Application Form - The Woodstock Police Service (Page 4 of 4) in pdf

CHARACTER REFERENCES

List three (3) people whom we may personally contact or write, for a character reference.

(DO NOT LIST RELATIVES, FORMER EMPLOYERS, PRIESTS, PASTORS, MINISTERS OF RELIGION, OR POLITICAL LEADERS)

NAME

HOME PHONE NUMBER

STREET

BUSINESS PHONE NUMBER

CITY

YEARS KNOWN

NAME

HOME PHONE NUMBER

STREET

BUSINESS PHONE NUMBER

CITY

YEARS KNOWN

NAME

HOME PHONE NUMBER

STREET

BUSINESS PHONE NUMBER

CITY

YEARS KNOWN

POLICE OFFICERS YOU ARE ACQUAINTED WITH:

APPLICANT - PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING:

I confirm the information given is true and correct to the best of my knowledge. I authorize the WOODSTOCK POLICE SERVICE to review

my personnel file with past and present employers, which I understand will include disciplinary actions, if any. I further authorize the

WOODSTOCK POLICE SERVICE to collect personal information concerning myself including academic records, employment history, finan-

cial records, character statements, and non-pardoned criminal records from sources other than myself; to require me to perform job relat-

ed academic and physical fitness testing; and, to require me to undergo job related medical tests (after a written offer of employment).

Furthermore, I hereby absolve and save harmless the WOODSTOCK POLICE SERVICE and all its individual employees from all liability,

causes of action, or damages resulting from the release of any or all such information. I agree to comply with all WOODSTOCK POLICE

SERVICE directives, Rules and Regulations, safety procedures, the Ontario Police Services Act and such other Terms and Conditions of

Employment as my be instituted or revised by the WOODSTOCK POLICE SERVICE from time to time. I also agree that continuing employ-

ment is conditional upon the satisfactory completion of a probationary period, and I agree that I must enrol in such Welfare and Pension

Plans, WOODSTOCK POLICE ASSOCIATION, etc. as my be obligatory for paid WOODSTOCK POLICE SERVICE employees.

REFERENCES:

For employment and/or character references, I, _________________________________________________________________ (Print Name)

authorized the WOODSTOCK POLICE SERVICE to contact and collect information, concerning my job performance and character from

employers/supervisors and persons name herein. The persons named herein my furnish information they may have concerning my suit-

ability for the position applied for to the WOODSTOCK POLICE SERVICE, and I do release such individual from any and all liability by rea-

son of furnishing such information.

I agree and understand that any misrepresentation of facts shall constitute just cause for the termination of my employment and/or asso-

ciation with the WOODSTOCK POLICE SERVICE, at any time.

DATED ________________________

Applicant’s Signature ___________________________________________________________

Application Form - The Woodstock Police Service Page 4