Long Application

HAMMOND POLICE DEPARTMENT
CITY OF HAMMOND, INDIANA
509 DOUGLAS STREET
HAMMOND, INDIANA 46320
(219) 852-6329

This application is to be completed and submitted online to the Hammond, Indiana Police Department.

This completed form is required for a position with the Hammond, Indiana Police Department. If this application is considered favorable, you will be notified as to when and where to appear for further processing.

Upload a Face Photo (2"x2", like a passport photo) *

JPG or PNG only.

Applicant Name *

IMPORTANT

STUDY EACH QUESTION CAREFULLY. ANSWER FULLY AND FOLLOW THE DIRECTIONS EXACTLY. ANY FALSE OR MISSING INFORMATION IS JUST CAUSE FOR DENYING YOU FURTHER PROCESSING. ALL INFORMATION IS VERIFIED; THEREFORE, ACCURACY IS ESSENTIAL. SHOULD THIS APPLICATION BE UNSATISFACTORILY COMPLETED IT MAY BE REJECTED ON THE GROUNDS OF BEING INCOMPLETE OR THE APPLICANT’S INABILITY TO FOLLOW DIRECTIONS. IF A QUESTION OR THE INFORMATION REQUESTED DOES NOT APPLY, INDICATE THIS BY THE USE OF THE SYMBOL N/A.

Complete every question fully and accurately. If the space provided for any answer is insufficient, use the Additional Questions area near the end of this application, or contact us for guidance -- please reference which section/question you are expounding on.

Hammond Police Department
Police (Pre-Employment) Application

A. Personal / Family

Name *

Address *

City *

State *

Zip Code *

Home Phone

Cell *

Work

Email *

Maiden, and/or Any Other Names You May Have Used

Sex

Height

Weight

Hair Color

Eye Color

Date of Birth *

Age (auto, please confirm)

Location of Birth

Scars, Marks, or Tattoos (location and description)

Are You a U.S. Citizen?

Yes No

If Naturalized, Certificate #

Social Security Number *

Residence History (Past 10 Years)

Address

City

State

Zip

This is my current address/residence

Moved In (From)

Moved Out (To)

Marital Status

Date of Present Marriage

City/State of Marriage

Spouse Name (incl. maiden name)

Spouse's Date of Birth

Spouse Age (auto, please confirm)

Spouse's Address

Spouse's Employer

Position Held

City

State

Zip

Phone

If Not Married, Who Do You Live With?

Do you live alone?

Yes No

Name

Sex

Age

Relationship

Ex-Spouse

Name

Date of Birth

Address

City

State

Zip Code

Phone

Date of Marriage

Date of Divorce

Children

Number of Persons Dependent on You for Support

Do you have children?

Yes No

Full Name

Date of Birth

Age (auto, please confirm)

Father's Information

Full Name

Age

Address

City

State

Zip Code

Employer

Phone

Employer City

Employer State

Employer Zip Code

Mother's Information

Full/Maiden Name

Age

Address

City

State

Zip Code

Employer

Phone

Employer City

Employer State

Employer Zip Code

Siblings (including half/step)

Full Name

Relationship

Date of Birth

B. Driving History

State of Issue

License Type

Month/Year of Expiration

Driver's License No.

Is Your License Restricted?

Yes No

For What Reason

Has Your Driver's License Ever Been Suspended, Revoked, or Placed on Probation?

Yes No

Explain in Full

Traffic Citations (not including parking tickets)

Charge

City

State

Date

Vehicle

Do You Own or Are You Presently Buying an Automobile?

Yes No

Year

Make

Model

Color

License Plate # / State

Accidents (regardless of fault)

Have you ever been in an accident (regardless of fault)?

Yes No

Year

City

State

Brief Circumstances

C. Arrest(s)

Have You Ever Been Arrested or Detained by a Law Enforcement Agency?

Yes No

Charge

City

State

Date

Have You Ever Been Arrested or Received a Ticket for a Traffic Offense?

Yes No

Date, Location, Charge, Fine or Sentence

Have You Ever Been Arrested for Any Alcohol Violation(s)?

Yes No

Explain

Have You Ever Been Arrested for a Criminal Offense?

Yes No

Describe

Are There Any Warrants, Traffic or Otherwise, Now Pending Against You?

Yes No

Explain

Have You Ever Had a Criminal Record Expunged?

Yes No

Explain

Have You Ever Been Fingerprinted for Any Reason?

Yes No

Explain (arrest, job application, etc.)

D. Education

Grade/Middle School

Address

City

State

Zip Code

From

Graduated?

Yes No

High School

Address

City

State

Zip Code

From

Graduated?

Yes No

College

Address

City

State

Zip Code

From

Graduated?

Yes No

If a Degree Was Attained, Field of Study

Other School

Address

City

State

Zip Code

From

Graduated?

Yes No

Course of Study & Certification Received

Other School (2)

Address

City

State

Zip Code

From

Graduated?

Yes No

Course of Study & Certification Received

Provide any additional information concerning your education if you did not receive a high school diploma.

Did You Take a G.E.D. Test?

Yes No

Did You Pass the G.E.D. Test?

Yes No

G.E.D. Location

G.E.D. Date

Foreign Languages

E. Employment

Employers' telephone numbers MUST be included on application.
If you have ever been discharged from a position of employment, explain in full.
If you have ever been asked to resign from a former employer in lieu of being terminated, explain in full.

List all employment held during the past ten (10) years, regardless of length of time. Begin with your present employer.

Employer Name

Phone

Address

City

State

Zip

This is my current employer

From

Supervisor's Name

Reason for Leaving

Eligible for Rehire?

Yes No

Do You Feel Your Previous Employers Have Treated You Fairly?

Yes No

Explain

Were You Ever Discharged or Forced to Resign Because of Misconduct, Unsatisfactory Service, or While Under Investigation?

Yes No

Explain

F. References

List the name, address, and phone number of three (3) persons you have known for at least five (5) years. These persons cannot be related to you or be present or previous employers. Local references are preferred.

Reference #1

Name

Phone

Address

City

State

Zip Code

Business or Occupation

Reference #2

Name

Phone

Address

City

State

Zip Code

Business or Occupation

Reference #3

Name

Phone

Address

City

State

Zip Code

Business or Occupation

G. Military

Did You Ever Serve in the U.S. Armed Forces?

Yes No

Branch

Enlistment Date

Discharge Date

Type of Discharge

Have You Ever Been Discharged With Less Than Honorable Discharge?

Yes No

Explain

Highest Rank Obtained

Present Draft Status

Military Citations or Other Awards Received

Are You Now a Member of an Organized Reserve or National Guard Unit?

Yes No

Rank and Location of Unit

While in the Military Service, Were You Ever Arrested for an Offense Which Resulted in a Trial by Deck Court or by Summary, Special or General Court Martial Including Article 15 Discipline or Punishment?

Yes No

H. Alcohol / Drugs

Do You Drink Alcoholic Beverages?

Yes No

How Often

In the Past 5 Years, Have You Used, Tried, or Experimented With Any Illegal Drugs or Narcotics Without a Prescription?

Yes No

What Type and When for Each Occurrence

Do You Currently Use or Sell, or Have You Ever Used or Sold Cocaine?

Yes No

Explain Fully (dates of last use/sale, how long used/sold)

Do You Currently Use or Sell, or Have You Ever Used or Sold Methamphetamines?

Yes No

Explain (dates of last use/sale, how long used/sold)

Do You Currently Use or Sell, or Have You Ever Used or Sold PCP?

Yes No

Explain (dates of last use/sale, how long used/sold)

Do You Currently Use or Sell, or Have You Ever Used or Sold LSD?

Yes No

Explain (dates of last use/sale, how long used/sold)

Do You Currently Use or Sell, or Have You Ever Used or Sold Any Illegal Drug?

Yes No

Explain (dates of last use/sale, how long used/sold)

Have You Ever Possessed or Distributed Any Illegal Drugs?

Yes No

Explain

Have You Ever Used Habit-Forming Drugs Without a Doctor's Prescription?

Yes No

Explain in Full

Are You Currently Taking Any Narcotics or Drugs (Including Barbiturates, Amphetamines, or Hallucinogens) Without an Authorized Prescription by a Licensed Physician?

Yes No

Explain

Have You Ever Abused Prescription Drugs?

Yes No

Explain in Full

I. Criminal Activity

Have You Ever Committed or Assisted in a Crime (murder, kidnapping, rape, burglary, arson, theft, conversion, or any other crime)?

Yes No

Explain

Have You Ever Been Present When a Crime Was Committed?

Yes No

Explain

What Is the Most Serious Undetected Crime You Have Ever Committed and When?

Have You Ever Been Placed on Probation?

Yes No

When and Why

Do You Currently Reside With Anyone Who Has Been Convicted of a Felony?

Yes No

Name, Date of Birth, and Charge(s)

Are You Associated With Anyone Who Has Been Convicted of a Felony?

Yes No

Name, Date of Birth, and Charge(s)

Are You or Have You Ever Been a Gang Member or Associated With a Gang?

Yes No

When, Which Gang, and City

Are Any of Your Family Members Gang Members?

Yes No

Name, Date of Birth, Address, and Which Gang

Have You Ever Purchased or Sold Anything You Suspected Was Stolen?

Yes No

Explain

J. Miscellaneous

Past or Present Membership in All Clubs and Organizations (political, fraternal, social, etc.)

Special Skills Developed Through Hobbies, Education, Occupation, or Other Special Interests

Have You Ever Been Denied a Gun Permit?

Yes No

When, Why, and In What State

Have You Had Any Civil Actions/Judgements or Restraining Orders Made Against You?

Yes No

Explain

Do You Know of Anything That Would Disqualify You for Appointment to HPD or Prevent Full Discharge of Official Duties?

Other Law Enforcement Agencies Applied To (Last 5 Years)

List any and all law enforcement agencies you have applied to within the last 5 years. State whether you are on their list, currently going through their process (and which stage), or were declined (and the reason or stage).

Department

Date

On List / Stage / Declined Reason

Are You Now or Have You Ever Been a Member of Any Organization, Association, Movement, Group or Combination of Persons Which Advocates the Overthrow of Our Constitutional Form of Government, or Which Has Adopted the Policy of Advocating/Approving the Commission of Acts of Force or Violence to Deny Other Persons Their Rights Under the Constitution of the United States, or Which Seeks to Alter the Form of Government of the United States by Unconstitutional Means?

Yes No

Explain in Depth

Declaration

I declare the answers I have provided are complete and true to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of information is just cause for the rejection of this application.

Type Full Legal Name as Signature *

Date *

Authorization / General Consent

I, the undersigned, hereby consent and authorize any member of the Hammond, Indiana Police Department, designated by the Chief of Police, to conduct a thorough and complete investigation of me, my employment record, or my reputation. I understand this information will be used to determine my qualifications and fitness for the position I am applying for with the Hammond Police Department.

I respectfully request that you release to the Hammond Police Department any and all information contained in your files and/or records pertaining to me. This information will be used to determine my qualifications and fitness for the position I am seeking with the Hammond Police Department.

I also agree to execute waivers, releases, and authorizations, which may be required to obtain this information.

I hereby release you and/or your employer from any liability and damage of whatsoever nature as a result of furnishing the information needed.

I also release this information to be given to the Voice Stress Analysis Examiner and Psychologist for the process of my evaluations.

I understand that any information obtained is the property of the Hammond Police Department and does not have to be released to me.

Full Name *

Signature (type full legal name) *

Date of Birth *

Social Security # *

Date *

Witness

I have read and agree to the Authorization/General Consent above. *

IMPORTANT

Hammond Police DepartmentPolice (Pre-Employment) Application

A. Personal / Family

Residence History (Past 10 Years)

Marital Status

If Not Married, Who Do You Live With?

Ex-Spouse

Children

Father's Information

Mother's Information

Siblings (including half/step)

B. Driving History

Traffic Citations (not including parking tickets)

Vehicle

Accidents (regardless of fault)

C. Arrest(s)

D. Education

Foreign Languages

E. Employment

F. References

Reference #1

Reference #2

Reference #3

G. Military

H. Alcohol / Drugs

I. Criminal Activity

J. Miscellaneous

Other Law Enforcement Agencies Applied To (Last 5 Years)

Declaration

Authorization / General Consent

Hammond Police Department
Police (Pre-Employment) Application