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Eugene Police Department Cadet Program Application for Membership
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This form has been modified since it was saved. Please review all fields before submitting.
Application for Membership
Please complete the following sections.
Name: Last, First, Middle
*
Date of Birth
*
Today's Date
*
Address
*
Phone
*
Alternate phone number
Email Address
*
Have you ever been a police explorer or cadet?
*
-- Select One --
Yes Explorer
Yes Cadet
No
Please choose one:
Have you ever applied to be a Eugene Police Cadet?
*
Yes
No
Where?
*
If you have been a police explorer or cadet, please indicate where.
Do you have a valid driver's license?
*
-- Select One --
Yes
No
License number and issuing state
Have you ever been cited or arrested
*
-- Select One --
Yes
No
Choose one answer
If yes, please explain
Education History
List each school you have attended, the location, course of study and dates attended.
High School
*
College Information
If you have attended college, please list school name, location, course of study and dates attended.
Other Information
List any courses, training, special licenses, scholastic honors or other qualifications, which may have a bearing on this position
Work history
Beginning with the most current, list the jobs you have held in the last five years. Include any other experiences related to the position for which you are applying, including any volunteer work.
Employment History
*
List employers, job title, complete address, phone number, date hired, date terminated, supervisor's name, reason for leaving the job, and if we may contact your employer
References
Individuals not related to you, who can provide information about your character, work ethic, etc.
Name & Occupation, Phone #, Nature of Association
*
Name & Occupation, Phone #, Nature of Association
*
Certificate of Application
In making this application, I certify that the statements I have made are true,complete and I agree that nay willful false statements or misrepresentations herein, are just cause for rejection of my application or disciplinary dismissal from the post. I hereby authorize the Eugene Police Department advisors of Cadet Post #501 to contact any source to verify and obtain information in assessing my qualifications, including past and present employers, law enforcement agencies and references, unless otherwise specified. In consideration of my acceptance, I agree to conform to the rules and regulations of the Eugene Police Department Cadet Program.
Electronic Signature
*
Sign
By checking this box, I am providing an electronic signature.
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