Wisconsin Departm ent of Justice Law Enforcement Sta ndards Board DJ-LE-330, Rev. 5/2 017 www.wilenet.o rg APPLICATION FOR EMPLOYMENT LAW ENFORCEMENT, JAIL OR SECUR E JUVENILE DETENTION OFFICER NOTICE: All questions must be answered. Incomplete or illegibl e applications will not be considered. If the space provided is insufficient for complete answers or you wish to furnish additional information, please attach additional pages. 1. PERSO NAL INFORMAT ION Name (Last, First, Middle) Social Security # (xxx-xx-xxxx) Address (Apartment, Street, P.O. Box) Home Telephone Number City State Zip Code Work Telephone Number Email Address Cell Phone Number Have you successfully completed the basic training required for certification (i.e. 720-hour law enforcement academy)? Yes No If yes, what type(s) of basic training have you successfully completed? Law Enforcement Jail Secure Juvenile Detention If ap plicable, include the name of the school where you completed basic training and the date that training was completed: Are you at least 18 years old? Yes No A re you a United States citizen? Yes No Do you have a high school diploma, GED or HSED? Yes No Do you have an Associate Degree or 60 associate degree level college credits or higher? Yes No If No, were you employed as a law enforcement officer prior to February 1, 1993? Yes No The college credit requirement as written in Wisconsin Administrative Code § LES 2.01(1)(e), pertains to law enforcement and t ribal law enforcement officers first employed on or after February 1, 1993. Have you ever been convicted of a felony? Yes No Have you ever been convicted of a misdemeanor crime of domestic violence? Yes No A re you prohibited by state or federal law from possessing a firearm? Yes No Do you possess a valid Wisconsin driver’s license or a valid driver’s license from another state? Yes No 2. EDUC ATION Dates Name of School(s) From (mm/yyyy) To (mm/yyyy) Degree, Diploma, or Credits Earned High School(s) College(s) 1 2 3. EMPLO YME NT Begin with current or most recent employer. List chronologically all employment, including summer and part-time employment whi le attending school. To furnish additional employment information, attach sheets of the same size and format as this application. Dates of Employment Name and Address of Employer From (mm/yyyy) To (mm/yyyy) Name of Employer: Address: Full-Time Part-Time Ann ual Salary/Wages: City: State: Zip Code: Supervisor’s Name / Telephone Number: May we contact the employer / supervisor? Yes No Position and kind of work: Reason for Leaving: Dates of Employment Name and Address of Employer From (mm/yyyy) To (mm/yyyy) Name of Employer: Address: Full-Time Part-Time Ann ual Salary/Wages: City: State: Zip Code: Supervisor’s Name / Telephone Number: May we contact the employer / supervisor? Yes No Position and kind of work: Reaso n for Leaving: Dates of Employment Name and Address of Employer From (mm/yyyy) To (mm/yyyy) Name of Employer: Address: Full-Time Part-Time Ann ual Salary/Wages: City State: Zip Code: Supervisor’s Name / Telephone Number: May we contact the employer / supervisor? Yes No Position and kind of work: Reason for Leaving: 3 4. MILIT ARY SE RVICE Branch of Service From (mm/yyyy) To (mm/yyyy) Active Duty or Reserve Highest Grade Skill Specialty or Primary Duty Honorably Discharged from Military Service? Yes No Not Applicable 5. REFEREN CES Gi ve three references (not relatives, or present employer; avoid listing members of the clergy). Name: Position/Title/Profession: Num ber of Years Acquainted: A ddress: Cit y/State/Zip: T elephone Number: Name : Position/Title/Profession: Num ber of Years Acquainted: A ddress: Cit y/State/Zip: T elephone Number: Name : Position/Title/Profession: Num ber of Years Acquainted: A ddress: Cit y/State/Zip: T elephone Number: 6. GENER AL COMPLETE IF INSTRUCTED TO DO SO BY EMPLOYING AGENCY. Attach no more than one additional page for each answer. A.Why have you chosen to apply for this position? B.Discuss things you have done which have contributed to your life experience. Be sure to include information regarding volunteer work with civic, school, or professional organizations. Be specific about names and dates. C.Why do you believe you could relate to and/or work with p eople of different races, genders, cultures, ages, socio-economic groups, and educational levels?APPLICANT PLEASE READ CAR EFULLY AND SIGN BELOW Information provided and statements made as part of this application may be grounds for not employing you or for dismissing you after you begin work. All informatio n and statements made are subject to verification. CERTIFICATION ALL INFORMATION PROVIDED AND STATEMENTS MADE BY ME AS PART OF THIS APPLICATION, OR AS PART OF ANY ADDITIONAL INFORMATIO N PROVIDED IN SUPPORT OF TH IS APPLICATION, ARE COMPLETE, CORRECT, AND TRUE TO THE BEST OF MY KNOWLEDGE. I UNDE RSTAND THAT IF I AM EMPLOYED, FALSE INFORM ATION PROVIDED OR FALSE STATEMENTS MADE AS PART OF THIS APPLICATION MAY BE CO NSIDERED AS CAUSE FOR DISMISSAL. Applica nts Signature Date Signe d Und er the provisions of § 19.36, Wis. Stats., I request that my identity as an applicant for this position not be revealed without my consent or until required under law. Applica nts Signature Date Signe d 4
