Employment Interest Form - Winthrop Harbor Police printable pdf download

Employment Interest Form - Winthrop Harbor Police

Employment Interest Form

Community Service Officer – Seasonal, Part-Time

North Point Marina Security Detail

INSTRUCTIONS: Print this form and complete the required information. Please complete the form by

hand and write legibly. Use back side if you need more space to list your information. The Authority to

Release Information form on pg. 2 must be signed and notarized. Submit completed form, both pages,

with a copy of your Driver’s License to Cmdr. Mike Bitton at the Winthrop Harbor Police Department.

You may FAX it to 847-872-0190, or E-mail it to , or mail it to 830 Sheridan Road,

Winthrop Harbor, IL 60096. Thank you for your interest in this Community Service Officer position.

PERSONAL INFORMATION:

Full name: ______________________________________ Date of Birth: ____ /____ /____

Home address: ____________________________________________ Unit/Apt. _________

City: ________________________________________ State: _____ Zip code: __________

Home Phone: ____-____-________ Cell Phone: ____-____-________

E-Mail Address: ___________________________________________________________

Driver’s License #: _________________________________ State: _____ Valid? ___Yes ___ No

Are you currently a student? ___Yes ___No (If yes, where? ___________________________________)

List employment experience that may qualify you for this position:

_____________________________________________________________________________________

List specific training that you’ve had that may be applicable to this position:

_____________________________________________________________________________________

List any other Law Enforcement agencies you have submitted applications to:

_____________________________________________________________________________________

Signature: ________________________________ Date ___ /___ /___

Submit this page together with page 2 and a copy of your Driver’s License. Note

that page 2 must be signed before a Notary Public. If qualified, you will be

notified with an invitation to submit an Employment Application.

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Employment Interest Form – Revised 2/2/2016

Employment Interest Form - Winthrop Harbor Police