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Middleburg Police Employment Application

  1. Middleburg Police Department Shield

  2. List your drivers license number and the state of issue

  3. List the academy and the expiration date

  4. Have you ever been convicted of a violation of the law other than a minor traffic violation?*

  5. List the charges and the dates of conviction. Offer an explanation if you desire.

  6. Are you eligible to work in the United States?*

  7. (From Most Recent)

  8. Have you ever used illegal drugs?*

    Illegal drugs are defined as "any prescription drug not prescribed to you, any drug whose production or use is prohibited or controlled via prescription."

  9. List types of drugs used, approximate dates/years, and last date/year used. List N/A if never used an illegal drug.

  10. Please list three professional references.

  11. I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

    I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

    Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.

  12. Leave This Blank:

  13. This field is not part of the form submission.