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DJ-LE-330, Rev. 8/00
UWMPD revisions 11/05
University of Wisconsin-Milwaukee
Police Department
3410 North Maryland Avenue
Milwaukee, WI 53211
APPLICATION FOR EMPLOYMENT
Position Applying for: _______________________________ Date: _________________________________
NOTICE: Application must be typewritten or clearly printed in ink. All questions must be answered, if applicable. If not, indicate NA (not
applicable). Applications which are incomplete or illegible will not be considered. If space provided is insufficient for complete
answers or you wish to furnish additional information, attach sheets of the same size as this application and number answers to
correspond with questions.
1. PERSONAL INFORMATION
Name in Full (Last, First, Middle) Date of Birth Social Security Number
Address (Apartment, Street, P.O. Box) Home Telephone Number
( )
City State Zip Code Work Telephone Number
( )
Are you over the age of 18? Yes No
Do you have a valid Wisconsin driver's license? Yes No
Have you ever been convicted of a felony? Yes No
If yes, please attach a separate sheet giving full information?
Are you a United States citizen? Yes No
Do you have a valid driver's license from another state? Yes
No
Have you completed at least 60 college credits? Yes No
IMPORTANT: Administrative Rule LES 2.01(1)(e) requires that an applicant possess either a two-year Associate Degree or 60 college level
credits, or meet the standard within the first five years of employment. The Law Enforcement Standards Board may waive up to 30 credits
upon documentation of writing, problem solving, and other communication skills. [Waiver forms available via the Department of Justice,
Training and Standards Bureau, P.O. Box 7070, Madison, WI 53707-7070, 608/266-8800.]
2. EDUCATION
Dates
Name of School Location From To Course Pursued Degree, Diploma, or Credits
Earned
High Schools
College
Graduate School
List any scholarships, apprenticeships, licenses, certifications, membership in professional organizations or other information you believe
should be considered in evaluating your qualifications.

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3. EMPLOYMENT
Begin with current or most recent employer. List chronologically all employment, including summer and part-time employment while
attending school. All time must be accounted for. If unemployed for a period, provide dates. To furnish additional employment information,
attach sheets of the same size and format as this application.
Name and Address of Employer Dates Position and Kind of Work
Name
Street
City, State
Supervisor's Name/Telephone:
May we contact the employer/supervisor? Yes No
From To
Full-Time
Part-Time
Annual
Salary/Wages:
Reason for Leaving
Name
Street
City, State
Supervisor's Name/Telephone:
May we contact the employer/supervisor? Yes No
From To
Full-Time
Part-Time
Annual
Salary/Wages:
Reason for Leaving
Name
Street
City, State
Supervisor's Name/Telephone:
May we contact the employer/supervisor? Yes No
From To
Full-Time
Part-Time
Annual
Salary/Wages:
Reason for Leaving
Name
Street
City, State
Supervisor's Name/Telephone:
May we contact the employer/supervisor? Yes No
From To
Full-Time
Part-Time
Annual
Salary/Wages:
Reason for Leaving

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4. MILITARY SERVICE
Branch of Service Month/Year Served
From To
Active Duty or Reserve Highest Grade Skill Specialty or Primary Duty
List special schools attended/skills acquired during military service.
5. REFERENCES
Give three references (not relatives, or present employer; avoid listing members of the clergy).
Name Number of Years Acquainted
Address
City/State/Zip
Telephone Number ( )
Position/Title/Profession
Name Number of Years Acquainted
Address
City/State/Zip
Telephone Number ( )
Position/Title/Profession
Name Number of Years Acquainted
Address
City/State/Zip
Telephone Number ( )
Position/Title/Profession
6. GENERAL
COMPLETE IF INSTRUCTED TO DO SO BY EMPLOYING AGENCY.
For questions A-C, attach no more than one additional page for each answer.
A. Why have you chosen to apply for this position?
B. Discuss things you have done which have contributed to your life experience. Remember to include information regarding
volunteer work with civic, school, or professional organizations. Be specific about names and dates.
C. Why do you believe you could relate to and/or work with people of different races, sexes, cultures, ages, socio-economic groups,
and educational levels?

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APPLICANT PLEASE READ CAREFULLY AND SIGN BELOW
Information provided and statements made as part of this application may be grounds for not employing you or for dismissing you after
you begin work. All information provided and statements made are subject to verification.
CERTIFICATION
ALL INFORMATION PROVIDED AND STATEMENTS MADE BY ME AS PART OF THIS APPLICATION, OR AS PART OF ANY
ADDITIONAL INFORMATION PROVIDED IN SUPPORT OF THIS APPLICATION, ARE COMPLETE, CORRECT, AND TRUE TO THE
BEST OF MY KNOWLEDGE.
I UNDERSTAND THAT IF I AM EMPLOYED, FALSE INFORMATION PROVIDED OR FALSE STATEMENTS MADE AS PART OF
THIS APPLICATION MAY BE CONSIDERED AS CAUSE FOR DISMISSAL.
Applicant's signature: Date signed:
Under the provisions of section 19.36, Wisconsin Statutes, I request that my identity as an applicant for the position of
not be revealed without my consent or until required under law.
Applicant's signature: Date signed:

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APPLICANT CONSENT AND DISCLOSURE FORM
University of Wisconsin-Milwaukee
NOTE TO APPLICANT: The position you have applied for requires candidates to pass a criminal background check as a condition of
employment. This includes a review of any pending charges or convictions. The Wisconsin Fair Employment Act prevents employers
from disqualifying applicants based on criminal history unless the position being applied for has job responsibilities that are
substantially related to the criminal history. To facilitate this process, please complete this form and return it sealed in the attached
envelope.
The information requested below is required for the sole purpose of accurately gathering information needed for the criminal
background check and will not be used for any other purpose. A record of conviction and/or pending criminal charges may not, in and
of itself, disqualify you from employment at UWM. Such information will be considered only if there is a substantial relationship
between the circumstances of the conviction and/or pending charge and the position being applied for. Failure to disclose required
information, or any misrepresentation made in connection with such disclosure, may affect the UWM's decision to hire and/or discipline
up to and including discharge.
To be completed by the applicant (Please print). Submit directly to School/College/Division Personnel Rep.
Name: Gender:
Female _____ Male ______First Middle Last
Other names you have used in the past (including maiden name):
Birthdate:
Social Security Number(s):
(mm/dd/yyyy)
Current Address:
(street, city, state and ZIP required):
Previous Address:
(street, city, state and ZIP required – Use back of this sheet for additional addresses covering the last 7 years):
Have you ever been convicted of, or pleaded ‘no contest’ to, a felony or misdemeanor?  No  Yes (provide details on next page)
Do you have any charges for felony or misdemeanor pending against you?  No  Yes (provide details on next page)
If you answered Yes to either or both questions above, please provide details on next page (Use additional sheet(s), if necessary).
Name:
To be completed by hiring department (Please print): (DO NOT VIEW APPLICANT ENTRIES)
School/College/Div.: University of Wisconsin – Milwaukee Department: UW-Milwaukee Police Dept.
Recruitment
Number:
Position
Number: Title:
Type of appointment (check one):  Faculty  Academic Staff  Classified  LTE  Adjunct AS
 Student  Other  Limited Appointment LI
Driving record check required?  Yes  No
PREP to notify:
Billing
Code:
Submitted by:
(PREPs only): Email/phone:
Send report to: Email/phone:

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First Middle Last
Have you resided in the United States for the last seven years?  No  Yes
Nature of offense(s)/charge(s):
Date(s) of conviction(s)/charge(s):
Location of court (s):
(for additional information/space, use additional sheets)
The information I have provided on this form is true and correct. I understand that if the University of Wisconsin--Milwaukee receives information at a
later date that shows I did not accurately disclose all convictions and pending charges, I may be disqualified from this position, or if already hired,
subject to discipline up to and including discharge.
I hereby authorize the University of Wisconsin-Milwaukee (UWM) to obtain criminal and other records about me from any source for the purpose of
evaluating my employability for the position I have applied for. I also authorize UWM to provide such records to third parties for the same purpose.
Such third parties and the Board of Regents of the University of Wisconsin System, its agents, employees, and officers, including UWM, are hereby
released of any liability that may arise from the disclosure of such information.
I have read and understand the above authorization and release.
Signature (do not print or type) Date
Please sign and date form and all attachments.
_____________________________________________
Return directly to the School/College/Division
Email and telephone number Personnel Rep only.
California, Minnesota or Oklahoma Applicants only – You will be provided with a free copy of any consumer reports or
investigative reports obtained on you if you check the box below.
 I wish to receive a free copy of the report