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2. Personal Information
4. Position Title
6. First Name*
7. Middle Name*
8. Last Name*
10. Address: Street, City, State, Zip Code*
12. Email Address*
14. Home Phone*
15. Alternate Phone*
17. Education
19. High School Name*
20. Dates
21. Degree Received
23. College
24. Dates
25. Degree Received
27. Other/Additional School
28. Dates
29. Degree Received
31. Additional School
32. Dates
33. Degree Received
35. Employment
37. Present Employer*
38. Dates*
39. Position Title
41. Address: Street, City, State, Zip Code
43. Phone Number
44. Supervisor
45. May We Contact This Employer?

    1. Yes
    2. No
47. Other
49. Certificates and Licenses
51. Skills
53. Additional Information
55. References
57. (1) Reference Type*
58. Name*
59. Position
61. Address: Street, City, State, Zip Code*
63. Email Address*
64. Phone Number*
66. (2) Reference Type*
67. Name*
68. Position
70. Address: Street, City, State, Zip Code*
72. Email Address*
73. Phone Number*
75. (3) Reference Type*
76. Name*
77. Position
79. Address: Street, City, State, Zip Code*
81. Email Address*
82. Phone Number*
84. Job Specific Supplemental Questions
86. Are you at least 18 years of age?*

    1. Yes
    2. No
88. Do you possess a high school diploma or GED?*

    1. Yes
    2. No
90. Do you possess a valid MN driver's license?*

    1. Yes
    2. No
91. If no, please explain.
93. Do you have a good driving record?*

    1. Yes
    2. No
94. If no, please explain.
96. Have been a Reserve Officer for another City/County?*

    1. Yes
    2. No
97. If yes, please explain where and length of service.
99. Do you have any public safety related volunteer or professional experience?*

    1. Yes
    2. No
100. If yes, please explain where and length of service.
102. Are you trained in First Aid, First Responder, or EMT?*

     1. Yes
     2. No
     3. No, but currently enrolled in class
103. If yes, what are you trained in? When does it expire?
105. Are you able to attend the monthly training meeting that is held on the third Monday of each month (except for December) from 7:00 pm to 9:00 pm?*

     1. Yes
     2. No
107. Have you ever been convicted as an adult of a felony or gross misdemeanor for which a jail sentence of more than 30 days could have been imposed?*

     1. Yes
     2. No
108. If yes, please explain.
110. Please explain why you would like to become a Police Reserve Officer.*
112. Where did you learn about this opportunity?
114. I certify that all answers to the above question are true and understand that any false information or omission of information from this application will be cause for rejection of this application or termination without notice.*

     1. Yes
     2. No
116. You may attach a resume if you desire
118. Electronic Signature Agreement *

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. Agree
120. Electronic Signature*
Leave This Blank:


122. 1. Receive an email copy of this form.
123. Email address

     This field is not part of the form submission.

124. Submit

* indicates a required field