police academy application instruction - Kellogg Community College

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Michigan Commission on Law Enforcement Standards CANDIDATE’S PERSONAL HISTORY STATEMENT PLEASE PRINT IN INK OR TYPE YOUR RESPONSES TO THIS QUESTIONNAIRE PERSONAL INFORMATION LAST NAME FIRST NAME MIDDLE NAME DATE OF BIRTH AGE SOCIAL SECURITY NUMBER* mm dd yy - - DRIVER’S LICENSE NUMBER AND STATE ISSUED Are you a citizen of the United States? Yes No * In accordance with the Federal Privacy Act of 1974, disclosure is voluntary. If necessary, the Social Security Number will be used for identification purposes to ensure proper records are obtained. HOME ADDRESS CITY STATE ZIP SCHOOL ADDRESS (If different from above) CITY STATE ZIP PRIMARY PHONE NO. SECONDARY PHONE NO. SCHOOL/ACADEMY YOU PLAN ON ATTENDING ( ) - ( ) - EMPLOYMENT Have you ever been fired or asked to resign from any place of employment? Yes No If “Yes”, please give the details (include when, where, and the circumstances): Have you ever been an unsuccessful candidate for a law enforcement position because of failure to pass the background check? If “Yes”, please give the details (include when, name of agency and the circumstances): Yes No MILITARY SERVICE Have you ever served in the armed forces, National Guard, or military reserves? Yes No If “Yes”, have you ever been the subject of any judicial or non-judicial disciplinary action? Yes No If “Yes”, please give the details (include branch of service, when, where, and the circumstances):
MOTOR VEHICLE OPERATION List all traffic citations (exclude parking) you have received in your lifetime. Attach additional pages if needed: APPROXIMATE DATE NATURE OF VIOLATION JURISDICTION WHERE VIOLATION OCCURRED DISPOSITION (Fine, Points, Other) Do you currently have active violation points on your driver’s license? Yes No If “Yes”, how many points do you have? pts Has your driver’s license ever been suspended or revoked? Yes No If “Yes”, please provide the details (what, when, where, and why): Have you ever been refused a driver’s license by any state? Yes No If “Yes”, please provide the details (what, when, where, and why): Do you currently have any restrictions placed on your driver’s license? Yes No If “Yes”, please explain (nature of restriction and why): Have you been involved, as a driver, in a motor vehicle accident? If “Yes”, please provide the following information: APPROXIMATE DATE LOCATION INVESTIGATING POLICE AGENCY Yes No INDICATE INJURIES
Page 1 and 2: 450 NORTH AVENUE, BATTLE CREEK, MI
Page 3 and 4: Physical Integrity Vision, Color Be
Page 5 and 6: 09/2009 Michigan Commission on Law
Page 7: Michigan Commission on Law Enforcem
Page 11 and 12: SCHOOL HISTORY Have you ever been s
Page 13 and 14: 12/2009 MICHIGAN COMMISSION ON LAW
Page 15 and 16: MEDICAL HISTORY STATEMENT 8. Have y
Page 17 and 18: MEDICAL HISTORY STATEMENT 84. Has y
Page 19 and 20: MEDICAL HISTORY STATEMENT MEN ONLY
Page 21 and 22: Fitness Test Application The fitnes
Page 23 and 24: MCOLES PREENROLLMENT FITNESS TEST
Page 25: The Michigan Commission on Law Enfo

police academy application instruction - Kellogg Community College

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