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.
Not applicable
Full-Time Law Enforcement Officer
Special Deputy/Officer
Reserve Officer
Civilian
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
Yes
No
What is the name of the referring Officer? (If this does not apply enter N/A).
Sex
select one
Male
Female
Race
select one
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White or Caucasian
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?
Yes
No
Foreign Languages
Enter N/A if you only speak English
Education
select one
High School Diploma/GED
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate
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 eschneider@cityoflawrence.org.
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.
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