Form Center

2. 
3. Application for Police Officer

   Orono Police Department

   2730 Kelley Pkwy

   Orono, MN 55323

   (952) 249-4700

5. Contact Information:
7. First and Middle Name
8. Last Name
10. Address
12. City
13. State
14. Zip Code
16. Phone Number
17. Email Address
19. County of Residence
21. Title of Specific Position for Which You Applying
22. Date of Application
    Date of Application
23. Date Available for Work
    Date Available for Work
25. Are you 18 years of age or over?*

    1. Yes
    2. No
26. Are you legally eligible to work in the United States in the position for which you are applying? Proof of citizenship or work eligibility will be required as a condition of employment.

    1. Yes
    2. No
28. Have you previously been employed by the City?

    1. Yes
    2. No
29. If yes, date
    If yes, date
30. Previous Position with the City of Orono
32. Driver's License Number
33. Driver's License Class
34. Driver's License State
36. Education:
38. Did you graduate from high school or receive a GED?*

    1. Yes
    2. No
39. School Attended
40. How many years of education have you had *
    -- Select One --7891011121314151617181920
42. Name and Location of College, University, Technical School
43. Did You Graduate?

    1. Yes
    2. No
44. Degree, Certificate - Course of Study
46. Name and Location of College, University, Technical School
47. Did You Graduate?

    1. Yes
    2. No
48. Degree, Certificate - Course of Study
50. Name and Location of College, University, Technical School
51. Did You Graduate?

    1. Yes
    2. No
52. Degree, Certificate - Course of Study
54. Work Experience (Experience and training ratings are determined by this information. Please be complete.) List your present or most recent experience first. Attach additional sheets if necessary.
56. Employing Firm
57. Phone Number
59. Address
61. City
62. State
63. Zip Code
65. Your Title
66. Supervisor
    Supervisor's Title
68. Number and Type of Positions You Supervised
70. Principal Responsibilities
72. Length of Employment
    Length of Employment Start Date

    —

    Length of Employment End Date
73. Hours Per Week
74. Last Salary
76. May we contact your present employer?

    1. Yes
    2. No
77. If No, Please explain
79. Reason for Leaving
81. Employing Firm
82. Phone Number
84. Address
86. City
87. State
88. Zip Code
90. Your Title
91. Supervisor
    Supervisor's Title
93. Number and Type of Positions You Supervised
95. Principal Responsibilities
97. Length of Employment
    Length of Employment Start Date

    —

    Length of Employment End Date
98. Hours Per Week
99. Last Salary
101. May we contact your present employer?

     1. Yes
     2. No
102. If No, Please explain
104. Reason for Leaving
106. Employing Firm
107. Phone Number
109. Address
111. City
112. State
113. Zip Code
115. Your Title
116. Supervisor
     Supervisor's Title
118. Number and Type of Positions You Supervised
120. Principal Responsibilities
122. Length of Employment
     Length of Employment Start Date

     —

     Length of Employment End Date
123. Hours Per Week
124. Last Salary
126. May we contact your present employer?

     1. Yes
     2. No
127. If No, Please explain
129. Reason for Leaving
131. Employing Firm
132. Phone Number
134. Address
136. City
137. State
138. Zip Code
140. Your Title
141. Supervisor
     Supervisor's Title
143. Number and Type of Positions You Supervised
145. Principal Responsibilities
147. Length of Employment
     Length of Employment Start Date

     —

     Length of Employment End Date
148. Hours Per Week
149. Last Salary
151. May we contact your present employer?

     1. Yes
     2. No
152. If No, Please explain
154. Reason for Leaving
156. Are you eligible to be POST licensed?

     1. Yes
     2. No
157. If already licensed, please provide a POST #.
159. The City of Orono will not discriminate against or harass any employee or applicant for employment because of race, color, creed, religion, national origin, sex, disability, marital status, or status with regard to public assistance.
161. List any relevant current professional memberships, registrations or licenses. Include date first issued.
163. Job Relevant Volunteer and Unpaid Work Experience
165. Kind of Volunteer Activity
166. No. Hrs Per Mo.
167. Dates
     Dates Start Date

     —

     Dates End Date
169. Major Responsibilities
171. Kind of Volunteer Activity
172. No. Hrs Per Mo.
173. Dates
     Dates Start Date

     —

     Dates End Date
175. Major Responsibilities
177. Kind of Volunteer Activity
178. No. Hrs Per Mo.
179. Dates
     Dates Start Date

     —

     Dates End Date
181. Major Responsibilities
183. Describe any additional experience or training that qualifies you for this job.
185. Cover Letter
186. Resume
187. Other
189. In accordance with the Immigration Reform and Control Act of 1986, the City of Orono hires only U.S. Citizens and lawfully authorized alien workers. If hired, you will be required to provide written documentation of citizenship or legalized alien program. Failure to provide said documentation will result in dismissal.
191. MN Stat. Sec. 518.611, Subd. 8, requires employers to obtain information from all new employees regarding court-ordered child support obligations that are required by law to be withheld from income. Failure to provide said documentation will result in dismissal.
193. Have you served a sentence in jail or prison or been convicted of a misdemeanor or felony for which a jail sentence could have been imposed?

     1. Yes
     2. No
194. You may answer "No" if the conviction or criminal records have been annulled, sealed, set aside, or purged, or if you have been pardoned pursuant to the law.

     1. Yes
     2. No
196. Yes If "Yes", please specify.
198. If you are hired for this position you may be required to undergo a physical examination at the City's expense to determine whether or not you are able to perform the duties of this position in an effective and safe manner, and whether or not accommodations need to be made for you.
200. The City of Orono does not discriminate on the basis of handicapped status in the admission or access to, or treatment or employment in, its programs or activities. It is the policy of the City of Orono to provide reasonable accommodations to the known physical and mental limitations of qualified handicapped applicants and employees in order for them to perform the essential functions of the job in question.
202. Did you serve in the military service of this country and separate under honorable conditions from any branch of the armed forces of the U.S. after having served on active duty for 181 consecutive days or by reason of disability incurred while serving on active duty?

     1. Yes
     2. No
204. If "Yes", indicate dates of military service.
     If "Yes", indicate dates of military service. Start Date

     —

     If "Yes", indicate dates of military service. End Date
205. If "Yes", are you a permanent resident of the State of Minnesota?

     1. Yes
     2. No
207. Describe your duties and any special training.
209. Give the names of three people outside of relatives who can be contacted regarding your qualifications, work habits, and character.
211. First Name
212. Last Name
214. Phone Number
215. Position and relation to your work
217. First Name
218. Last Name
220. Phone Number
221. Position and relation to your work
223. First Name
224. Last Name
226. Phone Number
227. Position and relation to your work
229. The City of Orono is an EQUAL OPPORTUNITY EMPLOYER
231. The City of Orono has the right to verify information provided in the application. False information may subject an applicant to the penalty provisions of M.S. 43A.39.
233. In connection with this application for employment, I authorize the City of Orono and any agent acting on its behalf to conduct an inquiry into any job-related information contained in this application, including, but not limited to, my records maintained by an educational institution related to academic performance such as transcripts. Moreover, I hereby release the City of Orono and any agent acting on its behalf from any and all liability of whatsoever nature by reason of requesting such information from any person.

     1. Yes
     2. Yes, but not present employer until job is offered.
     3. No (We may be unable to hire you without this information.
235. Electronic Signature Agreement

     I declare that any statement in this application or information provided is true and complete and hereby acknowledge that I have read and understand the information below.

     1. I agree.
237. Electronic Signature
238. Date
     Date
240. IMPORTANT FACTS ABOUT INFORMATION ON YOUR APPLICATION This application is to assist in the process of referring you for possible employment. Certain information requested on the application is private, that is, may be released only to you or to agencies where you may be considered for employment (to comply with M.S. 15.165, Subd. 2). If you are employed, the data will be available to the Department of Finance, the Internal Revenue Service, and the Social Security Administration for payroll and tax purposes. If you disagree with the data we have about you, you may notify the City.
242. Private Data
243. Why we Ask for it
244. Are You Legally Obligated to Provide it?
245. What May Happen if you Don't Provide it?
247. Social Security Number
248. To distinguish you from all other applicants, and to make processing more efficient.
249. No
250. In most cases, nothing. However, it will help to ensure that we do not confuse your records with those of others.
252. Date of Birth (Final applicants only)
253. To conduct check of criminal record for certain positions
254. No
255. Failure to provide information may be cause for rejecting an applicant.
257. Name (The names of finalists for a position are public information.)
258. To distinguish you from all other applicants.
259. Yes
260. Failure to provide information may be cause for rejecting an applicant.
262. Street Address (City and County of residence are public information.)
263. To be able to contact you to determine availability for interview.
264. No
265. We may not be able to employ you in certain jobs where you may be required to come to work on short notice.
267. Sex, Racial/Ethnic Group, Handicapped Status, Veteran Status
268. To be able to make Equal Opportunity reports as required by law.
269. No
270. We will not be able to determine whether our selection processes result in discrimination, or to take affirmative action in our hiring.
272. Conviction Record
273. To determine whether we may legally accept an application from you and determine whether your record may be a job-related consideration.
274. Yes
275. We will not be able to make determinations required by law.
277. All other information on the application is public, and may be given to anyone for any purpose.
Leave This Blank:


279. 1. Receive an email copy of this form.
280. Email address

     This field is not part of the form submission.

281. Submit

* indicates a required field