HomeMy WebLinkAboutMembershipApp2014Oshkosh
Auxiliary Police
Application For Membership
Have you ever been convicted of any violation of law or ordinance? No Yes If yes, give info:
Occupation: Place of employment: Shift:
Have you any physical limitations or health problems which may effect work performance with us?
No Yes If yes, give info:
Name:
Home Address:
School Address:
Home Phone: Cell Phone:
E-Mail Address:
Has your drivers license ever been suspended? No Yes If yes, when and for what reason:
I hereby declare that the foregoing statements are true and correct to the best of my knowledge and belief,
and understand that falsification may result in disqualification or removal from the position. I understand that,
if accepted, my position can be terminated with or without notice at any time, for any reason.
Signature: Date:
Oshkosh Auxiliary Police 420 Jackson Street Oshkosh, WI 54901
Date received:
Inteview date:
Start date:
First Middle Name (Full)Last
Street Apartment City State Zip Code
Street Apartment or Dorm City State Zip Code(If Applicable)
Name Street Address City State Phone
Name Street Address City State Phone
Name Street Address City State Phone
( )( )
Complete this form and return to:
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