• Must be a United States Citizen

    • Must be at least 21 years of age on or before the applicant’s start date

    • Must meet a minimum vision standard (corrected or uncorrected) of 20/50 acuity in each eye and 20/50 binocular acuity in both eyes

    • Must not have a recorded felony conviction

    • Must be legally allowed to carry a firearm

    • Must have earned a high school diploma or GED

    • Must meet residency requirement, as agreed upon in pre-employment negotiations, when applying for a full-time position

    Position you are applying for:

    Please Read the Following Carefully

    As an applicant for a position with the Cloverdale Police Department (the Department), you may be asked to submit to a complete background check of criminal, civil history; required to complete a polygraph examination); credit/financial-responsibility history. You may also be asked to submit to a complete 3rd party health physical and/or mental evaluation, as they relate to job performance requirements. You may also be asked to complete a medical waiver and meet physical fitness requirements (testing) as they relate to job performance.

    Are you willing to meet any-and-all conditions as stated above?

    Any false, misrepresented or fictious information provided may cause you to be removed from further consideration regarding a position or employment with the Cloverdale Police Department.

    Acceptance of this application does not constitute an offer of employment or a position with the Cloverdale Police Department.


    • Unless otherwise requested, enter dates in the following format: MM/DD/YYYY

    • Telephone numbers shall be entered in the following format: XXX-XXX-XXXX

    • Incomplete applications will not be considered

    • Any misrepresentation of facts on this application will disqualify the applicant or otherwise lead to immediate termination

    To determine your eligibility for a position with Cloverdale Police Department, please answer the following questions truthfully and as accurately as possible:

    As an applicant, I understand that all information provided may be verified as noted previously.


    Have you ever had your name as documented at birth changed or otherwise altered after the age of 18? (Other than by marriage)YesNo

    Mailing Address and Physical address are the sameYesNo


    Please review carefully and correct your e-mail address, if needed! Failure to do so may result in a lost opportunity!


    An-and-all references may be contacted as part of the background investigation. Please make sure contact information is accurate.


    Have you ever been convicted or charged in an activity that would be currently classified as domestic violence?YesNo

    Have you ever been convicted or participated in an activity that would be currently classified as a “Hate” crimeYesNo

    Have you used an illegal drug (other than marijuana), or abused a legal drug within the past five (5) years?YesNo

    Have you use marijuana within the past three (3) years?YesNo

    Have you ever knowingly or intentionally sold, transported, or manufactured any illegal drug for profit?YesNo

    Do you currently abuse alcohol?YesNo

    Have you received any of the following Military Discharges: Bad Conduct Discharge (BCD), Dishonorable Discharge (DD), or Administrative Discharge of Other Than Honorable?YesNo

    Have you engaged in any form of beastyality since the age of 18?YesNo

    Do you have any tattoos, brands or mutilations exposed while wearing a short sleeve shirt with your arms extended downward?YesNo

    NOTE: Mutilation is defined under current Department policy as a purposeful, knowing, or intentional disfigurement, modification, or alteration of one’s natural appearance that could bring discredit to the Department or create a non-uniform appearance which might hinder Department esprit de corps. Such mutilations may include, but are not limited to brands, ear gauges, nose gauges, facial piercings, tongue trimming, tongue splitting, tongue studs, cranium cosmetic implants or any other implant that does not project an anthropomorphic appearance.


    Prior Law EnforcementYesNo

    Do you have full-time paid law enforcement experience as a police officer or reserve police officer with full enforcement and arrest powers?YesNo

    If “Yes”, complete the following information:

    Did you complete an ILEA pre-basic course within the past 2 years?YesNo

    Did you complete a state accredited law enforcement academy?YesNo

    Did you receive a certificate upon completion of this training?YesNo

    Below, list ALL law enforcement experience, beginning with the most recent:


    Include active-duty service with the National Guard and Reserve Components.

    Have you ever served in the United States military on active duty:YesNo

    If “Yes”, complete the information below for each branch of service, beginning with the most recent:


    Employment history will be verified

    List current and past employment-beginning with the most recent (include part-time less than 20 hours per week):

    Employer #1

    Employer #2

    Employer #3

    Employer #4


    List current issued driver’s license information below: (List all current license)

    Do you currently hold a chauffeur or commercial driver’s license?YesNo

    Has your driver’s license ever been suspended or revoked?YesNo

    Have you ever been involved in a vehicle crash or other traffic accident?YesNo

    Have you ever received a ticket for a traffic offense?YesNo

    Have you ever appeared in court regarding a traffic accident or ticket? (traffic/civil court)YesNo

    Have any criminal or civil actions been taken against you. in regard to. a t crash/traffic accident?YesNo


    Have you ever been arrested or ticketed for a criminal offense that has not been expunged by a court, regardless of outcome?YesNo

    If “Yes”, complete the information requested below for each offense, beginning with the most recent:

    Have you ever been arrested for an act as a juvenile that would have been a crime had it been committed by an adult?YesNo


    To avoid nepotism during the interview process, it is necessary that you notify the Department of all relatives who have or currently work for the Cloverdale Police Department in the spaces provided below. For purposes of this procedure, “relative” means father, mother, brother, sister, uncle, aunt, husband, wife, son, daughter, son-in-law, daughter-in-law, niece, or nephew.

    Do you currently have or ever had relatives employed by the Cloverdale Police Department?YesNo

    If “Yes”, enter their information below:


    Are you a U.S. citizen?YesNo


    Do you currently possess a personal protection handgun permit?YesNo

    Have you ever had a personal protection handgun permit that was suspended or revoked?YesNo

    Are you able to speak a foreign language(s)?YesNo


    Are you legally required to make child support/supplemental payments?YesNo

    If “Yes” are your child support payments current?YesNo

    Have you ever been, or are you currently involved as a plaintiff, defendant, petitioner, or respondent in any civil court case?YesNo

    Are you currently paying restitution for any legal claims against you as ordered by a court/legal action?YesNo


    If you answered “Yes” to any questions above or would like to explain further, please use the space provided below or you may attach a separate document(s):

    By placing my name in the box below, I swear or affirm under the penalty of perjury, all information contained in this application is true, accurate and complete to the best of my knowledge. I understand any false information provided may cause me to be removed from further consideration for a position with the Cloverdale Police Department.