Maryland Heights Police Department Application Form (Updated 4/29/2022) Instructions

Check this box if you have served active duty in the Armed Services of the United States.

Check this box if you have not served active duty in the Armed Services of the United States.

Enter your family/surname (last name) exactly as it appears on official documents.

Enter your given (first) name as shown on official identification.

Enter your middle name or middle initial; if none, leave blank or enter 'N/A' as instructed.

Enter the date the applicant's signature was provided.

Provide the applicant's signature.

Enter the total number of college credit hours you have earned or are currently showing on your transcript.

Please enter your college major.

Please enter your college minor.

If you answered yes to being discharged or asked to resign, briefly describe the circumstances including employer name(s), approximate date(s), and the reason or events that led to the discharge or resignation. Fill only if '10. Were you ever discharged or asked to resign from any employment? — Yes' is 'Yes'.

Enter your primary email address to contact you (e.g., [email protected]); include the full address with the @ and domain.

The period of time the applicant resided at the fifth listed address.

The street address of the fifth place the applicant resided.

The city of the fifth place the applicant resided.

The county of the fifth place the applicant resided.

The state of the fifth place the applicant resided.

The zip code of the fifth place the applicant resided.

Enter the date you began this employment.

Enter the date you ended this employment or leave blank if still employed.

Enter the full name of the employer (company or organization) for this job.

Enter the employer's full mailing address, including street address, city, and state.

Enter the employer's telephone number, including area code and any extension if applicable.

Enter the name of your direct supervisor or manager at this job.

Enter the job title or position you held at this employment.

Enter the salary you were paid for this position.

Provide a brief explanation of why you left this employment (for example: resignation, termination, relocation).

Enter the dates (from and to) for your first address history.

Enter the street address for your first address history.

Enter the city for your first address history.

Enter the county for your first address history.

Enter the state for your first address history.

Enter the zip code for your first address history.

Enter the start and end dates of attendance for this education entry.

Enter the name of the school for this education entry.

Enter the street address of the school for this education entry.

Enter the zip code of the school for this education entry.

Enter the number of years completed for this education entry.

Enter the degree or diploma obtained for this education entry.

Enter the month and year you began this first (A) employment.

Enter the month and year you ended this first (A) employment or indicate if it is your current position.

Enter the full name of the employer for your first (A) listed employment.

Enter the complete street address of this employer, including city and state.

Enter the phone number for this employer, including area code.

Enter the name of your supervisor or immediate manager at this employer.

Enter the job title or position you held at this employer.

Enter your salary for this position as a numeric amount.

Provide a brief reason why you left this employment (for example: resignation, layoff, or termination).

Enter the branch of military service for the first record.

Provide the serial number associated with your first military service record.

Specify the dates of service, from start to end, for your first military record.

Indicate the highest rank achieved during your first military service.

Describe your primary duty or job during your first military service.

Enter the type of discharge received from your first military service.

Enter the full name of the first reference.

Enter the complete address, including city, state, and zip code, for the first reference.

Enter the phone number of the first reference.

Enter the email address of the first reference.

Enter the number of years you have known the first reference.

Enter the occupation or profession of the first reference.

Enter the start and end dates for the fourth address in your address history.

Enter the street address for the fourth address in your address history.

Enter the city for the fourth address in your address history.

Enter the county for the fourth address in your address history.

Enter the state for the fourth address in your address history.

Enter the zip code for the fourth address in your address history.

Enter the date of the fourth arrest.

Enter the specific charge for the fourth arrest.

Enter the location where the fourth arrest occurred.

Enter the disposition or outcome of the fourth arrest.

Enter the police agency involved in the fourth arrest.

Enter the dates you attended the fourth educational institution.

Enter the name of the fourth educational institution you attended.

Enter the address of the fourth educational institution you attended.

Enter the zip code of the fourth educational institution you attended.

Enter the number of years completed at the fourth educational institution.

Enter the degree or diploma received from the fourth educational institution.

Enter the start date for this employment period.

Enter the end date for this employment period or the date you left this job.

Enter the full name of the employer or company for this position.

Provide the employer's full mailing address, including street, city, state, and ZIP code.

Enter the employer's main telephone number, including area code and extension if applicable.

Provide the name (and optionally title) of your immediate supervisor at this job.

Enter the job title or position you held at this employer.

Enter the salary or pay you received for this position.

Provide a brief explanation for why you left this employment.

Check this box if you are between the ages of 21 and 45.

Check this box if you are a United States citizen.

Check this box if you currently hold a valid Missouri motor vehicle operator's license.

Check this box if you are NOT between the ages of 21 and 45.

Check this box if you are NOT a United States citizen.

Check this box if you do NOT have a valid Missouri motor vehicle operator's license.

Check this box if you have been discharged or asked to resign from any job.

Check this box if you give permission for the employer named on your current application to be contacted about this application.

Check this box if you do not give permission for your present employer to be contacted about this application.

Check this box if you have previously submitted an application to this department.

Check this box if you have never previously applied to this department.

Check this box if you have never been discharged or asked to resign from any job.

Check this box if you have never been convicted of any crime.

Check this box if you have ever been convicted of any crime.

Enter your full operator's (driver's) license number followed by the license expiration date (e.g., 123456789 / MM/DD/YYYY); include both pieces of information in this single entry. Fill only if 'Do you possess a valid license to operate a motor vehicle in the state of Missouri? — Yes' is 'Yes'.

Enter any other names you have used (for example maiden name, nicknames, aliases, or prior legal names), separated by commas if listing more than one.

Enter the job title or position you are applying for (e.g., Patrol Officer, Records Clerk) as a short text string.

Enter the house or building number and any apartment/unit identifier for your current residence (e.g., 123 or 123 Apt 4).

Enter the street name including any directional and street type (e.g., N Main St, Elm Avenue).

Enter the city or municipality of your present residence.

Enter the state where you currently reside (either the full state name or its standard abbreviation).

Enter the postal ZIP code for your present address.

Check this box if you are currently a member of any Reserve or National Guard organization.

Check this box if you are not currently a member of any Reserve or National Guard organization.

Please provide the start and end dates for your second previous residence.

Please enter the full street address for your second previous residence.

Please enter the city for your second previous residence.

Please enter the county for your second previous residence.

Please enter the state for your second previous residence.

Please enter the zip code for your second previous residence.

Provide the date of the second arrest.

Enter the charge associated with the second arrest.

Specify the location where the second arrest occurred.

Describe the disposition or outcome of the second arrest.

Indicate the police agency involved in the second arrest.

Please enter the dates you attended this educational institution.

Please enter the name of the school you attended.

Please enter the full street address of the school.

Please enter the zip code of the school.

Please enter the number of years you completed at this institution.

Please enter the degree or diploma you received from this institution.

Enter the month and year you began this second employment.

Enter the month and year you ended this second employment or indicate if it is your current position.

Enter the full name of the employer for this second employment.

Enter the employer's full mailing address (street, city, state, and ZIP as applicable).

Enter the employer's telephone number, including area code and any extension.

Enter the full name of your supervisor or immediate manager at this employer.

Enter the job title or position you held at this second employment.

Enter the salary you were paid for this employment.

Provide a brief explanation of why you left this employment.

Enter the branch of service for your second military service record.

Enter the serial number for your second military service record.

Enter the dates of service, from start to end, for your second military service record.

Enter your highest rank achieved during your second military service record.

Enter your primary duty during your second military service record.

Enter the type of discharge received for your second military service record.

Enter the full name of the second reference.

Enter the complete address, including city, state, and zip code, of the second reference.

Enter the phone number of the second reference.

Enter the email address of the second reference.

Enter the number of years the second reference has known you.

Enter the occupation of the second reference.

Enter the start and end dates of attendance for the second school.

Enter the name of the second school attended.

Enter the street address of the second school.

Enter the zip code for the address of the second school.

Enter the number of years completed at the second school.

Enter the degree or diploma obtained from the second school.

Provide the start and end dates for this sixth address history entry.

Provide the street address for this sixth address history entry.

Provide the city for this sixth address history entry.

Provide the county for this sixth address history entry.

Provide the state for this sixth address history entry.

Provide the zip code for this sixth address history entry.

Enter your nine-digit Social Security Number as a single string (include dashes if desired), e.g., 123-45-6789.

Enter your primary home telephone number, including area code and any necessary prefixes (e.g., 10-digit number).

Enter your business or work telephone number, including area code and any necessary prefixes where applicable.

Enter the start and end dates for the third address in your history.

Enter the street address for the third address in your history.

Enter the city for the third address in your history.

Enter the county for the third address in your history.

Enter the state for the third address in your history.

Enter the zip code for the third address in your history.

Enter the date of the third arrest.

Enter the charge for the third arrest.

Enter the location where the third arrest occurred.

Enter the disposition of the third arrest.

Enter the police agency involved in the third arrest.

Please provide the dates you attended this educational institution.

Please provide the name of this educational institution.

Please provide the full address of this educational institution.

Please provide the zip code for this educational institution's address.

Please provide the number of years you completed at this educational institution.

Please provide any degree or diploma obtained from this educational institution.

Enter the start date of this employment.

Enter the end date of this employment.

Enter the full name of the employer (company or organization) for this job.

Enter the employer's full mailing address for this job.

Enter the employer's telephone number for this job.

Enter the name of your supervisor or manager at this job.

Enter the job title or position you held at this employer.

Enter the salary amount associated with this position.

Provide the reason you left this job.

Enter the branch of the military in which you served for this third military service record.

Enter your serial number for this third military service record.

Enter the start and end dates you served for this third military service record.

Enter your highest rank achieved during this third military service record.

Enter your primary duty or job role during this third military service record.

Enter the type of discharge you received for this third military service record.

Enter the full name of the third reference.

Provide the complete street address, city, state, and zip code for the third reference.

Enter the phone number of the third reference.

Provide the email address for the third reference.

Enter the number of years you have known the third reference.

Enter the occupation of the third reference.