may result in the rejection of my application and/or discharge from the Easton Police Department. In submitting this application, I further understand that it becomes the property of the Town of Easton Government and will not be returned.
179. I acknowledge and agree to Verification and Certification Statement above*

     1. I agree
181. Authorization For Release of Information
     EASTON POLICE DEPARTMENT AUTHORIZATION FOR RELEASE OF INFORMATION I, , DO HEREBY AUTHORIZE a review of a full disclosure of ALL records, or any part thereof, concerning myself, by a duly authorized agent of the EASTON TOWN POLICE DEPARTMENT, whether said records are of a public, private or confidential nature. THE INTENT OF THIS AUTHORIZATION is to give my consent for FULL AND COMPLETE disclosure of the records of educational institutions, financial or credit institutions, including records of deposits, withdrawals and balances of checking and savings accounts and loans, and also the records of commercial or retail agencies (including credit reports and/or credit ratings); medical and/or psychiatric treatment and/or consultation(s), including hospitals, clinics, private practitioners, and the United States Veterans’ Administration; public utility companies; employment and pre-employment records, including background reports and polygraph examination results, efficiency ratings, complaints and/or grievances filed by me or against me, and salary records; real and personal property records, and other financial statements and records, where-ever filed; records of complaint, arrest, trial and/or convictions for alleged or actual violations of law, including criminal and/or traffic records, records of complaints of civil nature made by me or against me, wheresoever located, and to include the records and recollections of attorneys at law, or of other counsel, whether representing me or another person in any case in which I presently have, or have had an interest. The Easton Police Department’s acquisition, retention, and sharing of information related to your employment application is generally authorized under (state and federal citations). The purpose for requesting this information is to conduct a complete background investigation pertaining to your fitness to serve as an employee. This background investigation may include inquiries pertaining to your (employment) (education) (medical history) (credit history) (criminal history) and any information relevant to your character and reputation. By signing this form, you are acknowledging that you have received notice and have provided consent for The Easton Police Department to use this information to conduct such a background investigation, which may include the searching of (N-DEx) (criminal justice databases) (private databases) (public databases). Specific N-DEx statement: I authorize any employee or representative of The Easton Police Department to search N-DEx to obtain information regarding my qualification and fitness to serve as an employee. I understand that N-DEx is an electronic repository of information from federal, state, local, tribal, and regional criminal justice entities. This national information sharing system permits users to search and analyze data from the entire criminal justice cycle, including crime incident and investigation reports; arrests, booking, and incarceration reports and probation and parole information. This release is executed with full knowledge, understanding, and consent with any information discovered in N-DEx may be used for the official purpose of conducting a complete employment background investigation. I also understand that any information found in N-Dex will not be disclosed to any other person or agency unless authorized and consistent with applicable law. I release The Easton Police Departments from any liability or damage that may result from the use of information obtained from N-DEx. I REITERATE AND EMPHASIZE that the intent of this authorization is to provide FULL AND FREE access to the background and history of my personal life, for the specific purpose of pursuing a background investigation which may provide pertinent data for the EASTON TOWN POLICE DEPARTMENT to consider in determining my suitability for employment by said agency. It is my specific intent to provide access to personal information, however personal or confidential it may appear to be, and the source(s) of information specifically identified herein. I UNDERSTAND THAT ANY INFORMATION OBTAINED by a personal history background investigation which is developed directly or indirectly, in whole or in part, upon this authorization for release of information will be considered in determining my suitability for employment by the EASTON EPD - 021 (1) 19 TOWN POLICE DEPARTMENT. I AGREE TO INDEMNIFY AND HOLD HARMLESS the person(s) to whom this request is presented and his/her agents and employees, from and against ALL CLAIMS, damages, losses and expenses, including reasonable attorney’s fees arising out of or by reason(s) of complying with this request. I FURTHER UNDERSTAND that in the event my employment application and/or resume is disapproved and/or not considered for employment, the sources of confidential information CANNOT BE RELEASED AND/OR REVEALED to me. IT IS FURTHER UNDERSTOOD by me that a photocopy of this release form will be valid as an original hereof, even though the said photocopy does not contain an original writing of my signature.
183. I Agree*

     1. .
184. Electronic Signature - Release of Information Authorization*
185. Date*
     Date
187. If applying for a Police Officer position, review and sign below:
     It is understood and agreed that I am required to successfully complete the approved Maryland Police Training Commission course (Police Academy). Failure to complete this course may result in the applicant's immediate dismissal from the Easton Police Department.
189. I Agree

     1. .
190. Electronic Signature
191. Date
     Date
193. If applying for a Police Officer position, review sign below:
     Applicant, if hired, is required to serve a two-year probationary period from date of appointment, during which time his/her services may be terminated at the discretion of the Chief of Police.
195. I Agree

     1. .
196. Electronic Signature
197. Date
     Date
Leave This Blank:


199. 1. Receive an email copy of this form.
200. Email address

     This field is not part of the form submission.

201. Submit Submit and Print

* indicates a required field