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City of everson police department

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Daniel A. MacPhee, Chief

109 W. Main Street

P.O. Box 315

Everson, WA 98247

(360) 966-4212 / Fax (360) 966-3466

Application Packet

Police Officer

Thank you for your interest in the Police Officer

position with the City of Everson.
This application package includes:

  • A thirteen page applications and background form

  • A copy of minimum standards

A complete application will include the following:

  • A completed and signed application form, including all requested attachments.


(Read carefully before answering the following questions.)

1. All the statements in this application shall be under the penalties of perjury and in the applicant's own printing in ink. An unreadable application may be rejected.
2. Please fill in all the blanks. Attach additional sheets of paper, if necessary, to completely answer any question.
3. Applications which show the applicant lacks the qualifications as to age, health, experience, etc. required by Civil Service Regulations will be cause for disqualification and the applicant will be notified.
4. Applicants will be notified of the time and place of the oral board examination. Applicants must give notice of any change of Post Office address, phone number, or any inability to attend the examination.
5. Everson Police Department will accept applications until position is filled. All required documents must be turned in a one time.

Everson Police Department

P.O. Box 315

111 W. Main Street

Everson, WA 98247

* * * * * * * * * * *

The City of Everson is an Equal Opportunity Employer.

1. Must be at least 21 years of age.
2. Must have no previous criminal convictions.
3. Must be in good health.
4. Must have good credit.
5. Must successfully complete a physical examination prior to employment.
6. Must be a citizen of the United States.
7. Must possess or obtain a Washington State Driver's License by the time of employment.
8. Must have a High School Diploma or G.E.D.
To be considered for this position, applicants must complete and return the attached application with a detailed resume explaining the education and experience they possess which qualifies them for this position, and letter of interest.
Qualified applicants will be interviewed and administered an oral examination. Prior to appointment to service, the applicant selected will be subject to a complete credit check, background investigation, polygraph examination and psychological examination. In addition, successful applicants will be asked to provide, at their own expense, evidence of successful completion of a physical examination.
I understand and agree to the above qualifications and requirements. I declare the answers to the following questions to be true to the best of my knowledge. I understand the failure to correctly answer, or completely answer any questions is grounds for my dismissal at any time.


Signature of Applicant





(last) (first) (middle)
Current Street Address_____________________________________________________________
City___________________________ State:___________________ Zip__________
Home Phone:_______________ Cell Phone________________ Business__________________
Social Security No._______________________ Date of Birth_______________

Education:--Circle total years of pre-college years completed: 1 2 3 4 5 6 7 8 9 10 11 12

Colleges or universities attended: Years Degree? Course of study

Attended (Yes or no & state type)


Military, service and rank if applicable____________________________ Years of service________

Type of military discharge:__________________________________________________________
Are there any limitations on physical abilities that you think we should be aware of which may affect your work performance as a police officer?
Yes:_____ No:_____ If yes, please explain____________________________________________
Have you ever been declined for insurance coverage? Yes:___ No:___
If yes, why?_____________________________________________________________________

Regarding vision and hearing, is there anything that you think we should be aware of that would in any way interfere with your performance as a police officer should you be selected for this position?

Yes_____ No___ If yes, please explain________________________________________________
Height in bare feet:_________ Weight:________ Most ever weighed:____________

Have you ever applied for police work? Yes:_____ No:_____

Accepted? Yes:______No:________ If no, why not?_____________________________________

Do you have prior police experience: Yes:_____ No:_____

Do you have prior civil service or government experience?
Yes:____ No____When:_____________Where__________________________________________
Do you have any relatives in law enforcement work? Yes_____No______
Do you have any firearms training? Yes:_____ No:_____
What kind?______________________________________________________________________

Employment record: List all employment beginning with latest; attach a separate sheet of paper if needed.
Company Name_______________________________________________Phone_______________
Job Title:___________________________Immediate Supervisor___________________________
Salary (monthly): Beginning: $______________ Final:_____________
Duties included:__________________________________________________________________
Dates Employed:__________________________Why did you leave ? _______________________

Company Name_____________________________________________Phone_________________

Job Title:_____________________________Immediate Supervisor_________________________
Salary (monthly): Beginning: $______________ Final: $__________
Duties Included:__________________________________________________________________
Dates Employed:__________________________Why did you leave ? _______________________
Company name___________________________________________________Phone__________________
Job Title:__________________________Immediate Supervisor____________________________
Salary (monthly): Beginning: $______________ Final: $___________
Dates Employed:__________________________Why did you leave ? _______________________

Have you ever been laid off a job? Yes:_____ No:_____

Have you ever been fired from a job? Yes:_____ No:_____

Please describe your skill level with computers. Please include the types of software you have used.


Please list any other types of equipment you are trained to operate:


Please list any special training, skills, and professional licenses or certifications that may be applicable:


Do you possess a valid Washington's driver's License? Yes___________No_________

Driver's Lic. No.____________________ Car License No. ______________________________
Do you possess a motorcycle endorsement? Yes:_____ No:_____

Do you have any activities, commitments, or responsibilities that may prevent you from meeting work attendance requirements (work involves rotating shift work schedule)? Yes:___No:________

Do you have any problems in becoming lawfully employed in this country because of visa or immigration status? Yes____No____
Can you provide proof of citizenship, visa, or alien registration number after being hired?

Yes:________ No:__________

Have you ever been fingerprinted? Yes:_____ No:_____
Have you ever had any traffic tickets? Yes:_____ No:_____
Have you ever been arrested? Yes:_____ No:_____ Reason______________________________
Comment _______________________________________________________________________

Have you ever been convicted of any crime other than traffic tickets? Yes:_____ No:_____ If yes, please give details of each conviction, including whether trial or guilty plea, and exact nature of sentence.

Do you have satisfactory credit rating? Yes:_____No________
Have you ever been refused credit? Yes:_____No_______
Are you buying on credit now? Yes:_____No_______
Have you ever declared bankruptcy? Yes:_____No_______

Talents, hobbies, other skills _______________________________________________________

Volunteer or other types of activities you are involved in _________________________________
Why do you want to be an Everson police officer?

List three references who are neither relatives nor former employers.

Name:____________________________________________ Occupation____________________

Name:____________________________________________ Occupation____________________


Name:_____________________________________________ Occupation___________________



I certify that all statements above are true under penalty of perjury. I understand that false statements shall be sufficient cause for termination.

________________________________ ________________________

Signature of Applicant Date


  1. Applicant must be at least 21 years of age for appointment.

  1. Minimum education High School Graduate or equivalent.

  1. A Valid Washington State Driver’s License is required to being hired.

  1. TRAFFIC RECORD: An applicant’s driving record will be thoroughly assessed and may be a factor for disqualification. Examples of infractions which may be disqualifying include, but are not limited to:

    1. Driving While Under the Influence or Reckless Driving

    2. Hit and Run

    3. Five convictions for moving violations (speeding, negligent, etc.) within a five year period

    4. Three or more accidents within a five year period wherein the applicant was judged at fault or charged

    5. Alcohol / Drug related driving

  1. MEDICAL: Applicants must meet LEOFF medical standards.

  1. CRIMINAL CONVICTIONS: Felony convictions are disqualifying. Misdemeanor arrests/convictions will be reviewed on a case-by-case basis.

Authorization For Release Of Information Agreement
TO WHOM IT MAY CONCERN: I ____________________________________, am an applicant for a position with the Everson Police Department/City of Everson hereinafter potential employer. The employer needs to thoroughly investigate my employment background and personal history to evaluate my qualifications to hold the position for which I applied. It is in the public’s interest that all relevant information concerning my personal and employment history be disclosed to the above employer.
I hereby authorize any representative of the employer bearing this release to obtain any information in your files pertaining to my employment records and I hereby direct you to release such information upon request of the bearer. I do hereby authorize a review of and full disclosure of all records or any part thereof, concerning myself, by and to any duly authorized agent of the employer whether said records are of public, private or confidential nature. The intent of this authorization is to give my consent for full and complete disclosure. I reiterate and emphasize that the intent of this authorization is to provide full and free access to the background and history of my personal life for the specific purpose of pursuing a background investigation that may provide pertinent data for the employer to consider in determining my suitability for employment with that employer. It is my specific intent to provide access to personnel information, however personal or confidential it may appear to be.
I consent to your release of any and all public and private information that you may have concerning me, my work record, my background and reputation, my military service records, educational records, my financial status, my criminal history record, including any arrest records, any information contained in investigatory files, efficiency ratings, complaints or grievances filed by or against me, the records or recollections of attorneys at law or other counsel, whether representing me or another person in any case, either criminal or civil, in which I presently have or have had an interest, attendance records, and any internal affairs investigations and discipline, including any files which are deemed to be confidential and/or sealed.
I hereby release you, your agency and all others from liability or damages that may result from furnishing the information requested, including any liability or damage pursuant to any state or federal laws. I hereby release you as the custodian of such records of the Everson Police Department/City of Everson including its officers, employees or related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information, or any attempt to comply with it. I direct you to release such information upon request of the duly accredited representative of the employer regardless of any agreement I may have made with you previously to the contrary. The law enforcement organization requesting the information pursuant to this release will discontinue processing my application if you refuse to disclose the information requested.
For and in consideration of the employer’s acceptance and processing of my application for employment, I agree to hold the Everson Police Department/City of Everson, its agents, and employees harmless from any and all claims and liability associated with my application for employment or in any way connected with the decision whether or not to employ me with the employer.

A photocopy of FAX copy of this release form will be valid as an original thereof, even though the said photocopy or FAX copy does not contain an original writing of my signature.

This waiver is valid for a period of ________ months from the date of my signature.

Should there be any questions as to the validity of this release, you may contact me at the telephone number listed on this form.

I agree to indemnify and hold harmless the person to whom this request is presented and his agents and employees from and against all claims, damages, losses and expenses, including reasonable attorney’s fees, arising out of or by reason of complying with this request.

SIGNATURE: ______________________________________

SIGNATURE (Printed): _______________________________
DATE: ___________________________________________
PHONE NUMBER: _________________________________




On this ____ day of 20___, before me, the subscriber, a Notary Public in and for said State and County, personally appeared , the of ____________________________, known or identified to me to be the person whose name is subscribed to the within instrument, and in due form of law acknowledged that he/she is authorized on behalf of said company to execute all documents pertaining hereto and acknowledged to me that he/she executed the same as his/her voluntary act and deed on behalf of said company.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my seal in said State and County on the day and year last above written.

Notary Seal

(Signature of Notary)

My Commission Expires:

Everson Police Department Benefits

Good Until January 1, 2015

Paid Holidays: New Year’s Day Veteran’s day

Martin Luther King Jr. Birthday Thanksgiving Day

President’s Day Day after Thanksgiving

Memorial Day Christmas Day

Fourth of July Floating Holiday

Labor Day

Paid Vacations: Accrues at 6.67 hours/month, to be used after completion of 12 months

After completion of one year employment, 80 hours per year

After completion of four years employment, 120 hours per year

After completion of ten years employment, 160 hours per year

Sick Leave: Accrues 8 hours/month, to a maximum of 720 hours
Health & Welfare: Medical
AWC/FirstHealth Plan – 100% premium paid for employee,

90% premium paid for dependents.


Group Health ($10-copay) 100% premium paid for employee,

100% premium paid for dependents.


AWC/WDS Dental Plan “E” 100% premium paid for employee

90% premium paid for dependents


AWC/VSP 100% premium paid for employee

100% premium paid for dependents
Pension: $0.25 per hour to Western Conference of Teamsters Pension Trust Fund
Retirement: WA State Department of Retirement LEOFF 2 Plan

Uniform Allowance: $800 per year

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