Interest Form for Reserve Police Officer

First Name

full first legal name

Middle Name

full middle name

Last Name

current legal last name

Date of Birth

Make sure the entry is the correct date (mm-dd-yyyy).

Are you currently, or have you previously been, employed as a Law Enforcement Officer?

If yes, provide the name of the Department(s). If no, enter N/A.

Have you been previously employed by a Law Enforcement Agency? If so, in what capacity?

If applicable, check all that apply.

List all Law Enforcement Departments you have previously and/or currently submitted an application of employment.

If not applicable, enter N/A.

Provide your Public Safety Identification (PSID) Number.

If not applicable, enter N/A.

Did a Lawrence Police Officer or a Reserve Lawrence Police Officer refer you to submit an interest form?

select one

What is the name of the referring Officer? (If this does not apply enter N/A).

If you selected "Yes" in the field above place the name of the referring City of Lawrence Police Officer in this field. If you selected "No" in the field above, place N/A in this field.

Sex

select one

Race

select one

Operator's License #

Operator's License State

Social Security Number

Home Address

City

State

Zip

Home Phone

Cell Phone

Other Phone

Email

Must be a valid e-mail address. All information about the hiring process will be communicated through the e-mail address provided.

Have you previously submitted an application for the Lawrence Police Department Reserve Division?

Foreign Languages

Enter N/A if you only speak English

Education

select one

Initials Required

I understand that failure to arrive as scheduled for any event will cause my elimination from the entire process.

Initials Required

I understand that failure to have complete, accurate, and legible information for any forms completed will cause my elimination from the entire process.

Initials Required

If at any time my address, email, and/or telephone number were to change, I agree to notify Captain Erika Schneider at [email protected].

Initials Required

I understand as a result of submitting this interest form for pre-application I will be subject to the following: Wanted Persons Check, Local Criminal History Check (defined by IC 35-47-1-7), and Driver's License Check.

Initials Required

I certify the information contained on this form is correct to the best of my knowledge. I realize my misrepresentation of the facts or my failure to update my information contained on this form may be cause for rejection of this application.

Initials Required

I understand the submission of this interest form is for the position of a Reserve Police Officer and not for the position of a Merit Police Officer.

Signature

By entering your full name here, you agree to sign this electronic document as your electronic signature.