Must be from a recognized accredited school - Bring...

HR 401 REV 08/06/2016 of 1

Crabtree Valley Special Police Department

4325 Glenwood Avenue Raleigh, NC 27612 Phone: (919) 787-2506 Fax: (919) 786-7354

R. Flaherty Chief of Police

__________________________________________________________________________________________________ Thank you for your interest in the Crabtree Valley Special Police Department. The minimum requirements for employment with this agency are a high school diploma or GED, the ability to obtain a NC Driver’s License, and be in good physical condition. You will also be required to pass an extensive background investigation, medical examination, and drug test. Security applicants are to provide the following:

Completed Application Applicant Questionnaire

A copy of their Birth Certificate

A copy of their Social Security Card

A copy of their Driver’s License (black and white copy)

A copy of their High School Diploma or GED

Copies of any degrees or certificates from schools or colleges Must be from a recognized accredited school - Bring transcript with initial application.

If prior military, a copy of their DD-214. (We require an Honorable Discharge)

Police applicants are to provide the following in addition to the items listed above:

Copy of Basic Law Enforcement Training Certificate F-3, Personal History Statement

Applicants are to return these documents to the Mall Management Office with attention to the Watch Commander on Duty. Failure to produce such documents could result in elimination from the hiring process.

HR401 REV 08/06/2016 Page 1 of 9

>>> Please read employment application instructions before completing this form <<<

Position you are applying for: Last Name

First Name

Middle Name

Date of Birth

Social Security Number

Mailing Address

City

County

State

Zip

Cell Telephone No.

Home Telephone No.

E-Mail Address

Driver’s License Number

State

Have you EVER been convicted, under any name, of an offense against the law, other than a minor traffic violation? Offenses include, but are not limited to, driving while impaired, simple worthless check, and ANY misdemeanor or felony, even if resolved outside of court. A conviction does not mean you cannot be hired; the offense and how recently you were convicted will be evaluated in relation to the job for which you are applying. If yes, fully explain each, giving dates and details. Use additional sheets, if necessary. ____________________________________________________________________________________________

Yes No

Are any of your educational or employment records found under a different last name? If yes, please give the last name. Previous Last Name

Yes No

Are you currently employed by Plaza Associates? If yes, please give: Supervisor/Location

Yes No

Are you a former employee of the Plaza Associates? If yes please give: Last Date(s) of Employment Department / Division Yes No

Have you ever been discharged or forced to resign from any position? If yes, please give employer, date and reason.

Yes No Employer: Reason:

Do you have any relatives working for the Plaza Associates? If yes, please complete the following: (Continue listing relatives on a separate page if necessary) Name Relationship Department

Yes No

If hired, are you authorized to work in the United States? For non citizens, a copy of your authorization to work issued by the U.S. Immigration and Naturalization Service must be submitted prior to appointment. Yes No Do you now hold or are have you ever held a security officer license or commission as police officer in the state of North Carolina? Yes No


4325 Glenwood Avenue Raleigh, North Carolina 27612 Phone (919) 787-2506 Ext. 13 / Fax (919) 786-7354

Web Address: www.crabtree-valley-mall.com

Employment Application

HR401 REV 08/06/2016 Page 2 of 9

EDUCATION, TRAINING AND CERTIFICATIONS Elementary and High School Education

Highest Grade Completed (choose one)

1 2 3 4 5 6

7 8 9 10 11 12

Do you have a: High School diploma YES NO or

GED YES NO

Name and Location of Last School Attended (High School, Junior High or Elementary)

Name: _______________________________ Location: ______________________________ ____________________________________

Related Training (Correspondence, Business, Trades, Vocational, Armed Forces Schools, etc.-provide documentation with application)

Names and Locations of School Courses/Subjects Completed Year Completed

Diplomas/Certificates Received

Colleges and Universities Attended (Undergraduate & Graduate) **Must be from a recognized accredited school - Bring transcript with initial application**

Names and Locations of School(s) Dates Attended

(Mo & Yr) Course of Study From To

Related Professional Licenses and Certifications (provide documentation with application)

License/Certification Issued By Field/Trade Specialization Issue Date

Expiration Date

TECHNOLOGY SKILLS

Indicate skills, knowledge and abilities in the following areas which relate to the position you are applying for. Please complete the section in its entirety.

• Typing(words per minute)___________ Shorthand (words per minute)__________

• Computer Software Programs (specify)

_________________________________________________________________________________________________________________

• Computer Systems (specify) ______________________________________________________________________________________________________

• Radio Communication Experience (specify)

______________________________________________________________________________________________________ • Early Warning Systems (Fire/Burglary Alarm) (specify)

______________________________________________________________________________________________________

• Closed Circuit Television(CCTV) (specify)

HR401 REV 08/06/2016 Page 3 of 9

EMPLOYMENT HISTORY

Using a separate section for each position, describe in detail all work experience beginning with your present or most recent job and ending with your first. Include periods of unemployment, self-employment, military service, internships, and volunteer and summer work. Use additional "Continuation Sheets" if necessary. Be sure to indicate whether employment was full-time or part-time, and if part-time, state the average number of hours worked per week. Incomplete information will result in the disqualification of your application. May we contact your present employer? YES NO Comment:

1 Starting Date

month / day / year

Ending Date month / day / year

Employer/Company Name and address (city and state are required)

Starting Salary Ending Salary

Paid Work Volunteer (letter of proof needed)

Hours per Week

Name & Title of Immediate Supervisor

Telephone Number

Title of Position Held

Reason for Leaving

Describe job duties: (DO NOT use pre-printed job descriptions.)

2 Starting Date

month / day / year





Hours per Week


Telephone Number


Reason for Leaving


3 Starting Date

month / day / year





Hours per Week


Telephone Number


Reason for Leaving


HR401 REV 08/06/2016 Page 4 of 9

EMPLOYMENT HISTORY CONTINUATION

4 Starting Date

month / day / year





Hours per Week


Telephone Number


Reason for Leaving


5 Starting Date

month / day / year





Hours per Week


Telephone Number


Reason for Leaving


6 Starting Date

month / day / year





Hours per Week


Telephone Number


Reason for Leaving


HR401 REV 08/06/2016 Page 5 of 9

References Name Telephone Number

Reminder: With your application, bring copies of Birth Certificate, Social Security Card, High School Diploma or GED, Transcripts, College Degrees and other documents as indicated in the application instructions. If a certification or license is renewed after

submission of this application, please bring in your current documentation. If you do not bring documentation of education and/or license(s) you may not e considered for interview.

CONDITIONS OF EMPLOYMENT STATEMENT

I declare that my answers to the questions on this application and any necessary examinations and supplements are true and give the Crabtree Valley Special Police Department the right to investigate all information given and to secure additional appropriate information if necessary. I understand that an investigative report may be made from information obtained through personal interviews with others. I understand that this inquiry may include information as to my personal characteristics, employment verification, credential verification, personal identity verifications, reference checks, criminal records, motor vehicle records, and appropriateness for employment. In accordance with the law and my understanding of this statement, I authorize my current and former employers to give any information regarding my employment, together with all information regarding me, and hereby release from all liability or responsibility all persons, companies, or corporations furnishing such information in good faith. I also authorize the release of my scholastic ratings to the Crabtree Valley Special Police Department by schools and other education institutions that I have attended.

I understand that the completion of this application does not assure me of a position with the Crabtree Valley Special Police Department and does not obligate the Crabtree Valley Special Police Department to me in any way. I further understand that any misrepresentation herein WILL cause my application to be rejected, my name to be removed from the eligible register and/or subject me to dismissal. Candidates selected for hire may be asked to submit to a drug screen prior to employment. I am aware that the results will be made available to the Crabtree Valley Special Police Department or a duly authorized representative. The Crabtree Valley Special Police Department is committed to a drug free work place to protect the safety of workers and the public and will comply with the Federal Drug Free Work Place Act.

I understand that this application, exam documents and attachments become a part of the Crabtree Valley Special Police Department records and will not be returned, reused or copied for me once submitted. (It is recommended that you make a copy of this application for yourself before submitting it to the Watch Commander on Duty. Please read the minimum requirements (and application notes if the job is posted) before applying. Employment is contingent upon successful completion of a background investigation including criminal history. Criminal history will not automatically disqualify a candidate. By my signature, I certify, authorize and acknowledge the above statements and declare that I have read the application instructions.

### - ## - __ __ __ __

Signature Date Social Security Number (Unsigned applications will not be considered)

HR401 REV 08/06/2016 Page 6 of 9

APPLICANT DATA

The information requested in the following questions will not affect you as an applicant. This information will be used to determine if our recruitment efforts are reaching all segments of the community, to meet federal EEO reporting requirements and to conduct background checks. Last Name

First Name

Middle Initial

Social Security Number (required)

Date of Birth Female

Male Month Date Year

Race and Ethnicity (SELECT ONE--please refer to the definitions below as needed)

Hispanic or Latino

White (Non-Hispanic or Latino)

Black or African American (Non-Hispanic or Latino) Asian

(Non-Hispanic or Latino)

Native Hawaiian or other Pacific Islander (Non-Hispanic or Latino)

American Indian or Alaskan Native (Non-Hispanic or Latino)

Two or More Races (Non-Hispanic or Latino)

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Non-Hispanic or Latino) – All persons having origins in any of the original peoples of Europe, North Africa or the Middle East. Black or African American (Non-Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Asian (Non-Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, & Vietnam. Native Hawaiian or other Pacific Islander (Non-Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. American Indian or Alaska Native (Non-Hispanic or Latino) - A person having origins in any of the original peoples of North & South America (including Central America), & who maintain tribal affiliation or community attachment. Two or More Races (Non-Hispanic or Latino) - Persons who identify with two or more racial categories named above.

Internet Employment Sites: Monster – Indeed, Career Builder, Snag job, Craigslist: ___________________________

Job Fair - Which one? ___________________________

Job Service- Which one? ___________________________

Newspaper- Which one? ___________________________

Other publication - Which one? ___________________________

Referred by minority referral source, professional organization or other group - Which one? ___________________________

School (high school, college, trade school) - Which one? ___________________________

Other: ____________________________________________________________________

FOR DEPARTMENT USE ONLY DATE SUBMITTED:

DATE RECIVED: DATE INTEVIEWED: FOLLOW UP INTERVIEW DATE:

RELEASE WAIVER ON FILE:

YES NO

HIRED:

YES NO

DATE:

How did you learn about this job? Please select one below:

HR401 REV 08/06/2016 Page 7 of 9

Crabtree Valley Special Police Department Sample Shift Schedule

The following is an example of the CVSPD 7 on, 7 off work schedule. Shifts and start times are subject to change. Overtime and special assignments are available, but not included in this example. Schedules for new officers receiving field training may be modified to help facilitate training and meet operational needs.

WEEK 1 Officer Mon Tues Wed Thur Fri Sat Sun Total A 14 Hrs 13 Hrs 13 Hrs 40 Hrs B 10 Hrs 10 Hrs 10 Hrs 10 Hrs 40 Hrs C 13 Hrs 14 Hrs 13 Hrs 40 Hrs D 10 Hrs 10 Hrs 10 Hrs 10 Hrs 40 Hrs

WEEK 2

Officer Mon Tues Wed Thur Fri Sat Sun Total A 10 Hrs 10 Hrs 10 Hrs 10 Hrs 40 Hrs B 14 Hrs 13 Hrs 13 Hrs 40 Hrs C 10 Hrs 10 Hrs 10 Hrs 10 Hrs 40 Hrs D 13 Hrs 14 Hrs 13 Hrs 40 Hrs

HR401 REV 08/06/2016 Page 8 of 9


4325 Glenwood Avenue Raleigh, NC 27612 Phone: (919) 787-2506 Fax: (919) 786-7354

R. Flaherty Chief of Police

_________________________________________________________________________________________________

EmploymentApplicationQuestionnaireApplicant Name:__________________________________ Date:__________________ Time:__________ Reviewing Officer: ______________________ Title: ______________________ *IMPORTANT* The purpose of this questionnaire is for our department to learn more about you. We request that you provide as much information as possible when answering the questions provided. Simple ‘Yes’ or ‘No’ answers are discouraged. 1. Do you have primary and alternate transportation? _________________________________________________

2. What states have you held a valid driver’s license or state issued ID? __________________________________

____________________________________________________________________________________________

3. Have your driving privileges ever been Restricted or Revoked? (If so explain)___________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

4. Do you have any issues working the set schedules of the department with reasonable accommodation;

a 7 on/7 off rotation, working days or nights? _______________________________________________________

____________________________________________________________________________________________

5. Would you have any objection to being called in to work for last minute assignments or emergencies?

___________________________________________________________________________________________

6. Do you object to wearing a uniform, duty belt, bullet proof vest, etc. on duty and while walking or

standing for extended periods of time? ____________________________________________________________

7. Have you ever used illegal drugs? When was the last occurrence? ____________________________________

___________________________________________________________________________________________

8. Have you ever been sued with a civil judgment being rendered against you? Please note this includes

Repossessions, evictions, failure to pay child support, etc. ____________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

HR401 REV 08/06/2016 Page 9 of 9

9. Have you ever been discharged, requested to resign, or allowed to resign in lieu of termination, from

any position because of criminal or personal misconduct or rule violations?________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

10. Have you ever been arrested by a law enforcement officer or otherwise charged with a criminal

offense? (If so explain)_________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

11. Have you ever had a Domestic Violence Protection Order issued against you? (If so explain)

____________________________________________________________________________________________

____________________________________________________________________________________________

12. Have you ever stolen anything? _______________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

13. Do you speak any foreign language and to what proficiency?

____________________________________________________________________________________________

14. Have you applied with any other department? If so, what agencies? __________________________________

____________________________________________________________________________________________

16. Are you willing to use force, if necessary, to protect yourself or that of another? ________________________

____________________________________________________________________________________________

17. Are you able and willing to provide emergency aid to trauma victims? ________________________________

____________________________________________________________________________________________

18. How do you feel about enforcing a law or policy which you may not agree with? ________________________

____________________________________________________________________________________________

19. Are you able and willing to perform the essential job functions of the position for which you have

applied? ____________________________________________________________________________________

____________________________________________________________________________________________

20. Is there anything that you would like to tell us that might be discovered during your background

investigation that would affect our decision to hire you?

____________________________________________________________________________________________

____________________________________________________________________________________________

21. How would your friends describe you?

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________


R. Flaherty

Chief of Police 4325 Glenwood Ave. Phone 919-787-2506 Raleigh, NC 27612 FAX 919-786-7354

Uniform & Appearance Standards

HR402 REV08/06/2016 Page 1 of 3

All employees of the Crabtree Valley Police Department will maintain a neat and well-groomed appearance. When on duty, employees will comply with departmental standards for uniforms, other clothing, and grooming. Only the Chief of Police may approve exceptions. A. Appearance

1. Hair - All uniformed members are required to have their hair trimmed or arranged so it allows secure wearing of the uniformed hat and does not present a safety hazard. Male officers' hair will not extend below the collar of the uniform shirt and will not extend below the top of the ear. Female officers' hair will not extend more than one inch below the collar of the uniform shirt. Longer hair must be secured in a manner that does not extend more than one inch below the collar. Hair accessories may be used but are limited to those which remain hidden inside the hair, such as bobby pins.

2. Facial Hair - No facial hair is permitted with the exception of a mustache. Male officers are expected to shave every day before their tour of duty.

3. Mustaches - Will be neatly trimmed and may not extend below the corners of the mouth or below the lip.

4. Sideburns - Will be neatly trimmed, will not extend below the middle of the ear, and will not be wider than one inch.

5. Tattoos - Officers will not be permitted to display tattoos anywhere except on the arms. Multiple tattoos will not be allowed. No visible tattoo may be obscene, offensive, or bring discredit to the department and it must adhere to community standards. Acceptable tattoos may be no larger than the wearer’s hand with fingers extended. Officers may be asked to cover any tattoo and must do so by covering both arms, utilizing a long sleeve black undershirt or black half sleeves.

6. Jewelry - Officers will not wear jewelry which is gaudy, perverse or which jeopardizes safety. If an employee is requested to remove jewelry because of location and specific O.S.H.A. regulations, the employee will comply with the request.

a) Rings - Limited to two per hand. b) Bracelets - Limited to one c) Necklaces - May be worn but must be maintained under the uniform shirt.

d) Earrings - Male officers shall not wear earrings. Female officers may wear small post earrings with no hanging parts. Females are limited to one earring per ear.

e) Tongue Jewelry – is prohibited while on duty. 7. Fingernails - Officers shall keep fingernails clean and neatly trimmed (the length must

not exceed ¼ inch). No jewelry may be worn on nails. 8. Make-up - Make-up shall be conservative in nature and should not be worn in quantities

or a manner, which allows it to transfer from the face to the uniform or the clothing of others.

HR402 REV08/06/2016

Page 2 of 3

9. Sunglasses - Officers may wear sunglasses with metal or dark colored plastic frames. The lenses will not be mirrored or reflectorized. When talking with citizens' officers should remove sunglasses unless there is a valid safety reason for not doing so.

10. Gloves - Black or navy blue gloves may be worn in cold weather. Driving gloves are prohibited unless approved by the Chief of Police.

11. Cold Weather Headgear – Black earmuff type gear is permitted while in cold weather conditions. Black toboggan are only allowed after mall hours.

B. Clothing 1. Shirts - Long and short sleeve shirts should be clean and neatly pressed with a sharp

crease in the sleeve from the top of each shoulder through the shoulder patch to the bottom of the sleeve. a. Tie: the issued uniform tie will be worn at all times with long sleeve shirts. If an

officer is working on a post primarily outside and the weather is cold, the officer may wear a turtleneck shirt without a tie, but must have all buttons on the shirt buttoned except the top button. The turtleneck must be black. NO SUPERVISOR may wear a turtleneck.

b. Short sleeve shirts will be worn without a tie and with the top button unbuttoned. c. Only clean, black T-shirts may be worn with the short sleeve shirts.

2. Trousers - Trousers should be clean and pressed with a sharp crease from the fly line to the cuff. The bottom cuff of the trousers should extend to the top front of the shoe with one small break in the front of the trousers.

3. Footwear - Officers will wear only issued or approved uniformed shoes. While on special assignment or during inclement weather officers may wear optional footwear approved by the Chief of Police. Footwear must be black leather military style footwear when worn with the issued uniform. The shoes will be kept clean and in good repair. (polished and edge dressing)

4. Socks - Only black socks will be worn with the uniform. 5. Hats - The uniform hat is the most recognizable badge of authority an officer has and can

be seen quite often when a breast badge cannot. The uniform hat must be worn in the following circumstances:

a. Directing traffic b. Public events when stated in duty assignment c. Special assignments when stated in duty assignments d. Any time a supervisor deems it necessary to require the wearing of the hat When the uniform hat is worn it should be worn squarely on the head and not tilted to the

side or back. When a ball cap is worn it should be worn with the bill pointed towards the front and high enough above the eyes that will allow adequate viewing of the officers face.

6. Coats - Only issued or approved uniform coats will be worn with the uniform. 7. Leather Accessories - Uniformed officers shall wear belts or other leather accessories

that conform to those issued by the department. Leather accessories are to be kept clean and polished.

8. Nylon Accessories - Uniformed officers shall wear belts or other nylon accessories that conform to those issued by the Department. Nylon accessories are to be kept clean and functional.

C. Insignias 1. Badge - The uniform badge will be worn on the uniform shirt above the left breast

pocket. The tip of the bottom section of the badge should appear to rest on top off the pocket flap. It will be kept clean and untarnished.

HR402 REV08/06/2016

Page 3 of 3

2. Nametag - The nametag shall be issued by the department. The name shall be worn on the uniform shirt centered over the right breast pocket. The back pinpoints of the nametag shall be in line with the top seam of the pocket.

3. Collar Insignia - Officers shall wear the appropriate rank insignia on both collar points of the uniform shirt.

4. Collar Stays - Small collar stays may be worn on the uniform shirt to hold the collar down.

5. Additional Pins - Field Training Officer (FTO), Advanced Certificate, or any other departmental awarded pins and insignia may be worn as directed by the Chief.

I, ___________________________________________ have read and understand the Crabtree Valley Special Police Department Uniform & Appearance Standards and agree to fully adhere to the standards set forth in this document. I understand that failure to adhere to these standards may lead to disciplinary action including termination. Signature: ______________________ __________________ Date: _______________ Witness: ________________________ _________________ Date: _______________

HR401 REV 08/06/2016 COTINUATION PAGE

EMPLOYMENT HISTORY CONTINUATION

Using a separate section for each position, describe in detail all work experience beginning with your present or most recent job and ending with your first. Include periods of unemployment, self-employment, military service, internships, and volunteer and summer work. Use additional "Continuation Sheets" if necessary. Be sure to indicate whether employment was full-time or part-time, and if part-time, state the average number of hours worked per week. Incomplete information will result in the disqualification of your application. May we contact your present employer? YES NO Comment:

Starting Date

month / day / year





Hours per Week


Telephone Number


Reason for Leaving


Starting Date

month / day / year





Hours per Week


Telephone Number


Reason for Leaving


Starting Date

month / day / year





Hours per Week


Telephone Number


Reason for Leaving


HR401 REV 08/06/2016 COTINUATION PAGE

continuation page Any question that you answered yes to or that you feel requires addition explanation please use the following spaces to elaborate:

Must be from a recognized accredited school - Bring...

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