full first legal name
full middle name
current legal last name
Date of Birth
Make sure the entry is the correct date (mm-dd-yyyy).
How did you hear about the Lawrence Police Department interest forms?
If applicable, indicate what social media platform.
Age Requirement Exceptions
If applicable, check all that apply.
Veteran of the armed forces, received or is eligible to receive an honorable discharge.
Previous Merit Officer of the Lawrence Police Department.
Currently certified as a Tier 1 Indiana Law Enforcement Academy Graduate with continued enforcement experience.
If applicable, check the years of service.
ILEA Tier 1 Certified: less than one (1) year of service
ILEA Tier 1 Certified: greater than one (1) year of service but less than two (2) years of service.
ILEA Tier 1 Certified: greater than two (2) years of service but less than three (3) years of service.
ILEA Tier 1 Certified: greater than three (3) years of service but less than four (4) years of service.
ILEA Tier 1 Certified: greater than four (4) years of service, but less than five (5) years of service.
ILEA Tier 1 Certified: greater than five (5) years of service.
Provide your Public Safety Identification (PSID) Number.
If not applicable, enter N/A.
Did a Lawrence Police Officer refer you to submit an interest form?
What is the name of the referring Officer? (ONLY 1 name can be provided. If this does not apply enter N/A).
American Indian or Alaskan Native
Black or African American
Native Hawaiian or Other Pacific Islander
White or Caucasian
Operator's License #
Operator's License State
Social Security Number
Must be a valid e-mail address. All information about the hiring process will be communicated through the e-mail address provided.
Have you submitted an application to the Lawrence Police Department within the last two (2) years?
This does not apply to interest forms or pre-application. This only applies to a submission of an application for employment that would have been submitted on the day of your scheduled oral interview.
Enter N/A if you only speak English
High School Diploma/GED
I understand that failure to arrive as scheduled for any event will cause my elimination from the entire process.
I understand that failure to have complete, accurate, and legible information for any forms completed will cause my elimination from the entire process.
I understand that if I am removed from the employment process, after my submission of application for employment, by the Civilian Police Merit Commission I may not re-apply for a two (2) year period.
If at any time my address, email, and/or telephone number were to change, I agree to notify Captain Erika Schneider at email@example.com.
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.
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.
By entering your full name here, you agree to sign this electronic document as your electronic signature.
type the letters/numbers shown