Police Department Personal History Statement Form Page 4
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22EMPLOYMENT
10.
Your employment history is a critical part of your background. You must account for each and every job you have held in the
past, whether full-time, part-time or voluntary. Begin with your present or most recent job and work backward. You must be
as specific as possible about your reasons for leaving. Do not use “personal reasons.”
PRESENT Employer’s name/address ___________________________________________________________________
Telephone number: _______________ Supervisor’s name __________________________________________________
Start Date __________ End Date ___________ Starting salary __________________ Ending salary _________________
Your job title ___________________________________________________
Full time
Part time
Volunteer
Co-workers’ names - list three
1. ____________________________________________ Cell# ____________________
2. ____________________________________________ Cell# ___________________
3. ____________________________________________ Cell# ___________________
Why do you want to leave? ___________________________________________________________________________
May we contact your present employer?
Yes
No If no, please explain _________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Employer’s name/address ___________________________________________________________________________
Telephone number: _______________ Supervisor’s name __________________________________________________
Start Date __________ End Date ___________ Starting salary __________________ Ending salary _________________
Your job title ___________________________________________________
Full time
Part time
Volunteer
Co-workers’ names - list three
1. ____________________________________________ Cell# ____________________
2. ____________________________________________ Cell# ___________________
3. ____________________________________________ Cell# ___________________
Why did you leave? _________________________________________________________________________________
May we contact this employer?
Yes
No If no, please explain ________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Employer’s name/address ___________________________________________________________________________
Telephone number: _______________ Supervisor’s name __________________________________________________
Start Date __________ End Date ___________ Starting salary __________________ Ending salary _________________
Your job title ___________________________________________________
Full time
Part time
Volunteer
Co-workers’ names - list three
1. ____________________________________________ Cell# ____________________
2. ____________________________________________ Cell# ___________________
3. ____________________________________________ Cell# ___________________
Why did you leave? _________________________________________________________________________________
May we contact this employer?
Yes
No If no, please explain ________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Employer’s name/address ___________________________________________________________________________
Telephone number: _______________ Supervisor’s name __________________________________________________
Start Date __________ End Date ___________ Starting salary __________________ Ending salary _________________
Your job title ___________________________________________________
Full time
Part time
Volunteer
Co-workers’ names - list three
1. ____________________________________________ Cell# ____________________
2. ____________________________________________ Cell# ___________________
3. ____________________________________________ Cell# ___________________
Why did you leave? _________________________________________________________________________________
May we contact this employer?
Yes
No If no, please explain ________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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