CITY OF MOLINE POLICE OFFICER RECRUITMENT APPLICATION AND INFORMATION PACKET

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“River Gateway to Opportunity” 619-16th Street, Moline, IL 61265

Dear Police Officer Applicant: The City of Moline is recruiting for the position of Police Officer. Enclosed in this packet is information to help you become better acquainted with the recruitment process. It also is designed to give you insight into some of the duties you may encounter as a Police Officer, as well as information regarding pay and benefits. Contained in this packet are the following items: 1. 2. 3. 4. 5.

Schedule for the 2012 City of Moline Police Officer recruitment and tests. General requirements and testing procedures. City of Moline job description for Police Officer. Testing process and physical fitness requirements. Compensation and benefit information.

If you require additional information, please contact the Human Resources Office at (309) 5242069. Thank you for your interest in serving the citizens of Moline. Sincerely,

Alison Fleming Human Resources Manager

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TESTING SCHEDULE FOR CITY OF MOLINE POLICE OFFICER POLICE OFFICER APPLICATION DEADLINE Friday, August 24, 2012, 5:00 PM Written Exam Study Guides available upon return of completed application. Please return Study Guides at the Agility Test on September 28, 2012. POLICE OFFICER AGILITY TESTING Friday, September 28, 2012, 8:30 AM Black Hawk College Building 3, Lower Track 6600 34th Avenue Moline, IL 61265 INSTRUCTIONS:

1. All applicants are required to report for agility testing. There will be no further notice of this testing date! If you do not show up on this day for agility testing, you will be removed from this recruitment process. 2. Report ahead of time. Late arrivals will not be allowed to participate. 3. Bring a valid driver’s license. 4. Bring study guide.

POLICE OFFICER WRITTEN EXAMINATION (For applicants that pass agility test) Friday, September 28, 2012, 2:00 PM Moline Public Library 3210 41st Street Moline, IL 61265 INSTRUCTIONS:

1. Report ahead of time. Late arrivals will not be allowed to participate. 2. Bring a valid driver’s license. 3. Bring two sharpened #2 pencils.

POLICE OFFICER ORAL INTERVIEWS (Top 25 applicants that pass written exam will be scheduled for the 1st round of oral interviews) Interview times will be announced after the written examination.

All applicants are required to meet the deadlines, tests and events outlined in the recruitment process of the Rules and Regulations of the Board of Fire & Police Commissioners. Failure to complete any portion of the process will result in disqualification; therefore, there will be no variations in the schedule.

**THERE WILL BE NO FURTHER NOTICE OF THESE TESTING DATES AND NO MAKE-UP DATES.**

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GENERAL REQUIREMENTS AND TESTING PROCEDURES FOR CITY OF MOLINE POLICE OFFICER Applications are available from the City of Moline Human Resources Office during a given time period and must be completed and returned by the required deadline to be eligible to test. Applicants must:  Be citizens of the United States.  Be at least 21 years of age by the time of appointment. (Candidates who are 20 years of age and have taken 2 years of certified law enforcement courses are also eligible to test, but will not be appointed until reaching 21 years of age.)  Be under 40 years of age.  Have 20/20 correctable vision. Candidates will be required to successfully complete events as required by the Rules and Regulations of the Board of Fire and Police Commissioners such as a physical agility test, written examination and oral interview, in order to be placed on the eligibility register for the position of Police Officer. A copy of said Rules and Regulations may be obtained at City Hall, 619-16th Street, in the Human Resources Office for review. Physical Agility Test  All applicants must pass before proceeding to the written examination.  This is a pass/fail test.  Be prompt and dress in comfortable clothing; bring a valid driver’s license.  Test requirements are further described in this packet. Written Examination  Minimum passing score is 70%.  Be prompt and bring a valid driver’s license.  5 points added to passing written score for at least 1 year of military service with honorable discharge.  Study guides are available upon completion of application. Oral Interview  Top 25 applicants with passing scores will be scheduled to participate in the 1st round of oral interviews.  Subsequent rounds of interviews may be conducted until an eligibility register of 25 is achieved.  Minimum passing score is 70%. Eligibility Register  Passing scores from the written examination and the oral interview are averaged together and posted on a 1 year eligibility register.  At the time a vacancy occurs, a background investigation, including reference checks, credit history check and a criminal history record check, is conducted. The Police Chief recommends a candidate from the top 3 candidates on the eligibility register.  The selected candidate is made a conditional offer of employment and must pass a medical evaluation with a drug screen and a bonafide, valid and job-related psychological evaluation. If more than 6 months has elapsed from the time of the physical agility test, the selected candidate must again pass such test. Appointment from the eligibility register is subject to the applicant passing a thorough medical examination by a licensed physician of the City’s choice; appointment is further subject to the applicant passing, with a rating of “recommended” or better, a bonafide, valid and job-related psychological examination performed by a licensed psychologist of the City’s choice. The current residency requirement states that employees shall live within 20 miles of the City of Moline’s Emergency Center located at 1630 Eighth Avenue within the prescribed time period.

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CITY OF MOLINE PHYSICAL AGILITY TESTS MINIMUM PHYSICAL FITNESS REQUIREMENTS The Physical Agility test consists of the following exercises, times and/or repetitions: Male

Female

TEST / AGE

20-29

30-39

40-49

50-59

20-29

30-39

40-49

50-59

Sit & Reach

16.0

15.0

13.8

12.8

18.8

17.8

16.8

16.3

1 Minute Sit-up

37

34

28

23

31

24

19

13

Bench Press Ratio

0.98

0.87

0.79

0.70

0.58

0.52

0.49

0.43

1.5 Mile Run

13:46

14:31

15:24

16:21

16:21

16:52

17:53

18:44

* The Power Chart events are used by the Illinois certified police academies and are provided to all candidates prior to entering the academy. SIT AND REACH TEST This is a measure of the flexibility of the lower back and upper leg area. It is an important area for performing police tasks involving range of motion and is important in minimizing lower back problems. The test involves stretching out to touch the toes or beyond with extended arms from the sitting position. The score is in inches reached on a yardstick with 15 inches being at the toes. ONE MINUTE SIT UP TEST This is a measure of the muscular endurance of the abdominal muscles. It is an important area for performing police tasks that may involve the use of force and is an important area for maintaining good posture and minimizing lower back problems. The score is in the number of bent leg sit-ups performed in one (1) minute. ONE REPETITION MAXIMUM BENCH PRESS This is a maximum weight pushed from the bench press position and measures the amount of force the upper body can generate. It is an important area for performing police tasks requiring upper body strength. The score is a ratio of weight pushed divided by body weight. 1.5 MILE RUN This is a timed run to measure the heart and vascular systems’ capability to transport oxygen. It is an important area for performing police tasks involving stamina and endurance and to minimize the rise of cardiovascular problems. Once the run begins candidates must continuously run without walking or stopping until the entire 1.5 miles is complete. The score is in minutes and seconds.

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JOB DESCRIPTION FOR CITY OF MOLINE POLICE OFFICER CHARACTERISTICS OF THE JOB Under general supervision, performs a variety of routine tasks requiring application of judgment based on knowledge gained through experience and training and occasionally exercises independent judgment when dealing with emergency situations. Is responsible for the protection of life and property and the preservation of order in the City of Moline through enforcement of laws and ordinances. Work normally consists of pro-active patrol responding to calls for service, traffic regulation and investigative duties in a designated area of the city. May also be assigned to specialized units responsible for follow-up investigations, self-initiated criminal investigations, traffic enforcement and other support or staff services. Performs other duties as assigned. EXAMPLES OF DUTIES Conduct preliminary and follow-up investigations as assigned requested directly by a citizen or self-initiated. Patrol a designated area by mechanical or physical conveyance to protect life and property; preserve order; prevent and discover criminal acts; and enforce appropriate federal, state and local law through arrests, citations or other means. Communicate as appropriate through electronic, oral or written means, factual information ascertained through investigation, observation or other sources. Cooperate in the adjudication of criminal, traffic or civil cases by providing testimony or evidence at court proceedings, inquests, depositions or other judicial processes. Seek and develop public contacts and confidential sources with respect to places and persons suspected of criminal activity. Maintain good interpersonal and working relations with officers and employees of the department and other agencies. Give presentations and lectures to the public on various facets of police service, public safety education and community programs. Communicate information of criminal activity or problems to appropriate divisions, sections or supervisors of the police department and other appropriate agencies. Communicate information of criminal activity or problems to appropriate divisions, sections or supervisors of the police department and other appropriate agencies. Maintain broad knowledge of federal, state and local laws and the application of enforcement principles. REQUIREMENTS High school diploma or GED equivalent; ability to successfully complete the Illinois Local Governmental Law Enforcement Officers Training Board Basic Recruit Training; must possess a valid Illinois driver’s license or equivalent. Knowledge of occupational hazards and safety precautions; good social and general intelligence. Skill in the use of firearms. Ability to exercise good judgment and establish and maintain satisfactory working relationships with peers, superiors, other agencies and the general public. 6

SUMMARY OF CURRENT POLICE OFFICER COMPENSATION AND BENEFITS The following is a summary of the current compensation and benefits available to eligible City of Moline Police Officers. This information is in effect as of January 2011, unless otherwise noted, however, it is subject to change or elimination at any time and for any reason by the City Council or its lawfully appointed designees. BASE WAGE The position of Police Officer is included in the City’s Pay and Classification Plan. The starting salary for a City of Moline Police Officer as of January 2, 2011 is $45,731.09. The 2012 salary has not yet been negotiated. Annual anniversary increases are available to eligible employees. HEALTH BENEFIT PLAN A health plan with medical, prescription drug, dental and vision benefits are available to eligible employees. As of January 1, 2011, employees with single coverage pay $106.06 per month towards the cost of insurance and employees with family coverage pay $276.83 per month. The 2012 rates have not yet been negotiated. Benefits become effective the first (1st) of the month following thirty (30) days of fulltime employment for both the employe e and eligible dependents, if applicable. PENSION For employees hired after 1/1/11, pension benefits include, for example:  Retirement benefits at a rate of 50% of final average salary (best 8 of last 10 years) after 20 years of service and at age 55.  Additional two and one-half percent (2½%) earned for each year thereafter, with the maximum of 75% attained at 30 years of service.  Maximum salary for pension purposes is capped at $106,800 for 2011. The cap will be increased each year thereafter by 3% or ½ of CPI-U whichever is less. Contributions are made into the plan by both the employee and the employer. The employee’s contribution is deducted from his/her paycheck prior to state and federal taxes being withheld through a tax-deferred program. VACATION LEAVE Police Officers accumulate paid vacation leave as provided for in the current labor agreement. During the first year of employment, Police Officers accrue 5 days of vacation leave, at a rate of 1.65 hours per pay period for those scheduled on the five-two/five-three schedule or at a rate of 1.53 hours per pay period for all other officers. Accrual rates increase with length of service. SICK LEAVE Police Officers accrue 12 days of sick leave per year, at a rate of 3.96 hours per pay period for those scheduled on the five-two/five-three schedule or at a rate of 3.69 hours per pay period for all other officers. LIFE INSURANCE BENEFIT For their first 10 years of service, Police Officers receive a free $10,000 life insurance benefit. UNIFORMS Non-probationary Police Officers currently receive a $700 annual uniform allowance, payable semiannually. FITNESS INCENTIVE Non-probationary Police Officers currently receive a $200 annual fitness incentive upon successful completion of the annual physical standard test. 7

City of Moline, IL Board of Fire and Police Commissioners APPLICATION FOR POSITION OF POLICE OFFICER INSTRUCTIONS: Complete this application and attached release forms in ink and return to the Human Resources Office, 619 16th Street, Moline, IL 61265 prior to 5:00 PM on August 24, 2012. All statements are subject to verification. A thorough investigation will be made of each candidate’s background. Incorrect or omitted statement(s) will bar or remove you from employment. If writing space is inadequate, use extra sheets; if a question does not apply, indicate by using “NA.” All applicants will receive consideration without regard to race, color, religion, sex, national origin, ancestry, age, marital status, disability, sexual orientation, political affiliation, status as a veteran or any other protected class status in accordance with applicable federal and state laws. 1. _____________________________________________________ Name

(Last)

(First)

(Middle)

Social Security Number

3. _____________________________________________________ Home Address

2. _________________________________________________ _________________________________________________

(Street)

(City )

________________________ ________________________ Home Phone #

Cell Phone #

(State)

(Zip)

4. ________________________________________________ Email Address

5. Have you ever worked under a different name? __________ If yes, list name(s) __________________________________________ Is any additional information related to a change of name, use of an assumed name or nickname necessary to enable a check on your work and educational record? If yes, please explain: ________________________________________________________________ ___________________________________________________________________________________________________________ 6. How long have you lived at the above address? ____________ In the above City? ____________ In the above State? ____________ (Years/Months) (Years/Months) (Years/Months)

RESIDENCES 7.

List your addresses for the last five years, starting with your present address. From (Mo. / Yr.)

To (Mo. / Yr.)

Address of Residence

8. Are you a native born or naturalized citizen of the United States?* 9. Date of birth** _________/ _________/ _________ Month Day Year 10. Place of birth ______________________________ (City / State)

Yes

City, State, Zip

No

*Must be a U.S. citizen to apply

**Per the Rules and Regulations of the Fire & Police Commission, candidates must be 21 years of age by the time of appointment. Applicants who are 20 years of age and have successfully completed 2 years of law enforcement studies at an accredited college are eligible to apply. Applicants under the age of 40 are also eligible to apply.

11. Have you ever submitted an application for appointment to another Fire/Police Department? Where? _________________________________________

Yes

When? __________________________________________

12. Have you ever been a firefighter / law enforcement officer or held a similar position?

Yes

If “YES”

Location

Position

From (Date)

No

To (Date)

No Phone Number

13. Do you have any responsibilities, commitments or activities that may prevent you from meeting the specific work schedule and attendance required for the position? Yes No If yes, explain: ________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________

EDUCATION 14.

Name & Address of School (Include City / State) Elementary Schools

Date(s) Attended

Graduate Yes No High School Equivalency Test (GED) Date Passed:

High Schools

_______________________

Phone #

Test Site: _______________________ Colleges, Universities or Trade Schools Phone #

Major

Degree Attained

Extension or Correspondence Course(s)

15. Were you ever expelled or suspended from any school?

Yes

No

If “Yes”, explain: ____________________

_______________________________________________________________________________________________________ 16. List other formal education you have had including special training courses. _____________________________________ _______________________________________________________________________________________________________ 17. List any professional licenses or certificates you hold or have held. ____________________________________________ _______________________________________________________________________________________________________ 18. List any special work-related skills (data processing, photography, firearms, first aid, etc.). __________________________ _______________________________________________________________________________________________________ 19. Languages spoken: _________________________________ Languages written: _________________________________ 20. Explain your reason for applying for this position. _________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

EMPLOYMENT HISTORY 21. List all jobs you have held, including voluntary activities, military service, temporary and part time jobs. List your present or most recent position first. (1)

Employer’s Name

Address

Name & Title of Supervisor

From (Mo/Yr)

To (Mo/Yr)

Phone #

Type of Business

Annual salary

Exact title or position

Phone #

Type of Business

Annual salary

Exact title or position

Phone #

Type of Business

Annual salary

Exact title or position

Phone #

Type of Business

Annual salary

Exact title or position

Phone #

Type of Business

Annual salary

Exact title or position

Phone #

Type of Business

Annual salary

Exact title or position

List your duties May we contact for a reference?

(2)

Yes

No

Reason for leaving

Employer’s Name

Address

Name & Title of Supervisor

From (Mo/Yr)

To (Mo/Yr)

List your duties May we contact for a reference?

(3)

Yes

No

Reason for leaving

Employer’s Name

Address

Name & Title of Supervisor

From (Mo/Yr)

To (Mo/Yr)

List your duties May we contact for a reference?

(4)

Yes

No

Reason for leaving

Employer’s Name

Address

Name & Title of Supervisor

From (Mo/Yr)

To (Mo/Yr)

List your duties May we contact for a reference?

(5)

Yes

No

Reason for leaving

Employer’s Name

Address

Name & Title of Supervisor

From (Mo/Yr)

To (Mo/Yr)

List your duties May we contact for a reference?

(6)

Yes

No

Reason for leaving

Employer’s Name

Address

Name & Title of Supervisor

From (Mo/Yr)

To (Mo/Yr)

List your duties May we contact for a reference?

Yes

No

Reason for leaving

22. Have you ever served in any U. S. military organization?

Yes

No

If “Yes” , list branch. ___________________

A copy of your military service record and discharge papers (DD Form 214) must accompany your application. (Make sure type of discharge is listed on your DD Form 214.) If honorably discharged with a minimum of one (1) year of military service, five points will be applied to your passing written examination score to produce a total raw score. 23. Give date and location (City/State) of entrance into active duty. ____________________________________________________ 24. List periods of active service. From (Mo / Yr ) ________________________

To (Mo / Yr) ________________________

________________________

________________________

25. Give date & location (City/State) of discharge. _________________________________________________________________ 26. Highest rank held ___________________________________

Rank at discharge ___________________________________

27. What type of discharge did you receive? _______________________________________________________________________ 28. Are you now or were you ever a member of the U. S. Reserve Forces? If “Yes” ,

Active

Branch

No

Unit

Rank

From

To

Inactive

Address

Phone #

29. Are you now or were you ever a member of the National Guard? If “Yes” ,

Active

Yes

Yes

Branch

Unit

Yes

No No

Rank

Inactive

Address

Phone #

From

To

30. List any Court Martial or disciplinary action against you in the service, National Guard or Reserve unit. ____________________ ________________________________________________________________________________________________________

DRIVING HISTORY 31. Do you possess a valid driver’s license?

Yes

No

If “Yes,” date of expiration. _____________________________

32. Driver’s License No. ____________________________________ State ____________________________________________ 33. Have you ever been refused a driver’s license in any other state?

Yes

No If “Yes,” explain. _________________

________________________________________________________________________________________________________ 34. Have you ever had a driver’s license in any other state?

No If “Yes,” list state(s): _____________________

Yes

________________________________________________________________________________________________________ 35. Has your license ever been suspended or revoked? 36. Has your license ever been placed on probation?

Yes Yes

No If “Yes,” date of expiration. ______________________ No

If “Yes,” date of expiration. ____________________

37. List all traffic citations you have received. Location

Approximate Date

Nature of Violation

Outcome of Case

38. Have you ever been convicted of a crime or violation other than a minor traffic infraction? Date

Police Agency

Crime Charged

Yes

No If “Yes,” list below.

Outcome of Case

39. To your knowledge, are there any warrants, traffic or otherwise, now pending against you?

Yes

No

If “Yes,” explain. __________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________

ACQUAINTANCES 40. Fill in below the names of two adults, not related to you and not former employers or references, who are friends, fellow students or fellow workers that can provide information about you. Names listed should be those persons who see you frequently. (1)

(2)

Name

Address

Home Phone

Business Address

Business, occupation, profession

In what capacity do you know this person?

Name

Address

Home Phone

Business Address

Business, occupation, profession

In what capacity do you know this person?

REFERENCES 41. Fill in below the names of three adults, not related to you and not a former employer, who have known you for a period of time, preferably more than five years. All persons whom you refer will be asked to appraise your character, ability, experience, personality and other qualities. (1)

(2)

(3)

Name

Address

Home Phone

Business Address

Business, occupation, profession

Years Known

Name

Address

Home Phone

Business Address

Business, occupation, profession

Years Known

Name

Address

Home Phone

Business Address

Business, occupation, profession

Years Known

42. Person(s) to be notified in case of an emergency. (1)

Name

Address

Home Phone

Relationship

(2)

Name

Address

Home Phone

Relationship

43. Are there any other pertinent facts you would voluntarily like to present which, in your opinion, may help to evaluate your qualifications for the position you are seeking? _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________

I hereby certify that all statements in this application are true. I understand that if any of the above statements are untrue or if pertinent information is omitted, this application may be rejected, and may cause any appointment to a position to be rescinded or result in immediate discharge, irrespective of the time when the falsehood or omission is discovered and irrespective of the duration of employment. I hereby authorize the City of Moline to contact any of the employers listed above, unless otherwise indicated, to verify my employment work record. Also, I understand that employment with the City of Moline will require me to reside in a specific area defined by ordinance and that failure to comply within the time allotted for moving will result in my dismissal. I realize that it is also necessary for me to pass a pre-employment physical, that includes a drug screen, and a bonafide, valid and job-related psychological examination. Both examinations will be paid for by the City of Moline and will be performed by a physician and/or medical facility and a psychologist designated by the City of Moline. ______________________________________________________

_________________________________

Signature

Date

CONTINUATION SHEET Indicate the number of the question you are answering in the left hand column, then complete your answer in the space provided. Question Number

Signature

Continuation of Answer(s)

Date

City of Moline, Illinois

RELEASE FOR PHYSICAL AGILITY TEST The undersigned, recognizing that as part of the hiring/promotion process for the position of Police Officer with the City of Moline, Illinois, the undersigned must participate in a physical agility test and in consideration for the acceptance of the undersigned’s application for the position of Police Officer by the Board of Fire and Police Commissioners of the City of Moline, Illinois, hereby acknowledges that there are risks to the participation in said examination and that the undersigned, knowing his/her medical and physical condition, assumes said risks. Further, the undersigned hereby releases, remises and discharges the City of Moline, Illinois, its Board of Fire and Police Commissioners, the owner(s) of the property on which the test is conducted and the officers, servants, agents and all employees of any and all of said bodies or agencies, from any and all claims, demands and liabilities by him/her on his/her account of any and all injuries, losses and damages to his/her person which shall have been caused by or contributed to by or resulted from his/her physical and/or medical condition or from his/her conducts during the course of said physical agility test. Nothing herein is intended to release, remise or discharge the named parties for their own negligence in the laying out, construction of or conduct of said physical agility test or the maintenance of safe facilities where said test occurs, but is intended merely to express that the undersigned assumes all risks associated with his/her medical or physical condition and with his/her conduct during the course of said test. ____________________________________ Print Name ____________________________________ Signature ____________________________________ Date

City of Moline, Illinois

PRIVACY WAIVER I, ______________________________________ (Print Name), authorize and empower the Board of Fire and Police Commissioners of the City of Moline, Illinois, any consumer report agency, or other outside service company engaged by said Board for this purpose, now or subsequently, to obtain, prepare, use and furnish information concerning my current and former employment, military service record (to include rank at discharge, military occupations, criminal records, type of discharge, commendations, issued discipline, and duration of service), education, credit, general reputation, health, personal characteristics and mode of living, through correspondence or personal interviews with neighbors, friends or associates or others with whom I am acquainted or who may have knowledge concerning any of the above items. I understand that I have a right of privacy by federal and state law but that I have waived the rights provided therein by making application for appointment as a Police Officer with the City of Moline, Illinois. However, should my application for said appointment be withdrawn or terminated for any cause whatsoever, this waiver shall cease and be null and void from that date hence; and all inquiries initiated after said date of withdrawal or termination shall not be within the scope of this waiver. Any copy or reproduction of this document is to be given the same full force and effect as the original. Upon written request I understand that said Board will provide me with information regarding the scope of the investigation if one is made. ____________________________________ Signature ____________________________________ Date

City of Moline, Illinois

COMPLIANCE WITH RULES I, ________________________________________________ (Print Name), hereby agree to abide by all Rules and Regulations of the Board of Fire and Police Commissioners of the City of Moline, Illinois, pertaining to the giving of examinations, grading of examinations and ownership of examinations and their results and other documents associated therewith during the application and selection process during my probationary period, if appointed, and during the period I am appointed as a Police Officer of the City of Moline, Illinois. I further agree that should I fail to abide by said Rules and Regulations, I will be dismissed from further consideration as a candidate or may be discharged from the service of the City of Moline, Illinois, if already in service. I hereby acknowledge that I have been made aware that a written copy of said Rules and Regulations that pertain to the original appointment of a police officer are available for my review at City Hall located at 619-16th Street, Moline. I further agree that if selected for appointment by the Board of Fire and Police Commissioners of the City of Moline, Illinois, I shall abide by all conditions of employment now or hereafter established. I acknowledge that I have been made aware of the residency requirement of the City of Moline, all medical and physical standards adopted by said Board and all special conditions applicable solely to police appointees and that said provisions represent the conditions of employment currently in force.

____________________________________ Signature ____________________________________ Date

DISCLOSURE and AUTHORIZATION Pursuant to the Fair Credit Reporting Act, this notice is to inform you that as part of our procedure in processing and evaluating your application for employment, we will be obtaining and reviewing a consumer report or an investigative consumer (Background Check) report for employment purposes. This authorization may be used to obtain a consumer report at any time during my employment. I, _________________________, hereby consent and authorize the City of Moline, Illinois or its agents to prepare an investigative consumer report, including but not limited to obtaining a consumer report and information as to my credit worthiness, credit standing, character, general reputation, credit capacity, personal characteristics, and mode of living. This report may involve personal interviews with sources, such as neighbors, friends, associates, past employers and educational institutions in which case I understand that I am entitled to a copy of my rights under the FCRA as well as to request additional disclosures of the nature and scope of the investigation. Public records may be used in this report, such as civil and criminal records, driving records, liens, and judgments that are deemed to have a bearing on my job performance. This consumer report will be used for employment purposes as it is defined in the Fair Credit Reporting Act, section 603 (h). I am providing the following information for the preparation and proper verification of the consumer report. Have you used another name such as maiden name or other married name? Yes_____ No__--___ If yes, list names and corresponding years.____________________________________________________ Drivers License number: ____________________________State of issuance (DL):___________________ Date of Birth: __________________ Social Security Number: ____________________________________ List all past counties of residence and corresponding years: (i.e. Scott, IA 2000 – 2009) County_____________________ Years: From _______________through _________________________ County_____________________ Years: From _______________through _________________________ County_____________________ Years: From _______________through _________________________ County_____________________ Years: From _______________through _________________________ Current Address, City, State, & Zip ______________________________________________________________________________________ For Minnesota and Oklahoma and California, check here if you would like a copy of the consumer report. New York Applicants or employees: You have the right to inspect and receive a copy of any investigative consumer report requested by employer by contacting Inquirehire at 800-494-5922. By signing below you acknowledge receipt of Article 23-A of NY Correction Law. New York & Maine Applicants Only: You have the right to inspect and receive a cop of any investigative consumer report requested by the Company by contacting the consumer reporting agency identified below. You may also contact the Company to request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the Company shall provide within 5 days. Oregon Applicants Only: - Information describing your rights under federal and Oregon law regarding consumer identity theft protection, the storage and disposal of your credit information and remedies available should you suspect or find that the Company has not maintained secured records is available upon request.

Washington State Applicants or Employees only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. California Only: *Under CA law, employers are prohibited from obtaining a consumer credit report unless it meets one of the following exceptions.

(1) a position in the state Department of Justice, (2) a managerial position, as defined, (3) that of a sworn peace officer or other law enforcement position, (4) a position for which the information contained in the report is required by law to be disclosed or obtained, (5) a position that involves regular access to specified personal information for any purpose other than the routine solicitation and processing of credit card applications in a retail establishment, (6) a position in which the person is or would be a named signatory on the employer’s bank or credit card account, or authorized to transfer money or enter into financial contracts on the employer’s behalf, (7) a position that involves access to confidential or proprietary information, as specified, or (8) a position that involves regular access to $10,000 or more of cash. I hereby acknowledge that I have read and understand this document and authorize the obtaining the consumer report. _____________________________________ Signature Date

_____________________________ Email address

Print Full Name - Include Middle Name (please print legibly) ______________________________________ Inquirehire 320 LeClaire St. Davenport, IA 52801 800-494-5922 [email protected] Inquirehire Privacy Policy: http://www.inquirehire.com/misc/privacy.php

revised Jan 2012

City of Moline, Illinois

AUTHORIZATIONCity &ofGENERAL Moline, Illinois RELEASE FORM I, _________________________COMPLIANCE (Print Name), authorize the City of Moline to contact any WITH RULES organization or individual that I have listed on my employment application or resume or mentioned in job I,interviews and obtain from them any relevant information about my job qualifications, including ________________________________________________, hereby agree to abide by all my rules experience, skills, and abilities. I understand thatPolice I am consenting to theofrelease of any referenceand regulations of the Board of Fire and Commissioners the City of Moline, related information about megiving held orofknown by my former supervisors, and co-workers. Illinois, pertaining to the examinations, gradingemployers, of examinations and ownership of ex- In addition, I consent the release information about my education, experience, abilities, or workaminations andtotheir results of andany other documents associated therewith during the application related characteristics or traits held or known by other organizations or individuals, including schools and selection process during my probationary period, if appointed, and during the period I and am educational professional friends andthat acquaintances appointedinstitutions, as an officer of the Cityorofbusiness Moline,associates, Illinois. Iand further agree should I failthat to the Cityabide of Moline might in the course of conducting a reference checkconsideration or backgroundasinvestigation by said rulescontact and regulations, I will be dismissed from further a candiof my suitability for employment. date or may be discharged from the service of the City of Moline, Illinois, if already in service. I hereby acknowledge that I have received a written copy of said rules and understand I understand and acknowledge that this release of information can involve my qualifications, same. performance, credentials, or other characteristics or factors affecting my suitability for employment withI the Cityagree of Moline. further that if selected for appointment by the Board of Fire and Police Commissioners of the City of Moline, Illinois, I shall abide by all conditions of employment now or hereafter Specifically, I am the release anyreceived information performance, experience, established. I authorizing acknowledge that Iofhave a copyabout of themy residency requirement of capability, or other work-related characteristics currently are board in the and possession of the the Cityattitude, of Moline, all medical and physical standardsthat adopted by said all special following organizations theirtomanagers or representatives. Please all organizations conditions applicable or solely (fire/police) appointees and that saidlistprovisions representorthetheir managers or representatives who the City of Moline may contact regarding your performance, conditions of employment currently in force. experience, capability, attitude, or other work-related characteristics.

□ Check this box if the City of Moline may contact anyone listed on your application.

___________________________________ _ Phone Number: Signature

Name:

Company:

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___________________________________ _________________________ _______________________ _ Date _________________________ _______________________

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In exchange for the City of Moline's consideration of my employment application, I agree not to file or pursue any complaints, claims, causes, suits or legal actions of any kind, whether known or unknown, against any organization or individual that provides work-related information about me to the City of Moline or its agents in accordance with the terms and intent of this release. I also agree not to file or pursue any complaints, claims, causes, suits, legal actions or payment of fees (including, without limitation, reasonable attorney fees) against the City of Moline or any of its employees, representatives, or agents arising out of their efforts to obtain work-related information about me. _____________________________________ Signature ______________________________________ Date

City of Moline, Illinois

RESIDENCY H:Personnel:Fire & Police:Compliance with Rules 3-01 I,_____________________________________ (Print Name), understand and acknowledge that should I be appointed to the position of Police Officer, I must abide by the residency requirement dictated by the current labor agreement. I further acknowledge that residency shall be a continuing condition of employment and that failure to comply with the residency requirements or failure to notify the Chief of the department within ten days of any change in address may result in my dismissal.

The current residency requirement states that employees shall live within twenty (20) miles of the City’s Emergency Center located in Moline at 1630 8th Avenue within the prescribed time period. _____________________________________ Signature ______________________________________ Date

City of Moline, Illinois

PROFESSIONAL EXAMINATIONS AND TESTS I, ___________________________________________ (Print Name), understand that according to the Rules and Regulations of the Board of Fire and Police Commissioners that appointment to the position of Police Officer is subject to passing a thorough medical examination by a licensed physician of the City’s choice and a bona fide, valid and job-related psychological examination by a licensed psychologist of the City’s choice. The Rules and Regulations of the Board of Fire and Police Commissioners states the following: Section 9.

PROFESSIONAL EXAMINATIONS AND TESTS

Appointment from this Eligibility Register is subject to the applicant passing a thorough medical examination by a licensed physician of the City's choice; appointment is further subject to the applicant passing, with a rating of "recommended" or better, a bona fide, valid and job-related psychological examination performed by a licensed psychologist of the City's choice and, if more than six (6) months have elapsed from the date of testing for physical agility, repassing the valid and job-related physical agility test administered pursuant to Section 4 of this Chapter.

_____________________________________ Signature _____________________________________ Date

VOLUNTARY AFFIRMATIVE ACTION INFORMATION Name: _______________________________________________________________________ Last First Middle Position applied for: Police Officer

Date of Application: _______________

Please check if applicable:

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I do not choose to provide the following information.

Please check the following if you choose to provide this information: Gender

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Male Female

Race or Ethnic Origin

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White Black/African American Hispanic Asian or Other Pacific Islander American Indian or Alaska Native Other

Referral Source

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City Hall Reminder email/postcard City of Moline website City of Moline employee Please specify: _____________________

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Dispatch/Argus or QCOnline.com Quad City Times or QCTimes.com

Schools/Colleges

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Augustana College Black Hawk College IL State University St. Ambrose University University of Iowa WIU - Macomb WIU - Quad Cities

Other Source (Not listed above.) Please specify: _________________________

City of Moline, Illinois

THE MATERIALS FOLLOWING THIS PAGE ARE FOR YOUR INFORMATION. YOU SHOULD KEEP THESE MATERIALS FOR FUTURE REFERENCE. PLEASE DO NOT RETURN THESE PAGES WITH YOUR COMPLETED APPLICATION.

City of Moline, Illinois

A Summary of Your Rights Under the Fair Credit Reporting Act Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580. The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.  You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.  You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:  a person has taken adverse action against you because of information in your credit report;  you are the victim of identify theft and place a fraud alert in your file;  your file contains inaccurate information as a result of fraud;  you are on public assistance;  you are unemployed but expect to apply for employment within 60 days. In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit for additional information.  You have the right to ask for a credit score. Credit scores are numerical summaries of your creditworthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.  You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute procedures.  Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

A Summary of Your Rights Under the Fair Credit Reporting Act, continued 

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

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Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

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Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

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You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.ftc.gov/credit.

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You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a tollfree phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-800-5OPT-OUT (1-800-567-8688).

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You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

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Identity theft victims and active duty military personnel have additional rights. For more information, visit www.ftc.gov/credit.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are: TYPE OF BUSINESS:

CONTACT:

Consumer reporting agencies, creditors and others not listed below.

Federal Trade Commission: Consumer Response Center - FCRA Washington, DC 20580 1-877-382-4357

National banks, federal branches/agencies of foreign banks (word “National” or initials “N.A.” appear in or after bank’s name)

Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC 20219

800-613-6743

Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks)

Federal Reserve Board Division of Consumer & Community Affairs Washington, DC 20551

202-452-3693

Savings associations and federally chartered savings banks (word “federal” or initials “F.S.B.” appear in federal institution’s name)

Office of Thrift Supervision Consumer Complaints Washington, DC 20552

800-842-6929

National Credit Union Administration 1775 Duke Street Alexandria, VA 22314

703-519-4600

Federal credit unions (words “Federal Credit Union” appear in institution’s name) State-chartered banks that are not members of the Federal Reserve System

Federal Deposit Insurance Corporation Consumer Response Center, 2345 Grand Avenue, Suite 100 Kansas City, Missouri 64108-2638 1-877-275-3342

Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission

Department of Transportation, Office of Financial Management Washington, DC 20590 202-366-1306

Activities subject to the Packers and Stockyards Act, 1921

Department of Agriculture Office of Deputy Administrator - GIPSA Washington, DC 20250

202-720-7051