The City of Peñitas, TexasPolice/Fire Department Application

Police/Fire Department Application

This is an application for employment with the Penitas Police Department. You may fill out the online application form below, or you may download, complete and submit the application form in person.

Police Department Job Application.pdf

Firefighter Application.pdf

Volunteer Firefighter Application.pdf

Additional documents may be required for completion of this personal history statement, including the following:

Birth Certificate
Naturalization Papers (If Applicable)
NOTE: Federal law prohibits duplication of these documents; however, the Penitas Police Department Personnel Officer does not need to see them.
Driver's License
High School Diploma or GED Certificate
High School Transcript
College Diploma
College Transcripts
Military Discharge (If Applicable)
Selective Service Number (If Applicable)
Certificates of Specialized Training (i.e., Military, Police-Related, etc.)
Copy of Credit History

NOTE: A legible copy of the above documents can be uploaded below or submitted in-person.

This personal history statement must be completed in its entirety, along with any required supporting documentation, to be considered for employment.

*Position Applying For

Peace Officer

Reserve Officer

Firefighter

Volunteer Firefighter

Personal History Statement

*First Name

Middle

*Last Name

*Address 1

Address 2

*City

*State

*Zip

*Telephone Number (Home)

Telephone Number (Business)

Telephone Number (Cell)

*Email Address

Date of Birth

Nickname(s) or other name(s) by which you are/have been known:

Place of Birth City and State

Are you legally authorized to work in the United States?

Yes

No

Driver License Number

State Issued

Social Security Number

Other Identification Number

Issued By

Height

Weight

Hair Color

Eye Color

Scars, Tattoos, or other Distinguishing Marks Enter N/A if not applicable

Residences List all addresses where you have lived during the past ten (10) years. Begin with the present address, and list by month and year.

From/To/Address

*Work History Begin with your present or most recent job, list the three (3) most recent jobs you have held.

*Employer 1

*Dates Employed (from Month/Year to Month/Year)

*Address, City, State, Zip Code

*Job Title

*Duties

*Supervisor

*Phone Number

*Reason for Leaving

Employer 2

Dates Employed (from Month/Year to Month/Year)

Address, City, State, Zip Code

Job Title

Duties

Supervisor

Phone Number

Reason for Leaving

Employer 3

Dates Employed (from Month/Year to Month/Year)

Address, City, State, Zip Code

Job Title

Duties

Supervisor

Phone Number

Reason for Leaving

Upload Your Resume

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Upload a current resume detailing all employment since the age of 16, including part-time, temporary or seasonal employment. Include all periods of unemployment as well.

Military Record (If Applicable)

Have you served in the U. S. Armed Forces?

Yes

No (continue to next section)

Date(s) of Service (From Month/Year - To Month/Year)

Branch of Service

Unit of Designation

Military Service Number

Highest Rank Held

Type of Discharge

List specific military schools or courses completed with honors or awards:

Were you ever disciplined while in the military service (including court martial, captain's masts, and company punishment?

Yes

No

If you answered yes, please describe the charge, agency, and date(s):

If you received a discharge other than honorable, please give complete details below:

Educational History

*High School Attended

*City and State

*Dates Attended (From Month/Year to Month/Year)

*Graduated?

Yes

No

College/University Attended

City and State

Dates Attended (From Month/Year to Month/Year)

Units/hours completed

Major/Minor

Degree Received, if any

Other College University Attended (if applicable)

City and State

Dates Attended (From Month/Year to Month/Year)

Units/hours completed

Major/Minor

Degree Received, if any

Other Schools Attended List other schools attended (trade, vocational, business, etc.) Give name and address of school, dates attended, course of study, certificate, and any other pertinent information)

Special Qualifications and Skills

List any special licenses or certifications you hold (i.e., pilot, radio operator, scuba, public dispatcher). Specify licensing authority, original date issued, and date of expiration.

Upload Copies of Certificates (if applicable)

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List any specialized machinery or equipment which you can operate.

*If you are fluent in a foreign language, please list below. Indicate your degree of fluency of the language (reading, speaking, understanding and writing):

*List any other special skills or qualifications you possess:

Arrests, Detentions and Litigations

*Have you ever been convicted of a violation of the law other than a minor traffic violation?

Yes

No

*Have you ever been involved as a party in a civil litigation?

Yes

No

If yes, give details:

Traffic Record

*Has your driver's license ever been suspended or revoked?

Yes

No

If yes, give date(s), location(s) and reason(s)

*With what company do you carry auto insurance?

List to the best of your knowledge all traffic citations you have received, excluding parking tickets: Include Month/Year, Charge, City & State, Disposition

Describe in a brief narrative any traffic accidents in which you have been involved. Give date(s), location, and details:

References List five (5) persons who you know well enough to provide sufficient information about you. Do not list any relatives or former employers.

Reference 1 - Name

Address

Phone Number

Years Known

Reference 2 - Name

Address

Phone Number

Years Known

Reference 3 - Name

Address

Phone Number

*Years Known

Reference 4 - Name

Address

Phone Number

Years Known

Reference 5 - Name

Address

Phone Number

*Years Known

Membership in Organization(s) List any past or present organizations that you have been involved in, the type (social, professional, etc.), and the dates of participation:

Personal Declarations

Do you have any reason and/or obligations which would prevent you from fully performing assigned duties, including working on weekends, holidays, evenings, or night shifts?

Yes

No

If yes, please explain:

Have you ever been employed by the City of Penitas?

Yes

No

If yes, list department(s), position(s) held, and date(s) of employment:

Are you related by blood or marriage to any member of the Penitas City Council or any employee of the City of Penitas?

Yes

No

If yes, please list the name(s), department(s), position(s), and relation:

Certification and Signature

I hereby certify that there are no willful misrepresentations, omission or falsifications in the foregoing statements and answers to questions. I am fully aware that any such willful misrepresentations, omissions, or falsifications may be grounds for immediate rejection or termination of employment.

*Signature - By typing my name below, I hereby affix my signature to this application.

*Date

Upload any supporting documentation as listed in the description:

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