Police Officer Applicant Background Questionnaire - Sierra Vista Police Department Page 3
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24Sierra Vista Police Department
Police Officer Applicant Background Questionnaire
Applicant Name:
Please Print:
Last
First
Full Middle Name
Position Applied for:
Please Print:
TO THE APPLICANT: You will be the subject of a complete background investigation
consisting of family, personal, employment, financial, driving and criminal history.
Questions regarding financial history are used as an element of background
investigation, but do not, in and of themselves, constitute the basis for rejection of your
application for employment.
Any misstatement or falsification of fact, or omission of information requested in this
application may disqualify you from employment by the Sierra Vista Police
Department. Applicants for Certified Officer positions will be administered a polygraph
examination prior to acceptance for employment by the Sierra Vista Police Department
to determine the truthfulness of information furnished. Applicants for some civilian
positions may be administered a polygraph examination prior to acceptance. You will
also be administered a test or tests to determine the presence of alcohol and/or drugs in
your blood and/or urine prior to employment.
The responses made by you in the completion of this applicant questionnaire will be held
in the strictest confidence. This application, and any attachments thereto, remain the
property of the Sierra Vista Police Department and will not be returned to you. This
document is confidential and will remain confidential unless disclosure is required by
law.
Applicants – Read and Sign
“I certify that I have read and understand the foregoing information, AS
WELL AS THE INSTRUCTIONS, and further, under penalty of law, that all my
statements and responses in this application are, to the best of my knowledge and belief
true, complete and correct. These entries are made in good faith. I understand a
knowing and willful false statement on this form constitutes a violation of the law, and is
cause to initiate action to suspend or revoke certified peace officer status.”
“I further understand that if, as an employee in any position, commissioned or
civilian, that if I have omitted relevant information or provided false information to any
question contained herein, that I will be subject to disciplinary action, up to and
including termination of employment.”
Signature of Applicant
Date
3
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