Police Application

Please download, scan, and submit with this application the Background Investigation Waiver

In order for your application to be taken into consideration please download the Background Investigation Waiver by clicking here and upload it using the form below.

Upload the completed Background Investigation Waiver document(Required)

Max. file size: 50 MB.

Current Personal Data

Position Applying For(Required)

Date(Required)

Name(Required)

First Middle Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Social Security Number(Required)

Date Of Birth(Required)

Do vou have a valid driver's llcense? (lf applicable)(Required)

Yes

Drivers License Number(Required)

State(Required)

Address(Required)

Street Address City State ZIP Code

Home phone number (include area code)(Required)

Work Phone Number ( Include Area Code)(Required)

Do you have any relatives employed by the City of Quincy?(Required)

Yes

If yes, please name:(Required)

Have you ever worked for the City of Quincy?(Required)

Yes

Position/Department(Required)

Dates of employment(Required)

Race(Required)

Gender(Required)

Have you ever had your name changed (example: marriage)(Required)

Yes

Previous Name(s)(Required)

Date and location of change:(Required)

Reason for change(Required)

Education

Your name if different while attending school(Required)

First Middle Last

High School(Required)

Address(Required)

Phone (include area code)(Required)

Received(Required)

Diploma

GED

Certificate

None

College, University or Professional School:

(Transcripts may be required)

Name of school(Required)

Location(Required)

Dates of attendance(Required)

Major/Minor course of study(Required)

Degree earned(Required)

Name of school

Location

Dates of attendance

Major/Minor course of study

Degree earned

Job-related training or course work

(Vocational, Trade, Governmental, Business, Armed Forces etc.)

Name of school(Required)

Location(Required)

Dates of attendance(Required)

Major/Minor course of study(Required)

Degree earned(Required)

Name of school

Location

Dates of attendance

Major/Minor course of study

Degree earned

Llst any special skills, knowledge, or abilities that you possess which may be relevant to the posltlon applied for. For example; list equipment operatlon abllltles, bilingual ability, knowledge of computer hardware/software, typing or shorthand. etc. (Used separate sheet if necessary):

Knowledge / Skills / Abilities

List training or certifications you possess and believe relevant to the position you seek, such as fingerprint classification, narcotics investigation, computer skills, fluency in languages(s) etc.

Training Type(Required)

Date(Required)

Experience in years(Required)

Experience in years

Date

Training Type

Experience in years

Date

Training Type

Criminal History Information

Have you ever unlawfully sold, delivered, manufactured, smuggled, trafficked in, or possessed illegal substances or drug paraphernalia?(Required)

Yes

If yes, when and how often?(Required)

Are you currently engaged in or have you ever engaged in the unlawful use of illegal substances?(Required)

Yes

If yes, when and how often?(Required)

Have you ever committed a crime, whether arrested or not, that would constitute a felony or first degree misdemeanor?(Required)

Yes

lf yes, what crime (s) dld you commit and when?(Required)

NOTE: Information contained in sealed or expunged records Is not exempt for Law Enforcement applicants pursuant to F .S. 119.07. However some exem tlons do aoolv soeciflcallv to law enforcement personnel records.

Have you ever been arrested, detained by Law Enforcement ăuthorities, received a notice to appear, charged, convicted, pled Nolo Contendere or pled guilty to any criminal violation, regardless if the record was sealed or expunged?(Required)

Yes

If yes, list below. A misdemeanor arrest or conviction will not necessarily disqualify you from employment

Charge(Required)

Date(Required)

Disposition(Required)

Agency(Required)

Charge

Date

Disposition

Agency

Have you ever received a domestic violence injunction?(Required)

Yes

lf yes, what jurisdiction?(Required)

Note: lf you are arrested, detained, cited by a Law Enforcement Agency whlle undergoing process, lt Is your responslbility to notify this department. Your failure to do so wlll resuit in suspension of your applicalion.

lf you are noi sure or do not remember what happened in a criminal case(s), contact the appropriate county, state, or federal agency so !hat you can report acewrate informatlon on your criminal hlstory.

Law Enforcement Education/Experience

Law Enforcement Academy(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone number(Required)

Certificate received(Required)

Yes

Certificate Number(Required)

Date certified(Required)

State(Required)

If not presently working as a Law Enforcement Officer, date last worked as a certified Law Enforcement Officer

Date(Required)

State(Required)

Number of years and months experience as a Law Enforcement Officer

Years(Required)

Months(Required)

Have you ever applied to Quincy Police Department?(Required)

Yes

Have you ever applied to another Law Enforcement Agency?(Required)

Yes

If yes, what agency?

Agency Name(Required)

Address(Required)

Street Address City State ZIP Code

Date Applied(Required)

Status of Application(Required)

Agency Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Date Applied

Status of Application

References

Provide three (3) references (not relatives, fellow employees or school teachers) who are responsible adults of reputable standing ln their communities, such as heads of households, property owners, business 0r professional men or women, neighbors, who have known you well during the past five (5) years. References must be listed. Do not leave blank.

Name(Required)

Home phone number(Required)

Business phone number(Required)

Address(Required)

Street Address City State ZIP Code

Occupation(Required)

Name(Required)

Home phone number(Required)

Business phone number(Required)

Address(Required)

Street Address City State ZIP Code

Occupation(Required)

Name(Required)

Home phone number(Required)

Business phone number(Required)

Address(Required)

Street Address City State ZIP Code

Occupation(Required)

Provide three (3) social acquaintances that have known you well during the past five (5) years. (Must be different from the three references listed above) Social acqualntances must be listed. Do not leave blank.

Name(Required)

Home phone number(Required)

Business phone number(Required)

Address(Required)

Street Address City State ZIP Code

Occupation(Required)

Name(Required)

Home phone number(Required)

Business phone number(Required)

Address(Required)

Street Address City State ZIP Code

Occupation(Required)

Name(Required)

Home phone number(Required)

Business phone number(Required)

Address(Required)

Street Address City State ZIP Code

Occupation(Required)

Veteran's Preference Claim

Have you ever claimed and been employed through Veterans' Preference?(Required)

Yes

If yes, give the name and address of employer(Required)

IF NO, ARE YOU CLAIMING VETERANS; PREFERENCE? (ln accordance with chapter 55A -7, Florida Administrative Code, and chapter 295, Florida Statutes.(Required)

Yes

lf yes, what category are you claiming: (Please indicate number from Veterans' Preference categories below.)(Required)

A veteran with a service connected disability who is eligible for or recelving compensation, disability retirement, or pension under public laws administered by the U.S. Department of Veterans; Affairs and the Department of Defense, or

The spouse of a veteran who cannot qualify for employment because of a total and permanent disability, or the spouse of a veteran missing in action, captured, or forcible detained by a foreign power, or

A veteran of any war who had served on active duty of one day or more during a wartime period, excluding active duty for training, and who was discharged under honorable conditions form the Armed Forces of the United States of America, or

The un-remarried widow or widower of a veteran who died of a service connected disability.

Driving History

Have you ever had a driver's license in any state other than the State of Florida?(Required)

Yes

State(Required)

Month/Year Issued(Required)

Driver's License Number(Required)

Expiration Date(Required)

State

Month/Year Issued

Driver's License Number

Expiration Date

State

Month/Year Issued

Driver's License Number

Expiration Date

List all moving and non-moving traffic citations, i.e., speeding, running red light, expired registration, etc. that you have recelved in the past five years, starting with the mast recent, exclude parking tickets. (use additional sheets if necessary.)

State(Required)

Date(Required)

Violation(Required)

Disposition(Required)

State

Date

Violation

Disposition

State

Date

Violation

Disposition

Has your driver's license ever been suspended or revoked?(Required)

Yes

lf yes, for what reason(s)?(Required)

Length of suspension(s)(Required)

Month(s) and Year(s) reinstated:(Required)

Military History Information

Have you ever served in a military organization of the United States?

Yes

If yes, give periods of active or inactive military service and other data requested:

Service Number(Required)

If applicant between the ages of 18-25 list your selective service registration number

From(Required)

To(Required)

Branch of Service(Required)

Rank(Required)

Type Discharge(Required)

Reason for Discharge(Required)

While in any military organization of the United States have you ever been disciplined under the United States Military Code of justice?(Required)

Yes

lf yes, list circumstances below.(Required)

Periods of Employment

All employment information must be filled out in thls sectlon. Resumes and other attachments will nat be accepted in place of filling aut this secllon, but may be provided as supplemental information. Describe your work experience ln detail beginning with your present or most recent job, and describe all periods of employment and periods of unemployment if longer than slx months Be sure to provlde complete Information regarding each posltlon. IMPORTANT, indicate supervlsory responsibility and number of employees supervise. Ellgiblllty determinations are based on dates of employment, hours worked per week, and description of job duties and responsibilities. For the purposes of the City, supervisory responsibility involves having the authority, in the interest of the employer, to hire, transfer, suspend, lay oft, recall, promote, discharge, assign, reward, or discipline other employees, or responsibility to direct them or to adjust their grievances, or effectively to recommend such action, where the exercise of such authority requires the use of independent judgment.

May we contact your current employer?(Required)

Yes

May we contact your former employer?(Required)

Yes

Name of Present or Last Employer(Required)

Address(Required)

Street Address City State ZIP Code

Your Job Title(Required)

Supervisor's Name and Title(Required)

From(Required)

To(Required)

Number of hours worked per week(Required)

Annual Sallary(Required)

Supervisory Responsibility (see definition above):(Required)

Yes

Number of employees supervised(Required)

Duties & Responsabilities(Required)

Reason for Leaving(Required)

Name of Present or Last Employer

Address

Street Address City State ZIP Code

Supervisor's Name and Title

Your Job Title

From

Number of hours worked per week

Annual Sallary

Supervisory Responsibility (see definition above):

Yes

Number of employees supervised

Duties & Responsabilities

Reason for Leaving

Untitled(Required)

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Comments

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Quincy Police

Department

Quincy Police

Department

Please download, scan, and submit with this application the Background Investigation Waiver

Current Personal Data

Education

College, University or Professional School:

Job-related training or course work

Knowledge / Skills / Abilities

Criminal History Information

Law Enforcement Education/Experience

References

Veteran's Preference Claim

Driving History

Military History Information

Periods of Employment

Honest, Transparency, and Commitment

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