WESTBROOK POLICE DEPARTMENT by HC120915105024

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									                WESTBROOK COMMUNICATIONS DEPARTMENT

                         APPLICATION FOR EMPLOYMENT




                               PLEASE TYPE OR PRINT LEGIBLY


DATE:__________________________

NAME:________________________________________________________________
                        Last                    First                    Middle

ADDRESS:______________________________________________________________
________________________________________________________________________

POSITION APPLIED FOR:________________SOCIAL SECURITY #:_____________

HOME TEL:__________________________BUSINESS TEL:_____________________

BRANCH OF MILITARY SERVICE_________________SERIAL#________________

DO YOU HAVE ANY RELATIVES THAT WORK FOR THE CITY OF
WESTBROOK?__________
IF YES, STATE NAME & RELATIONSHIP__________________________________

ARE YOU WILLING TO SUBMIT A POLYGRAPH EXAMINATION IN ORDER TO
ESTABLISH THE INTEGRITY OF THIS QUESTIONNAIRE?___________________

IF “NO”, STATE REASON(S)______________________________________________
_______________________________________________________________________

WHAT IS YOUR FULL NAME:_____________________________________________
                                        Last                     First            Middle

WHERE DO YOU PRESENTLY RESIDE?____________________________________
                                                        Number                    Street

________________________________________________________________________________________________
        City/Town                       State                           Zip Code
GIVE ANY OTHER NAMES YOU HAVE USED OR HAVE BEEN KNOWN BY
(INCLUDING NICKNAMES)_______________________________________________




                                               1
IN CHRONOLOGICAL ORDER, state each and every place you have resided since
age 16:

From                  To                                                          Zip
Mo. Yr.               Mo. Yr.        Address        City/Town       State         Code




                             ARREST, SUMMONS, ETC.
Have you ever been charged, cited, arrested or convicted for any violation of any laws,
including moving traffic violations? YES or NO______________________________

If Yes, list each instance below:
Date            Violation         Location     Court Disposition Police Agency
                Actual Charge     City & State or Sentence       concerned
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________




                                            2
                               MILITARY SERVICE
                               (Answer all questions)



Have you ever served in a Military Organization of the United States?_______________
Give period or periods of military service. (Active or Reserves)

       From__________________________ To____________________________

       From__________________________ To____________________________

       From__________________________ To____________________________

Give branch of service________________________________

Were you ever court-martialed, tried on charges, the subject of Summary Court or
received an Article 15?___________________________________________________

If “YES”, give details of charges and disposition________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Are you currently an Active or Inactive member of the Reserve Forces (any branch), or
National Guard of the United States or any foreign government?____________________

State which, active or inactive___________________________

Branch__________________Unit_____________________Rank__________________

Address_________________From_____________________To____________________




                                          3
                                   EDUCATION
                                (Answer all questions)


List all of the schools and colleges you have attended. Begin with High School

                                            # of Years
School        Exact Address                 Attended                Degree Granted


_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________




                                           4
                             EMPLOYMENT HISTORY
                               (Answer all questions)


List below, CHRONOLOGICALLY, earliest dates first, each and every place in which
you were employed. OMIT NONE! Give CORRECT, FULL ADDRESSES. Give dates
of idleness between each period of employment, in proper order. (Include all part-time
employment

From          To             Name & Present      Position &
Mo. & Yr.     Mo. & Yr.      Address of Employer Supervisor        Reason for Leaving

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Do you have any objection to us contacting your present employer?_________________

Do you possess:
      A. Operator’s License?___________Number____________Issue Date:________
          Class:_______________State:________________

Did you ever possess an Operator’s license issued by any state other than
Maine?____________________
If “YES”, give City and State__________________________
When?__________________


ARE YOU ABLE TO WORK ALL SHIFTS?_________________________________




                                            5
                     PROFESSIONAL REFERENCES


LIST FIVE (5) PROFESSIONAL REFERENCES, DO NOT USE RELATIVES AS
REFERENCES.
Name             Address & Zip Code       Tel. Number

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________




                                   6
                     WESTBROOK POLICE DEPARTMENT



GENERAL AUTHORIZATION FOR RELEASE AND WAIVER:


I hereby authorize any and all schools, physicians, hospitals, Armed Services,
current and all previous employers, law enforcement agencies, any other person,
organization or agency to furnish the Westbrook Police Department, or its
designated agent(s), any and all information, or documents which may be requested,
including a consumer credit report; to allow the visual inspection and copy of all
reports, photographs, or other documents.

I hereby waive any objection to the release of said information and grant to the
Westbrook Public Safety Commission or its designated agent(s) any right I may
have to said information. Further I hereby release all of the above, the City of
Westbrook, and its designated agent(s) from any and all liability for any damage
whatsoever arising therefrom.

I also authorize investigation of all statements made in my application for
employment. I understand that in the event of my employment with the City of
Westbrook, I shall be subject to dismissal if any of the information I have given in
this application is false, or if I have failed to give any material information herein
requested.


_____________________________             ___________________________________
WITNESS                 DATE              APPLICANT’S SIGNATURE DATE




                                          7
     CITY OF WESTBROOK – Voluntary EEO Information

The City of Westbrook is an Equal Opportunity/Affirmative Action employer and
voluntarily complies with the laws and regulations related to employment. Some of these
laws and regulations require the organization to fire annual statistical reports about
applicants.

You are not required to provide the information below as a condition of your
employment. The information contained in this form will be used for government
reporting and voluntary affirmative action programs.

Any information you provide will be kept confidential, except that it may be provided to
government officials in the course of compliance audits or investigations.

POSITION APPLIED FOR:_______________________________DATE:__________

NAME________________________________________________________________
                  Last                   First                Middle

SEX: Male _____              Female _______

RACE:             White/Caucasian                             _____
                  Black/African American                      _____
                  Hispanic                                    _____
                  Asian American/Pacific Islander             _____
                  Native American/American Indian             _____
                  I do not wish to provide this information   _____

REFERRAL SOURCE:
 Portland Press Herald
 American Journal
 Maine Employment Security Comm. (Job Bank)
 Employee Referral
 Other – Please Specify_____________________




Revised September 15, 2012




                                                 8
 WHY DO YOU WANT TO BE A PUBLIC SAFETY DISPATCHER IN
   THE WESTBROOK COMMUNICATIONS DEPARTMENT?
             (PLEASE BLOCK PRINT ONLY)




PRINT NAME_____________________________

SIGNATURE______________________________




             FAIR CREDIT REPORTING ACT CONSUMER
                                9
           DISCLOSURE AND GENERAL AUTHORIZATION

In connection with my application for employment with the City of Westbrook, Maine
(“City”), I understand that a consumer report or investigative consumer report, as those
terms are defined in the federal Fair Credit Reporting Act as amended (“FCRA”), 15
U.S.C. 1681 et seq., may be obtained by the City from a consumer reporting agency
(“Agency”). I further understand that the Agency may not give out information about me
to the City without my written consent. It is also understood that the Agency may not
report medical information about me to the City without my specific prior consent as to
the release of such information, which is in addition to my general authorization herein.

I understand that an investigative consumer report is a special type of consumer report in
which information about my character, general reputation, personal characteristics, and
mode of living is obtained through personal interviews. In the event an investigative
consumer report is obtained, I understand that I (a) am entitled to receive a summary of
my rights, and (b) have the right to request additional disclosures provided for below as
follows:

Upon my written request to the City within a reasonable period of time after my receipt
of this Fair Credit Reporting Act Consumer Disclosure and General Authorization, the
City shall make a complete and accurate disclosure of the nature and scope of the
investigation requested. It is understood that this disclosure shall be made in writing
mailed, or otherwise delivered, to me not later than five (5) days after the date on which
the request for such disclosure was received from me or such report was first requested,
whichever is later in time.

I hereby authorize the City now, or at any time while I am employed by the City, to
obtain a consumer report or investigative consumer report on me, as applicable.
This authorization does not include the release of my medical information. I further
acknowledge that I have received a summary of my rights under the FCRA.


__________________________________                          _______________________
      Applicant Signature                                             Date




___________________________________
      Printed Name




                                           10
                      A SUMMARY OF YOUR RIGHTS
                  UNDER THE FAIR CREDIT REPORTING ACT

The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness,
and privacy of information in the files of every “consumer reporting agency” (CRA).
Most CRAs are credit bureaus that gather and sell information about you – such as if you
pay your bills on time or have filed bankruptcy – to creditors, employers, landlords, and
other businesses. You can find the complete text of the FCRA, 15 U.S.C. 1681 et seq., at
the Federal Trade Commission’s Internet web site (http://www.ftc.gov). The FCRA
gives you specific rights, as outlined below. You may have additional rights under state
law. You may contact a state or local consumer protection agency or state attorney
general to learn those rights.

 You must be told if information in your file has been used against you. Anyone
  who uses information from a CRA to take action against you – such as denying an
  application for credit, insurance, or employment – must tell you, and give you the
  name, address and phone number of the CRA that provided the consumer report.

 You can find out what is in your file. At your request, a CRA must give you the
  information in your file, and a list of everyone who has requested it recently. There is
  no charge for the report if a person had taken action against you because of the
  information supplied by the CRA, if you request the report within sixty days of
  receiving notice of the action. Where applicable, you also are entitled to one free
  report every twelve months upon request if you certify that (1) you are unemployed
  and plan to seek employment within sixty days, (2) you are on welfare, or (3) your
  report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight
  dollars.

 You can dispute inaccurate information with the CRA. If you tell a CRA that
  your file contains inaccurate information, the CRA must investigate the items (usually
  within 30 days) by presenting to its information source all relevant evidence you
  submit. Unless you evidence is frivolous. The source must review your evidence and
  report its findings to the CRA. (The source must also advice national CRAs – to
  which it has provided data – of any error.) The CRA must give you a written report
  of the investigation and a copy of your report if the investigation results in any
  change. If the CRA’s investigation does not resolve the dispute, you may add a brief
  statement to your file. The CRA must normally include a summary of your statement
  in future reports. If an item is deleted or a dispute statement is filed, you may ask that
  anyone who has recently received your report be notified of the change.

 Inaccurate information must be corrected or deleted. A CRA must remove or
  correct inaccurate or unverified information from its files, usually within thirty days
  after you dispute it. However, the CRA is not required to remove accurate data
  from your file unless it is outdated (as described below) or cannot be verified. If
  your dispute results in any change in your report, the CRA cannot reinsert into your
  file a disputed item unless the information source verifies its accuracy and
  completeness. In addition, the CRA must give you a written notice telling you it has

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   reinserted the item. The notice must include the name, address and phone number of
   the information source.

 You can dispute inaccurate items with the source of the information. If you tell
  anyone – such as a creditor who reports to the CRA – that you dispute an item. They
  may not then report the information to the CRA without including a notice of your
  dispute. In addition, once you’re notified the source of the error in writing, it may not
  continue to report the information if it is, in fact, an error.

 Outdated information must not be reported. In most cases, a CRA may not report
  negative information that is more than seven years old; ten years for bankruptcies.

 Access to your file is limited. A CRA may provide information about you only to
  people with a need recognized by the FCRA – usually to consider an application with
  a creditor, insurer, employer, landlord, or other business.

 Your consent is required for reports that are provided to employers, or reports
  that contain medical information. A CRA may not give out information about you
  to your employer, or prospective employer, without your written consent. A CRA
  may not report medical information about you to creditors, insurers, or employers
  without your permission.

 You may choose to exclude your name from CRA lists for unsolicited credit and
  insurance offers. Creditors and insurers may use file information as the basis for
  sending you unsolicited offers of credit or insurance. Such offers must include a toll-
  free number for you to call if you want your name and address removed from future
  lists. If you call, you must be kept off the lists for two years. If you request,
  complete, and return the CRA form provided for this purpose, you must be taken off
  the lists indefinitely.

 You may seek damages from violators. If a CRA, a user of (in some cases) a
  provider of CRA data, violates the FCRA, you may sue them in state or federal court.




                                            12
           REQUEST, AUTHORIZATION, CONSENT AND RELEASE FOR BACKGROUND INFORMATION

                                              PLEASE TYPE OR PRINT

I:____________________________________________________________________________________
   LAST NAME            FIRST NAME             MIDDLE NAM (PLEASE INCLUDE Jr., Sr., II, III Etc.)
Understand that in conjunction with my application for employment, CITY OF WESTBROOK, ME will use the
services of an outside agency to research and verify the information I have provided on my application for employment
including my personal background, character, professional standing, work history and qualifications. This agency will
provide a report to CITY OF WESTBROOK, ME. CITY OF WESTBROOK, ME uses Backgrounds Online, a
consumer-reporting agency, as an agent to perform background verifications.

Backgrounds Online will utilize various sources of information it deems appropriate including but not limited to: credit
reporting agencies, Workers Compensation records, Department of Motor Vehicle records, criminal conviction records,
current and former employers, military records, education records, professional and personal references. I request,
authorize and consent to the release and disclosure of any and all information including but not limited to the above to
CITY OF WESTBROOK, ME. and Backgrounds Online.

I request, authorize and consent to the procurement of an Investigative Consumer Report and understand that it may
contain information about my background, mode of living, character, personal characteristics and general reputation.
This authorization in original or copy form shall be valid for one year from the date indicated next to my signature.
According to the Fair Credit Reporting Act, I will be notified by CITY OF WESTBROOK, ME if employment is
denied because of information obtained from a Consumer Reporting Agency. Additionally, I understand that if
requested within 60 days, I will be given a full and accurate disclosure as to the nature and substance of all information
provided to CITY OF WESTBROOK, ME. I further understand that when requesting a copy of the report, proper
identification will be required and I should direct my request to: Backgrounds Online, 1401 El Camino Ave. 5th Floor,
Sacramento, CA 95815, phone: 800-838-4804.

LAW ENFORCEMENT AGENCIES AND OTHER ENTITIES FOR POSITIVE IDENTIFICATION
PURPOSES REQUIRE THE FOLLOWING INFORMATION WHEN CHECKING PUBLIC RECORDS. IT IS
CONFIDENTIAL AND WILL NOT BE USED FOR ANY OTHER PURPOSES. I HEREBY RELEASE CITY
OF WESTBROOK, ME AND ITS AGENTS, BACKGROUNDS ONLINE AND ALL PERSONS, AGENCIES,
AND ENTITIES PROVIDING INFORMATION OR REPORTS ABOUT ME FROM ANY AND ALL
LIABILITY ARISING OUT OF THE REQUEST FOR OR RELEASE OF ANY OF THE ABOVE
MENTIONED INFORMATION OR REPORTS.


Signed                                                                   Today’s Date


Printed Name                                                             Position Applied For

______---_____---_______ ____/_____/____
Social Security Number    Date of Birth                                  Driver’s License Number            State

Other names you have used or are also known as:

              PLEASE PROVIDE ALL RESIDENTIAL ADDRESSES FOR THE PAST 7 YEARS

Current Address:
              Street               Apt.#           City         State         Zip Code    How long here?

Former Address:
              Street               Apt.#           City          State         Zip Code   How long here?

Former Address:
              Street               Apt.#           City          State         Zip Code   How long here?

Former Address:
              Street               Apt.#           City          State         Zip Code   How long here?

May we contact your current employer?                  Yes               No



                                                           13
                              PUBLIC SAFETY DISPATCHER

DEPARTMENT:              Westbrook Public Safety
REPORTS TO:              Director of Communications
DATE:                    02/05

A Public Safety Dispatcher is often the first point of contact between a citizen and members of
our public safety departments. As such, dispatchers are required to present a positive, professional
image to those who call or come in to seek assistance or provide information. Dispatchers must
operate with the highest integrity and ethical behavior, as they are often privy to sensitive and
confidential information. They must be able to quickly assess any situation and ensure the proper
response of emergency personnel while creating an accurate record of each call and/or incident.

Minimum Requirements:

   Excellent interpersonal and communication skills.
   Ability to speak clearly and distinctly at all times, have good hearing, listening, writing, typing
    and computer skills.
   Ability to reduce rambling disconnected material and information into concise and accurate
    messages.
   Ability to handle multiple tasks while keeping track of personnel and situations with staff safety
    a prime focus.
   Ability to analyze a situation, prioritize it, assign appropriate personnel and equipment, make
    proper notifications and implement or suggest effective resolution(s) in emergency and non-
    emergency matters.
   Have a thorough understanding of communications systems, including radio, teletype, computer,
    telephone/E-911, TDD, Alarm notification systems for both Police and Fire, call check and
    logger recorders, and CCTV and Video multiplex           recorders.
   Work effectively with all members of the Public Safety Department.


Education and Other Special Requirements:

   Must possess or be able to become certified in all topics requiring a certificate within one year of
    employment and thereafter to maintain all certifications. Examples of certification include but
    are not limited to Terminal Operator Certification, Emergency Medical Dispatch Certification
    and Notary Public.
   Must have graduated from high school or possess GED equivalence.
   Must be at least 18 years of age.
   No criminal record or criminal history. Must be able to provide character references.
   Must wear all assigned Public Safety Dispatcher uniform as issued by the Westbrook Police
    Department while acting in the capacity of Public Safety Dispatcher.

Examples Of Work (Illustrative Only):

   Receive complaints and emergency requests by phone, radio, or in person, from the public, staff,
    and other public safety agencies.


                                                  14
   Assign field units to emergencies and routine calls for service, manage radio traffic and maintain
    status of all field units.
   Document activities and maintain records in a variety of formats including computer, video,
    audio, and paper as required.
   Perform data entry and retrieval on the department's and the State of Maine Metro computer
    systems.
   Provide information and perform services as requested by administration, field units, outside
    agencies and the public.
   Maintain the integrity and confidentiality of records.
   Issue permits and notarize department paperwork as required.
   Monitor automated alarm systems and maintain the communications center in a neat and well
    organized manner.
   Perform all other tasks as directed or required.

Physical and Mental Requirements

The physical demands described here are representative of those that must be met by an employee
to successfully perform the essential functions of this class. Reasonable accommodations may be
made to enable individuals with disabilities to perform the essential functions.

Physical Demands: Ability to sit in an upright position for prolonged periods of time; speak
clearly; use manual dexterity and motor skills to perform the essential duties of the position.
20/20 vision with corrective lenses allowed, ability to distinguish colors and good hearing as
related to the position.

Mental Demands: While performing the duties of this class, the incumbent is regularly required
to use listening and oral communication skills; observe and interpret situations; read and interpret
data, information and documents; work with constant interruptions; and interact with staff,
officials and the public.




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