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First Name |
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Middle Name |
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Last Name |
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E-Mail Address |
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Date of Birth |
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Address Line 1 |
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Address Line 2 |
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City |
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State |
ZIP
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| Contact Phone |
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Have you lived
at this address for 7 years? |
Yes
No |
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If no, list prior residences by County and State:
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Social Security Number
(if not entered here, you must be willing to provide prior to
being considered for employment) |
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Drivers License
Number |
State of Issue
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Which area are
you interested in? (Check all that apply) |
Investigations
Protective
Services |
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Are you willing
to travel within a 100 mile radius to complete work
assignments? |
Yes
No |
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Do you hold a
current Indiana concealed weapons permit? |
Yes
No |
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Have you been
convicted of any crime, felony or misdemeanor in the last 10
years?
(Do not count traffic violations) |
Yes
No
If yes, please describe:
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How many moving
violations have you received in the last 7 years? |
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Do you currently
have 24 hour access to a vehicle? |
Yes
No |
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If yes, make, model, year, and license plate # |
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Are you
currently a sworn Police Officer in the State of Indiana? |
Yes
No |
Have you served in the military?
If yes, explain. |
Yes
No
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How many years
of sworn law enforcement experience do you have? |
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How many years
of private security experience do you have? |
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Do you currently own any security related equipment? (handgun,
baton, duty
belt, etc.) |
Yes
No
If yes, please describe:
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Are you a
licensed Amateur Radio Operator? |
Yes
No |
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Are you a
licensed Recovery Agent? |
Yes
No |
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Are you
currently employed?
If yes, explain. If no, please describe your availability. 24 hour
availability is a plus, but not required. |
Yes
No
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Please rate your
computer expertise on a scale of 1-10 with 1 being "beginner"
and 10 being "advanced" |
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Please describe in detail any security or law enforcement training
you may
have received, and from which agency. If you are currently a sworn
police
officer, simply enter "Police Officer" If you have not received any
professional training, please enter "none" |
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Please describe in detail why you think you would be an asset to NCPI. |
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Please list
three professional references not related to you (Name, Phone) |
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