DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT
PERSONAL INFORMATION
Name ______LAST FIRST MIDDLE MAIDEN SUFFIX
______CELL PHONE HOME PHONE EMAIL ADDRESS
Social Security #______Are you a United States citizen? Yes No
Date of Birth ______Place of Birth ______MONTH DAY YEAR CITY COUNTY STATE
Are you acquainted with any member(s) of the DART Police Department? Yes No If yes, list their name(s): ______
Has your driver's license (or privilege) ever been suspended? Yes No If "Yes," explain in detail. ______
Have you ever taken a polygraph examination? Yes No If "Yes," complete the following: Date For whom Results (passed, failed, inconclusive, etc.) ______If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
Have you ever been fingerprinted? Yes No If "Yes", complete the following: Date Agency Purpose (arrest, job application, etc.) ______If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
DRUG USAGE
List all of your drug use below (to include any ingestion into your body by any means, such as
experimenting, trying, inhaling, injecting, smoking, swallowing, snorting, etc.): # of times Ever Date first Date last delivered, delivered, delivered, delivered, Ever used or # of uses Date First Date Last sold, Type of Drug sold, grown, sold, grown, sold, grown, possessed? or Used Used grown, or possessions or manu- or manu- or manu- manu- factured? actured actured actured Marijuana (less than 4 ounces) Yes No Yes No Marijuana (more than 4 ounces) Yes No Yes No Hashish Yes No Yes No Cocaine (crack, coke) Yes No Yes No Heroin (cheese, black tar, etc.) Yes No Yes No Meth/Amphetamines (crystal Yes No Yes No meth, ecstasy, XTC, speed, crank) PCP (angel dust) Yes No Yes No Hallucinogens (LSD, acid, peyote, Yes No Yes No mescaline, psilocybin, mushrooms) Barbiturates/Quaaludes/ Yes No Yes No Benzodiazepines (Xanax, Valium, Rohypnol, GHB, roofies, 4 bars) Inhalents (chemicals, paint, glue, etc.) Yes No Yes No Steroids Yes No Yes No Prescription medication not prescribed to you Yes No Yes No ______Prescription medication not prescribed to you Yes No Yes No ______Other ______Yes No Yes No Other ______Yes No Yes No If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
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DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT
RESIDENTIAL INFORMATION
List all addresses where you have lived for the past ten (10) years in chronological order, beginning with your present address. Provide full address, including apartment complex name and number and zip code. Also include duty station if in the military and/or dormitories when in college.
FROM TO ADDRESS MO YR MO YR STREET NUMBER CITY COUNTY STATE ZIP ______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE #
______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE #
______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE #
______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE #
______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE #
______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE #
______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE #
______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE #
______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE #
______House-Own House-Rent Apartment Dorm Military Base ______LANDLORD’S NAME OR APARTMENT COMPLEX NAME PHONE # If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
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MILITARY RECORD
Have you ever been refused entry into the United States Armed Forces? Yes No If yes, explain in detail: ______
Have you served in the United States Armed Forces? Yes No
**ONLY COMPLETE THE REMAINDER OF THIS SECTION IF YOU HAVE SERVED IN THE MILITARY**
Branch of Service ______Dates of Service: from ______to ______Highest Rank Held ______Type of Discharge ______Rank when Discharged ______Name of Last Commanding Officer ______Are you eligible for re-enlistment? Yes No If no, give complete details: ______
Were you ever disciplined while in the military (including court martial, captain's mast, company punishment, etc.)? Yes No If yes, give complete details: Date Charge Disposition ______If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
EMPLOYMENT RECORD
Are you eligible for rehire at all of your previous employers? Yes No If no, explain in detail. ______
In your employment history, have you ever: been investigated for misconduct, but no disciplinary/corrective action taken? Yes No received written or documented counseling? Yes No been issued a written reprimand? Yes No been demoted or received a reduction in rank? Yes No been suspended? Yes No been terminated from a job? Yes No received any other form of disciplinary or corrective action? Yes No resigned from a job where you believed termination was imminent? Yes No been allowed to resign to avoid being fired? Yes No been asked to resign from a job? Yes No resigned from a job while under investigation? Yes No resigned from a job while enrolled in a remedial training program? Yes No resigned from a job when enrollment was imminent in a remedial training program? Yes No If you answered yes to any of the above questions, explain in detail. ______
Page 3 of 12 DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT
EMPLOYMENT RECORD (cont’d)
List all of your previous employment information for the last ten (10) years, including part-time, temporary, and seasonal employment, as well as reserve police officer employment.
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING
Page 4 of 12 DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT
EMPLOYMENT RECORD (cont’d)
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING
______- ______START DATE ENDING DATE EMPLOYER'S NAME PHONE #
ADDRESS/CITY/STATE/ZIP______
______JOB TITLE SUPERVISOR'S NAME CO-WORKER'S NAME CO-WORKER'S PHONE #
Reason for leaving: Resigned Retired Laid Off Terminated Other Asked to resign Resigned fearing termination Resigned while under investigation ______SPECIFIC EXPLANATION FOR REASON FOR LEAVING If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
Page 5 of 12 DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT
LAW ENFORCEMENT EXPERIENCE
List all licenses/certifications related to law enforcement that you have ever held (peace officer, jailer, detention officer, dispatcher, etc.)
Type of License Licensing Authority Original date of issue Date of expiration ______If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
**ONLY COMPLETE THE REMAINDER OF THIS SECTION IF YOU HAVE PREVIOUS LAW ENFORCEMENT EMPLOYMENT EXPERIENCE**
List all employment at law enforcement agencies, including work in a reserve or part-time capacity:
START DATE END DATE LAW ENFORCEMENT AGENCY NAME & STATE ______If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
While employed in law enforcement, did you ever commit a felony or misdemeanor offense? Yes No If "Yes," explain ______
Have you ever used or been accused of using excessive force? Yes No If "Yes," explain ______
Have you ever confiscated any prisoner's property and made personal use of it? Yes No If "Yes," explain ______
Have you ever been accused of committing a misdemeanor or felony offense that directly relates to the duties and responsibilities of a peace officer? Yes No If "Yes," explain ______
LAW ENFORCEMENT APPLICATIONS
List ALL law enforcement agencies where you have made application for employment in the last five (5) years, in chronological order, beginning with the most recent, and check all boxes that apply regarding your progression through the steps in that employer’s hiring process:
Application Date Agency Written Physical Interview Background Exam Exam Board Investigation Polygraph Psychological Hired
______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
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CRIMINAL ACTIVITY, ARRESTS, DETENTIONS, AND LITIGATIONS Has anyone ever made a family/domestic violence complaint against you? Yes No If "Yes", complete the following: Date Agency/Court receiving complaint Complainant Disposition ______If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
Has anyone ever sought or obtained a restraining/protective order against you? Yes No If "Yes", complete the following: Date Agency/Court receiving complaint Complainant Disposition ______If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
Have you ever been involved as a party in civil litigation (civil litigation includes: divorces, custody cases, child support cases, paternity cases, bankruptcies, personal injury cases, negligence cases, landlord/tenant cases, etc.)? Yes No If "Yes", complete the following: Date Case Description Court Plaintiff Defendant Disposition ______If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
Excluding traffic violations, as an adult or a juvenile: Have you ever committed any crime (even if you were not caught or arrested)? Yes No Have you ever been arrested for any reason (even if you were not convicted or case was dismissed)? Yes No Have you ever been detained by the police for any reason? Yes No Have you ever been convicted of a crime (deferred adjudication and probation are considered a conviction)? Yes No Are you on court-ordered community supervision or probation for any criminal offense? Yes No If you answered "Yes" to any of the questions above, complete the following chart: DATE LOCATION LAW ENFORCEMENT AGENCY
CRIME/CHARGE TYPE / CLASS AGE AT TIME FELONY MISDEMEANOR A B C DISPOSITION (mark all that apply): 1 Deferred Adjudication Fine $______ Probation start date ______end date ______ Jail or Prison Sentence Prison Name ______Location______Sentence date from ______to ______Parole date from ______to ______ Dismissed No Bill Other ______
EXPLAIN IN DETAIL
DATE LOCATION LAW ENFORCEMENT AGENCY
CRIME/CHARGE TYPE / CLASS AGE AT TIME FELONY MISDEMEANOR A B C DISPOSITION (mark all that apply): 2 Deferred Adjudication Fine $______ Probation start date ______end date ______ Jail or Prison Sentence Prison Name ______Location______Sentence date from ______to ______Parole date from ______to ______ Dismissed No Bill Other ______
EXPLAIN IN DETAIL
If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
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MARITAL & FAMILY INFORMATION
Marital Status: Single Married Separated Divorced Widowed
______SPOUSE’S NAME DATE OF BIRTH
______RESIDENCE PHONE # WORK PHONE # OTHER PHONE #
______RESIDENCE ADDRESS CITY STATE ZIP
______MARRIAGE DATE (IF APPLICABLE) CITY & STATE OF MARRIAGE (IF APPLICABLE)
If you have ever been divorced or had an annulment, list the following:
______SPOUSE'S COMPLETE NAME (INCLUDING MAIDEN NAME) DATE OF BIRTH
______RESIDENCE PHONE # OTHER PHONE # OTHER PHONE # 1 ______RESIDENCE ADDRESS CITY STATE ZIP
______MARRIAGE DATE CITY & STATE OF MARRIAGE
______DATE OF ORDER/DECREE OF DIVORCE/ANNULLMENT CITY & STATE OF COURT WHERE ISSUED
______SPOUSE'S COMPLETE NAME (INCLUDING MAIDEN NAME) DATE OF BIRTH
______RESIDENCE PHONE # OTHER PHONE # OTHER PHONE # 2 ______RESIDENCE ADDRESS CITY STATE ZIP
______MARRIAGE DATE CITY & STATE OF MARRIAGE
______DATE OF ORDER/DECREE OF DIVORCE/ANNULLMENT CITY & STATE OF COURT WHERE ISSUED
If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
List ALL of your children including natural, step-children, adopted, or foster children: Name Relation Date of Birth Address Financially Supported by Whom ______If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
Page 8 of 12 DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT
MARITAL & FAMILY INFORMATION (cont'd)
List other relatives in the following order: father, mother, brother(s), sister(s), half-brother(s), half-sister(s), step-father, step-mother, step-brother(s), and step-sister(s) (include maiden and married names): [If deceased, so indicate.]
Relation ______FATHER__ FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE #
Relation ______MOTHER__ FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE #
Relation ______FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE #
Relation ______FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE #
Relation ______FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE #
Relation ______FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE #
Relation ______FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE #
Relation ______FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE #
Relation ______FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE #
Relation ______FULL NAME OTHER PHONE # ALIVE ______ DECEASED RESIDENCE ADDRESS CITY STATE ZIP RESIDENCE PHONE # If additional space is needed, use page 11. Are you using page 11 to supplement this section? Yes No
Page 9 of 12 DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT
REFERENCES
List three (3) persons who know you well enough to provide current information about you from at least two (2) of the different categories listed below. Do not list relatives or former employers.
CO-WORKERS (NOT SUPERVISORS)
Name ______Years known ______1 Address/City/State/Zip ______
Phone ______Other Phone ______Last interaction ______
Name ______Years known ______2 Address/City/State/Zip ______
Phone ______Other Phone ______Last interaction ______
ROOMMATES (PAST AND PRESENT)
Name ______Years known ______1 Address/City/State/Zip ______
Phone ______Other Phone ______Last interaction ______
Name ______Years known ______2 Address/City/State/Zip ______
Phone ______Other Phone ______Last interaction ______
FRIENDS / ASSOCIATES
Name ______Years known ______1 Address/City/State/Zip ______
Phone ______Other Phone ______Last interaction ______
Name ______Years known ______2 Address/City/State/Zip ______
Phone ______Other Phone ______Last interaction ______
POLICE / GOVERNMENT / MILITARY / TEACHERS / COMMUNITY LEADERS
Name ______Years known ______1 Address/City/State/Zip ______
Phone ______Other Phone ______Last interaction ______
Name ______Years known ______2 Address/City/State/Zip ______
Phone ______Other Phone ______Last interaction ______
Page 10 of 12 DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT
ADDITIONAL INFORMATION/EXPLANATIONS
Use this section to provide any additional information for which there was insufficient space in a previous section, or to provide any explanations for any information provided.
Page # Section Information/Explanation ______
Page 11 of 12 DALLAS AREA RAPID TRANSIT POLICE DEPARTMENT APPLICATION SUPPLEMENT
PERSONAL DECLARATIONS
Review the job description for a DART Police Telecommunicator. (If you do not have a copy of the job description for a Telecommunicator, obtain a copy before you attempt to answer this question. By answering this question, you are representing to the DART Police Department that you have reviewed and understand the duties listed in the job description for a Telecommunicator.) Additionally, be advised that Telecommunicators may be required to work evening shifts, deep night shifts, weekends, and/or holidays; may be required to work by themselves (without partners); are required to wear uniforms; and are required to work at a location that is not on a DART bus or train route. Given this information, are there any reasons, obligations, facts, situations, and/or circumstances that would prevent you from fully performing the duties of a DART Telecommunicator? Yes No If yes, explain in detail:
REPRESENTATION I represent and warrant the answers I have made to each and all of the questions contained in this form are complete and true to the best of my knowledge and belief. I understand and agree that any false ____ INITIALS information or misrepresentation provided by me may result in and is sufficient cause for the Dallas Area Rapid Transit Police Department immediately rejecting my application for employment and/or immediately terminating my employment.
In submitting this Application Supplement, I authorize investigation of all statements contained herein and contained in my DART Application for Employment. In order that the DART Police Department may ____ be fully informed as to my personal character and qualifications for employment, I refer to each of my INITIALS former employers and to any other person who is identified herein or who may have information concerning me. As this information is furnished at my express request and for my benefit, I do hereby release such individuals from any and all liability for damage of whatsoever nature on account of furnishing such information.
I understand that this application is the property of Dallas Area Rapid Transit. If I am accepted for ____ employment, I understand that this application will become part of my permanent file maintained by the INITIALS Police Department.
____ I understand that an incomplete application, including the failure to follow instructions, is sufficient cause INITIALS for the Dallas Area Rapid Transit Police Department to reject my application for employment.
____ I understand that the failure to submit photocopies of the below-listed documents at the time of the INITIALS Entrance Exam is sufficient cause for the Dallas Area Rapid Transit Police Department to reject my application for employment:
Driver’s License or State issued ID Social Security Card Birth Certificate /or/ proof of U.S. citizenship and age Proof of Military service: (a) previous military personnel: DD-214 that reflects the characterization of your discharge (b) current military personnel: separation orders reflecting proof of military service High School Transcript (may not be substituted with a diploma and is required even if you have a college degree) G.E.D. Certificate (if applicable)
By checking this box, I agree that all of the information is correct and show my intent to sign this document. Date ______
DART'S POLICY STATEMENT
DART is an Equal Employment Opportunity Employer and shall not discriminate against any employee or applicant for employment because of age, gender, marital status, national origin, religion, race, or disability.
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