Suffolk County Auxiliary Police - DOC by pte15377

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									                           Suffolk County Auxiliary Police
                                   Application Form
                                  This Section for Official Use Only
Date of Application: _______________                                       App. # ________________

                                      PRINT ALL INFORMATION

Name: ______________________________________________________________________________
                              (Last Name, First Name, M.I.)

D.O.B.: _____________                       Social Security No.: ________________________________

Age: ______ Height: ______ Weight: ______ Eye Color: ______ Hair Color: ______ Sex: ______

Home Address: _________________ City: _____________________ State: _____ Zip Code: _________

Mailing Address (if different from above):
____________________________________________________________________________________

Home Phone: _________________ Work Phone: ________________ Cell Phone: _________________

E-Mail Address: _____________________________

Marital Status: __________________

Emergency Contact Information:

Name: _________________________ Relationship: _______________ Phone: ___________________

Are you a Suffolk County resident? (Yes / No) ______ Are you a U.S. Citizen? (Yes / No) ______

Education: Do you have a High School Diploma / or GED equivalent? (Yes / No) ______

Are you registered with the Selective Service System? (Yes / No) ______

Do you have a valid driver’s license? (Yes / No) ______

Drivers license ID#: _________________________ State: ______

Occupation: ______________________________

Did you have any prior New York State Auxiliary Police Service? (Yes / No) _______ If Yes, enter
jurisdiction and length of creditable service time:
____________________________________________________________________________________

Special training: (List any military, college, trade school, etc.)___________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________
Hobbies: (Photography, electronics, etc.) ___________________________________________________

____________________________________________________________________________________

Explain any other training, skills or experience you feel could be useful to either the Suffolk County
Auxiliary Police or the Suffolk County Police Department.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________



Would you and your spouse (if applicable) object to an interview regarding this position? (Yes / No) _____

Would you object to a Medical/Psychological Exam? (Yes / No) ______

Would you object to an Agility Test? (Yes / No) ______

Would you object to a Polygraph Test? (Yes / No) ______

Have you ever been arrested? (Yes / No) ______ (If Yes – explain below)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

How did you become interested in the Suffolk County Auxiliary Police? ___________________________

___________________________________________________________________________________

____________________________________________________________________________________

Do you have a friend or relative you would like to refer to the Suffolk County Auxiliary Police
program? Yes ______ No ______

Name: _________________________________________ Phone: ______________________________




Please sign and date this application:

Signature: ____________________________________________________________

Date: _______________________
                Attach Photocopy of Drivers License




RETURN COMPLETED FORM TO THE SUFFOLK COUNTY AUXILIARY POLICE
                     FOR PROCESSING
              Department of Fire Rescue and Emergency Services
                          Suffolk County New York
                                  PO Box 127
                          Yaphank, NY 11980-0127
                       ATTN: Auxiliary Police Section


                              631-852-4921

								
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