APPLICATION FOR EMPLOYMENT
CITY OF MISSOURI CITY
1522 Texas Parkway, Missouri City, TX 77489
Phone: 281-403-8500
Fax: 281-261-4233
E-mail: apply@ci.mocity.tx.us
INSTRUCTIONS:
Type or print your answers to all questions
listed on the application. The City of
Missouri City requires that all individuals
interested in employment complete an
official application, and will accept a
professional resume as a supplement to the
application form. Applicant must attach
copies of all supporting documentation to
the official application.
SECTION I: PERSONAL INFORMATION
Position for which you are applying (one per application):
Police Officer/Police Cadet
Date:
Please complete (check one preferred method of contact):
Cell Phone _____________________________________ Home Phone ______________________________________________
Work Phone _____________________________________ E-mail Address ______________________________________________
Name (First) (Middle) (Last)
Street Address Apt./Suite
City State Zip Code
Are you legally authorized to work in the United States? Yes No
Can you provide evidence of your eligibility to work? Yes No
Have you ever worked for City of Missouri City?
Yes No
When ___/____/_____ to When ___/____/_____
Dept/Division__________________________________
Do you have relatives employed by City of Missouri City? Yes No Department ______________________________
Their Name(s) _________________________________________ Relationship(s) ________________________________________________
Do you have a valid Texas Driver's License? Yes No
The City of Missouri City may verify all information, including moving violations.
Do you have a High School Diploma or GED Certificate? Yes No
High School/
GED
Prior to an interview, the City may require official copies of college or university transcripts or High School/GED certificate
or Diploma, or professional certificates.
Name
Location
Dates (To and From) Credit Hours Earned
College or
University
Major
Minor
Type Degree
Date Graduated
Name
Location
Dates (To and From) Credit Hours Earned
College or
University
Major
Minor
Type Degree
Date Graduated
Name
Location
Dates (To and From) Credit Hours Earned
College or
University
Major
Minor
Type Degree
Date Graduated
List all applicable certificates or licenses.
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
THE CITY OF MISSOURI CITY IS AN EQUAL OPPORTUNITY EMPLOYER
HR013
Created: 8/12/06
Revised: 3/9/2007
THE CITY OF MISSOURI CITY IS AN EQUAL OPPORTUNITY EMPLOYER
HR013
Created: 8/12/06
Revised: 3/9/2007
SECTION II: EMPLOYMENT RECORD
Beginning with current or most recent dates, provide a comprehensive description of your professional experience. If you require additional
space attach an additional sheet to this document.
Current or Most Recent Employer____________________________________________________________________________________________
Starting Date _________________________ Ending Date _________________________ Total time employed: ____________________________
Address ____________________________________________________ City/State _____________________________ Phone _______________
Title _______________________________________________________Starting Salary ________________Ending Salary____________________
Duties ___________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Reason for Leaving ________________________________________________________________________________________________________
Previous Employer ________________________________________________________________________________________________________
Starting Date _________________________ Ending Date _________________________ Total time employed: ____________________________
Address ____________________________________________________ City/State _____________________________ Phone _______________
Title _______________________________________________________Starting Salary ________________Ending Salary____________________
Duties ___________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Reason for Leaving ________________________________________________________________________________________________________
Previous Employer ________________________________________________________________________________________________________
Starting Date _________________________ Ending Date _________________________ Total time employed: ____________________________
Address ____________________________________________________ City/State _____________________________ Phone _______________
Title _______________________________________________________Starting Salary _________________Ending Salary___________________
Duties ___________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Reason for Leaving ________________________________________________________________________________________________________
Previous Employer ________________________________________________________________________________________________________
Starting Date _________________________ Ending Date _________________________ Total time employed: ____________________________
Address ____________________________________________________ City/State _____________________________ Phone _______________
Title _______________________________________________________Starting Salary _________________Ending Salary___________________
Duties ___________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Reason for Leaving ________________________________________________________________________________________________________
Have you ever been convicted, plead guilty or no contest, or placed on deferred adjudication or probation for any
offense other than traffic violations? Yes No
Provide details (charges, penalties, where, when, and disposition)
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
By signing below, I certify, authorize, or acknowledge:
That all of the information provided by me on this application for employment and any attachments or supporting documents I submit are
accurate. Recognizing that the City may rely upon information I provide to make an employment decision, I hereby certify that all information
herein presented is accurate and free from intentional omission, falsification, or misleading information.
I authorize the City of Missouri City to conduct background, personal, criminal, employment history, or any type of investigation it may
require to determine of my fitness for the position for which I have applied. Additionally, I understand that the City may require a physical,
mental, or drug pre-employment screening after the City has made me a conditional offer for employment.
Usual Signature of Applicant
Printed Name of Applicant
Date
C:\DOCUME~1\Wanda\LOCALS~1\Temp\notes6030C8\~5766835.doc
Date Issued: March 27, 2006
Revised: 7/13/2007
Ana Diaz
City of Missouri City
Police Officer Application - Addendum
Name _________________________ DOB _____________ Date _____________
(Last, first, middle) dd/mm/year dd/mm/year
The Missouri City Police Department requires that all applicants answer the following questions. Your responses will provide the PD
with essential answers to critical questions relative to the established standards and expectations of each individual who works for our
PD. Please print or type your responses in black or blue ink. Answer all questions accurately. You must respond to ALL questions.
If the options presented as responses do not apply to your particular situation, simply write N/A.
Circle one ONLY
1.
Do you have a high school diploma or GED?
1a. If no, do you have a GED and at least 12 college hours?
Yes No
Yes No N/A
2.
Have you ever been convicted of any felony offense?
A conviction includes probation, community supervision, or deferred
adjudication for purposes of this application.
Yes No
3.
Have you ever been convicted of a misdemeanor offense, other than a
traffic charge?
A conviction includes probation, community supervision, or deferred
adjudication for purposes of this application.
Yes No
4.
Have you ever used any illegal drugs?
4a. If yes, what was your age the last time you used any illegal drug(s)?
Yes No
____________
5.
Have you ever been convicted of a family violence offense?
Yes No
6.
Have you ever used marijuana?
6a. If yes, in what year did you last use marijuana?
6b. If yes to #6, how many times have you used marijuana?
Yes No
____________
____________
7.
Are you a citizen of the United States?
Yes No
8.
Have you ever used any "hallucinogenic" drug such as ecstasy, LSD,
PCP, or other type of hallucinogen?
8a. If yes, in what year did you last use one of the hallucinogens?
8b. If yes to #8, how many times did you use a hallucinogen?
Yes No
____________
____________
9.
Have you ever been in the military?
9a. Have you ever been discharged from the military?
9b. If yes to 9a, did you receive an honorable discharge?
Yes No
Yes No
Yes No N/A
C:\DOCUME~1\Wanda\LOCALS~1\Temp\notes6030C8\~5766835.doc
Date Issued: March 27, 2006
Revised: 7/13/2007
Ana Diaz
10. Have you ever illegally used any "hard" drug such as cocaine, heroin,
speed, illegal steroids, downers etc.?
10a. If yes, in what year did you last use one of the hard drugs?
10b. If yes to #10, how many times have you used one of the hard drugs?
Yes No
____________
____________
11. Have you received a ticket(s) for a "moving" traffic violation in the past
36 months, e.g. speeding, ran red light, ran stop sign etc.?
11a. If yes, how many have you received in the past 36 months?
Yes No
____________
12. Have you ever delivered, sold, or possessed a controlled substance, with
intent to deliver?
Yes No
13. Do you have a brother, sister, parent, step-parent, grandparent, aunt,
uncle, niece, nephew, grandson, granddaughter, mother-in-law, father-
in-law, or significant other currently working at the Missouri City police
department?
Yes No
Authority to Release Information: By signing below, I affirm, agree, and understand that all statements on this form are true and
accurate. I further understand that any misrepresentation, falsification, or material omission of information or data on this application
for employment may result in exclusion from further consideration or, if hired, may result in termination of employment.
Furthermore, I authorize the City of Missouri City, TX to verify all information I have submitted on this application for employment.
I also give consent to the release of information to authorized officers, agents, and/or employees of the City of Missouri City, which
may include but not be limited to information concerning my past and present work; including my official personnel files; attendance
records; evaluations; educational records including transcripts; military service; law enforcement records; and/or any personnel record
deemed necessary. In addition, I authorize appropriate officers, agents, and/or employees of the City of Missouri City, Texas, to
make inquiries of third parties such as credit bureaus, educational entities, present and past employers, and police officer
organizations. I also absolve the City of Missouri City and all third parties from any and all claims of any nature that I may have now
or in the future as a result of any inquiry or response given to such inquiries made in connection with my application for employment.
Signature________________________________________________
Date_______
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