Application

    Pre-qualification

    I understand that by submitting this form for a potential position with the Cloverdale Police Department, all information provided is subject to verification.

    Position you are applying for:

    Personal Information





    Have you ever had your name as documented at birth changed or otherwise altered after the age of 18? (Other than by marriage)YesNo

    Physical Address



    Contact Information



    Please review carefully and correct your e-mail address, if needed. Failure to do so may result in a lost opportunity.

    Mailing Address and Physical address are the sameYesNo

    BASIC ELIGIBILITY REQUIREMENTS FOR POLICE OFFICERS

    • Must be a United States Citizen

    • Must be at least 21 years of age on or before the applicant’s start date

    • Must meet a minimum vision standard (corrected or uncorrected) of 20/50 acuity in each eye and 20/50 binocular acuity in both eyes

    • Must not have a recorded felony conviction

    • Must be legally allowed to carry a firearm

    • Must have earned a high school diploma or GED

    • Must be legally allowed to work in the United States

    • Must meet residency requirement, as agreed upon in pre-employment negotiations, if applying for a full/part-time position of employment

    Do you meet the basic eligibility requirements?YesNo

    Emergency Contact Information


    Background Information

    Have you ever been convicted or charged in an activity that would be currently classified as domestic violence?YesNo

    Have you ever been convicted or participated in an activity that would be currently classified as a “Hate” crime?YesNo

    Have you used an illegal drug (other than marijuana), or abused a legal drug within the past five (5) years?YesNo

    Have you used marijuana within the past three (3) years?YesNo

    Have you ever knowingly or intentionally sold, transported, or manufactured any illegal drug for profit?YesNo

    Do you currently abuse alcohol?YesNo

    Have you engaged in any form of bestiality since the age of 18?YesNo

    Declaration

    By placing my name in the box below, I swear or affirm under the penalty of perjury, all information contained in this pre-qualification is true, accurate, and complete to the best of my knowledge. I understand any false information provided may cause me to be removed from further consideration for a position with the Cloverdale Police Department.

    Attachment

    Please attach a completed resume with the following information:

    • Name (last, first, MI)

    • Address of current domicile

    • Home/Cell Phone

    • Email (you wish to receive potential correspondence, if applicable)

    • Employment History (Last 4 employers - include job position, responsibilities, job skills, start and end dates, reason for leaving, supervisor’s contact)

    • Education (High School and vocational, college (if applicable), and graduation dates)

    • Note any formal training or certifications

    • Note any special skill sets (e.g., bilingual, computer proficiency, etc.)

    • State/Country licensed to drive in (must be current and valid)

    • Any additional information relevant to your qualifications as a police officer