phil camus, constable precinct 5 - harris county, texas applic… · 3 office of phil camus,...
TRANSCRIPT
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Application for Employment
Phil Camus, Constable Precinct 5 Harris County
17423 Katy Freeway, Houston, Texas 281-492-3557
Revised 09/10
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OFFICE OF
Phil Camus, Constable Precinct 5
Employment Application of:
Name_________________________________________________________________
Last Name First Name Middle Name
Home number (________) _____________________________________
Work number (________) _____________________________________
Cell phone number (________) _____________________________________
Email address _______________________________________________
Position applying for:
Deputy Dispatch Clerical
We suggest you make a copy of this application for your own records.
Office use only
(time stamp)
Date & time
Received
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OFFICE OF
Phil Camus, Constable Precinct 5
Instructions to Applicant
A. If you meet all of the minimum requirements then complete the application, leaving
nothing blank. If a question does not apply to you then explain why. If you need more
space to answer any questions, attach additional sheets.
B. A copy of the following documents must be submitted with the completed application.
Do not enclose original documents; bring the originals to the initial interview.
Birth Certificate from Bureau of Vital Statistics
Naturalization Certificate
Drivers License (front and back)
Social Security Card
High School Diploma
GED Certificate
Official College Transcript if applicable
Basic Police Academy Graduation Certificate
Letter from TCLEOSE indicating passing test score
If you are a Veteran, form DD214. If you received a medical discharge and are
receiving disability compensation, you must submit page 4 of the DD214 and provide
evidence of your disability.
You may attach any and all copies of police related certificates as well as copies of
military educational certificates with your application.
C. Credit Reports are obtained at your expense. You may use but are not limited to using the
following organizations.
CSC Credit Services, Inc. Montgomery County Credit Bureau Services
652 N. Sam Houston Pkwy E 2040 N. Loop 336 West, Suite 306
Houston, Texas 77060 Conroe, Texas 77304
281 878-1900 / 1-800-305-7868 936-756-7741
http://www.csc.com/credit_services http://www.montgomerycountycreditbureau.com/
You may obtain a free credit report from any one of the three credit bureaus available through:
https://www.annualcreditreport.com/cra/index.jsp
You may link to the site through the federal trade commission website to avoid being misdirected
to other websites.
http://www.csc.com/credit_serviceshttp://www.montgomerycountycreditbureau.com/https://www.annualcreditreport.com/cra/index.jsp
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OFFICE OF
Phil Camus, Constable Precinct 5
Requirements
Age
Deputy Position at least 21 years of age on date of employment
Non-deputy Position at least 18 years of age on date of employment
Physical Condition
Deputy applicants must be examined by a licensed physician and be declared
physically sound and free from any defects which may adversely affect the
performance of his/her duties. A drug test will be conducted and the result must show
no trace of dependency on drugs or the usage of any illegal drugs, including marijuana.
In addition, eyesight must be correctable to 20/20, and the applicant may have no
uncorrectable hearing defects. The cost of these exams is not reimbursed.
Psychological Evaluation
Deputy applicants must be examined by a licensed psychologist (or psychiatrist) and
be declared in writing, by that professional, to be of satisfactory psychological and
emotional health to be a peace officer. Deputy applicants currently employed as law
enforcement officers may be exempt. The cost of this exam is not reimbursed.
Polygraph Examination
All applicants are required to take a pre-employment polygraph examination. The cost
of this exam is not reimbursed.
Education
Applicant must have a high school diploma or GED.
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OFFICE OF
Phil Camus, Constable Precinct 5
Certification
Deputy applicants must be certified by TCLEOSE or be currently enrolled in a TCLEOSE
accredited academy.
Residency
Deputy applicants must be a citizen of the United States of America.
Texas Drivers License
Deputy applicants must have a current, valid Texas Driver's License.
Military
Applicants must not have been discharged from any military service under less than
honorable conditions including, specifically; under other than honorable conditions,
bad conduct, dishonorable or any other characterization of service indicating bad
character.
Applicants must not have been convicted in a military court for an offense, for which
the elements would have been a Class B misdemeanor (or above).
Credit
Applicants must have a good credit history and must demonstrate a reasonable
willingness and ability to meet their financial responsibilities in a timely manner.
Past Employment
Past employment history, number of jobs, reason for leaving, employment references,
etc., will be considered. An unfavorable prior employment record may be grounds for
rejection.
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OFFICE OF
Phil Camus, Constable Precinct 5
Background investigation
A thorough background investigation is conducted on all applicants. Evidence of good
moral character and reputation is mandatory. Disclosure of any one or more of the
following may be grounds for rejection:
Convicted of any felony offense
Convicted of any misdemeanor offense
Convicted of driving while intoxicated
Convicted of driving under the influence of drugs
Currently on probation for any criminal offense
Currently under indictment, or awaiting trial on any criminal offense/charge
Current involvement in unsettled litigation may result in rejection or suspension
of application
Excessive traffic or collision convictions
An unfavorable drug history
Revocation of peace officers license by TCLEOSE
Bad credit history or failure to meet financial obligations
Military discharge under less than honorable conditions
Execution, at any time, of a confession to a felony offense, such confession
being admissible as evidence against the person in any criminal procedure in
any state or federal court
Membership in any subversive or extremist organization
Evidence of any mental or emotional instability
Any fraud, deception or any false statement of fact in this application can be grounds
for rejection.
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OFFICE OF
Phil Camus, Constable Precinct 5
Applicant Hiring Process
There are six (6) steps in the hiring process. No one will be hired until the final step is completed.
No one has the authority to circumvent these steps. NEVER ASSUME OR THINK YOU HAVE BEEN
HIRED UNTIL COMPLETION OF THE FINAL STEP.
The steps in the hiring process are:
1. Receipt of application and preliminary criminal background check of applicant.
2. An oral interview and pre-employment test conducted by the Personnel and Training
Division. Applicant will be notified of time, date and location of interview.
3. A complete background investigation conducted by the Personnel and Training Division
including but not limited to the information provided by the applicant in the application.
4. An oral interview conducted by a three member review board.
5. A drug screening test, polygraph exam, psychological exam, medical exam and finger
printing; all are conducted by professionals chosen by Precinct 5 and paid for by the
applicant.
6. Oral interview and swear in with the Constable.
I have read the preceding and understand that I may be rejected at any time in the hiring process.
Additionally, I understand that all initial offers of employment are conditional, contingent upon
successful completion of all phases of the hiring process required by the Department and/or State
Law. I also understand that no one has the authority to extend a final offer of employment except
the Constable, and this will only happen after all of the steps listed above are completed.
NOTE: Once hired, you will begin your training phase with an FTO. The Training Program must
be successfully completed in order for the deputy in training to proceed to his/her duty
assignment. If the training phase is not successfully completed, the individual will not be allowed
to continue their employment with this agency.
_______________________________________________________________ Applicants Printed Name
_______________________________________________________________
Applicants Signature
______________________________________________________________
Date
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OFFICE OF
Phil Camus, Constable Precinct 5
Applicants Please Note
As positions become available, Precinct 5 reviews the open applications on
hand and hires the most qualified applicants.
An application is considered open for one year from the date of receipt, or
until either the person is hired or the application is rejected.
If the application is considered favorably you will be notified when and where
to appear for further processing.
_______________________________________________________________ Applicants Printed Name
_______________________________________________________________
Applicants Signature
______________________________________________________________
Date
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OFFICE OF
Phil Camus, Constable Precinct 5
Confidential Agreement
A thorough and comprehensive investigation will be conducted on all
applicants for employment with the Harris County Precinct 5 Constables
Office. All information is confidential and the department will not reveal the
reason for rejection to those applicants who are not accepted. At no time will
any part of the investigation be made available to you.
I have read and fully understand the above statement and agree that all
information obtained during the application process will remain confidential
and will not be made available to me.
_______________________________________________________________ Applicants Printed Name
_______________________________________________________________
Applicants Signature
______________________________________________________________
Date
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OFFICE OF
Phil Camus, Constable Precinct 5
Release and Indemnity
It has been explained to me, and I fully understand, that in connection with my
applying for a position with the Harris County Precinct 5 Constables Office,
there will be costs incurred by me for:
Any and all:
1. pre-employment polygraph examinations
2. medical
3. psychological and/or emotional tests and evaluations
4. finger printing
5. documents required to be submitted
I also fully understand that I am not guaranteed a position of employment with
the Harris County Precinct 5 Constables Office and I may be rejected for
employment at any time even though I will have expended funds for
examinations and documents. I have decided to proceed with my application
even though I know the costs incurred by me will not be reimbursed and I
agree to hold the Harris County Precinct 5 Constables Office harmless from
any loss incurred by me during and after my application process.
_______________________________________________________________
Applicants Printed Name
_______________________________________________________________
Applicants Signature
______________________________________________________________
Date
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OFFICE OF
Phil Camus, Constable Precinct 5
Important
You are required to sign this form before a notary public and have your signature duly
notarized.
I, ________________________________________, hereby swear/affirm that I have personally
completed this employment application. I am aware of the contents and the answers
to all questions and statements made by me are true and correct.
I am also aware that any willful misrepresentation of fact(s) or falsification of any
answer or statement made by me herein will subject me to rejection, dismissal and
criminal prosecution under article 37.02 and/or article 37.10 of the Texas penal code.
Signature of Applicant Date and Time
State Of Texas
County Of Harris
Sworn and subscribed before me this __________ day of _________________________, 20______.
___________________________________
Notary Public Signature
(seal) ___________________________________ Printed Name
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Texas Commission on Law Enforcement Background Investigation - Authority to Release Information Waiver
OFFICE OF
Phil Camus, Constable Precinct 5
Authority to Release Information
To Whom It May Concern:
I hereby authorize Harris County Constable Precinct 5 and its authorized representatives bearing this release, or a copy
thereof, within one year of its date, to obtain any information in your files pertaining to my employment, military, credit,
education or medical records, including but not limited to academic, achievement, attendance, athletic, personal history,
and disciplinary records, medical records, and credit records.
I hereby direct you to release such information upon request of the bearer. This release is executed with full knowledge
and understanding that the information is for official use. Consent is granted to all parties to furnish such information, as
described above, to third parties in the course of fulfilling its official responsibilities. I hereby release you, as custodian of
such records, and any school, college, university, or other educational institution, hospital, or other repository of medical
records, credit bureau, lending institution, consumer reporting agency, or retail business establishment 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 attempt to comply with it.
A photocopy of this release form will be valid as an original thereof, even though the said photocopy does not contain an
original writing of my signature.
Should there be any question as to the validity of this release, you may contact me as indicated below:
_________________________________________________________________________________________________ Applicants Name (print) Phone Number _________________________________________________________________________________________________ Applicants Address _________________________________________________________________________________________________ City State Zip Code ________________________
Signature of Applicant Date and Time State Of Texas County Of Harris Sworn and subscribed before me this ______________ day of __________________________________, 20_________. ________________________________________ Notary Public Signature (seal) ________________________________________ Printed Name
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OFFICE OF
Phil Camus, Constable Precinct 5
All sections of the application must be personally completed by the applicant.
Print all information in black ink. Do not type.
Personal History
Name:
Last Name First Name Middle Name
Date of Birth: Age:
Drivers License Number: _____________________________ State:
Social Security Number: __________________________________________________________
Address: ____________________________________________________________________________
______________________________________________________________________________________
City County State Zip Code
Telephone Number(s): _________________ _________________ ___________________
Home Cell Phone Work
Maiden name, nicknames, or other names you have been known by:
_____________________________________________________________________________________
Place of Birth: _____________________ __________________ ____________________
City County State
Are you a citizen of the United States? ______ yes _______ no
Height: _________ Weight: __________ Eye Color: __________ Hair Color: _________
Describe any scars, tattoos or other distinguishing marks you have:
______________________________________________________________________________________
______________________________________________________________________________________
Note: Precinct 5 policy requires that no employee while on duty or in uniform may have tattoo(s)
that are visible to the public. This may require you, if tattoo(s) are visible, to wear a long sleeve
uniform shirt.
With whom do you reside? _________________________________________________________
Name Relationship
Are you related to an employee of this department?
_____ yes ______no (if yes, provide the following)
Name Relationship
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OFFICE OF
Phil Camus, Constable Precinct 5
Do you know any current or previous Harris County Precinct 5 employees?
_____yes _____no (if yes, please list names.)
___________________________________________________________________________________________________________
Have you ever worked for Harris County Precinct 5 in any capacity?
_____yes _____no (if yes, provide the dates and divisions.)
Date Division
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Have you ever submitted an application to this agency?
_____yes _____no (if yes, provide the date of application.)
____________________________________________________________________________________________________________
Are you willing to work?
Any Shift yes no
Holidays yes no
Weekends yes no
Criminal and Civil History
Have you ever been detained, arrested or issued a criminal citation (other
than traffic citations) by a law enforcement agency either as a juvenile or an
adult?
_____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Have you ever committed a Class B (or above) criminal offense for which you
were not arrested?
_____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Have you ever been listed as a suspect or defendant in a criminal or civil
case?
_____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Do you associate with anyone who has committed a Felony offense?
_____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Do you associate with anyone who has committed multiple criminal offenses
(Class B or above)?
_____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Do you associate with any gang members?
_____yes _____no (if yes, provide their names and frequency of contact.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Have you ever stolen or taken items or money, from an individual, employer,
business or entity without permission?
_____yes _____no (if yes, explain in detail providing dates, description of the item, value, and
circumstances.)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Have you ever purchased or received items that you knew or suspected were
stolen?
_____yes _____no (if yes, explain in detail providing dates, description of the item, value, and
circumstances.)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Do you consume alcoholic beverages?
_____yes _____no (if yes, please describe the frequency and quantity of your consumption.)
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OFFICE OF
Phil Camus, Constable Precinct 5
In the past 12 months have you operated a motor vehicle after consuming
enough alcohol to be considered intoxicated?
_____yes _____no (if yes, explain each instance.)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Have you ever tried, used, or experimented with any illegal drug or narcotic,
including prescription drugs not prescribed to you by your doctor?
(do not include over-the-counter drugs that can be legally purchased without a prescription)
_____yes _____no (if yes, provide the following.)
drug name # of times used first time used (mm/yy) last time used (mm/yy)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Have you ever sold, furnished or transferred any illegal drugs or narcotics
including prescription drugs?
_____yes _____no (if yes, provide the following.)
drug name # of times first time sold (mm/yy) last time sold (mm/yy)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Have you ever bought or received any illegal drugs or narcotics including
prescription drugs not prescribed to you by a doctor?
_____yes _____no (if yes, provide the following.)
drug name # of times first time bought (mm/yy) last time bought (mm/yy)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Are you now or were you ever a party to a civil litigation (including evictions,
repossessions and divorces).
_____yes _____no (if yes, provide the following.)
Type of Litigation City/State Date Disposition
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Have you ever been sued?
_____yes _____no (if yes, explain in detail, providing the dates, amount of suit, and
circumstances.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Have you ever been summoned into court?
_____yes _____no (if yes, explain in detail, providing the dates and reason.)
________________________________________________________________________________________________
________________________________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Traffic Record
Please list the vehicles you and/or your spouse own.
Year Make Model Lic# Insurance Provider Policy Number
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Do you presently hold or have you ever held a drivers license issued by
another state? _____yes _____no (if yes, complete the following)
State License Number Dates Held
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Has your drivers license ever been suspended or revoked?
_____yes _____no (if yes, provide the dates and a detailed explanation.)
Date Explanation
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
List all traffic citations you have received, excluding parking citations. Attach
additional sheets if necessary.
Date Issuing Agency Offense Disposition
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
List all motor vehicle crashes in which you have been involved.
Date Offense Disposition (indicate at fault/not at fault)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Education History
Police Academy attended: _________________________________________________________
City: _____________________________________________ State: ___________________________
TCLEOSE hours received: __________________________
Special awards received: ________________________________________________________
Dates attended: ____________________________________________________________________
Anticipated graduation date: ______________________________________________________
College or University attended: ___________________________________________________
City: _________________________________________ State: _____________________________
Dates attended: from:______________________________ to: ____________________________
Did you graduate? _______________
Number of hours completed: __________________________
Degree received: ___________________________________________________________________
High School attended: _____________________________________________________________
City: _______________________________________________ state: __________________________
Dates attended: from: _____________________________ to: ____________________________
Did you graduate? ___________ If not, do you have a GED? ____________________
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OFFICE OF
Phil Camus, Constable Precinct 5 List all other schools attended such as trade, vocation, business, etc. Give
name, address of school, dates attended, course of study, certificate received
and any other pertinent information:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
List any specialized machinery or equipment you are able to operate:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Do you speak a foreign language? ____yes _____no (if yes, complete the following.)
Language Speak Read Write
___________________________________
____________________________________________
___________________________________
Military History
Have you served in the United States Armed Forces? ____yes _____no
Branch of Service: _________________________________________________________________
Are you currently serving in the Military Reserves? ____yes _____no
Type of discharge: _________________________________________________________________
List any disciplinary actions:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Marital & Family History
Marital status:
Single: yes no
Married: yes no how long? ______________________________________
Common law: yes no how long? ______________________________________
Divorced: yes no how long? ______________________________________
Widowed: yes no how long? ______________________________________
List name of spouse or former spouse(s) and provide requested information. If
former spouse is deceased provide name and indicate deceased after date
of birth.
Name DOB (mm/dd/yy) Address Phone Length of Marriage
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Are you required to make child support payments? _____yes _____no
If yes, are you current with all payments? _____yes _____no (if no, provide the
number of payments you are behind and fully describe the reason for the
delinquency.)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
List all children related to you or your spouse (natural, adopted, step children
and foster children)
Name DOB (mm/dd/yy) Address Phone
If married list spouses employer, address & phone number:
List the following relatives, please indicate if deceased.
(Include step brother or sister)
Relation Name Address DOB Phone Number
Father_______________________________________________________________________________
Stepfather__________________________________________________________________________
Mother______________________________________________________________________________
Stepmother_________________________________________________________________________
Sister_______________________________________________________________________________
Sister_______________________________________________________________________________
Brother _____________________________________________________________________________
Brother _____________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Financial History
List all sources of income (including spouses) and amount per year.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Do you have a bank account? _____yes _____no (If yes, provide the following.)
name of bank phone checking/saving
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Give name and address of individuals, companies, or others to whom you are
indebted and the extent of your debt. Include rent, mortgages, vehicle
payments, charge accounts, credit card loans, child support payments and
any other debts or payments. Attach additional sheets if needed.
creditors name phone # type of debt total monthly payment/balance
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
List any accounts in which you are currently behind in payment thirty days or
more. If none, write none (include charge-offs & collections).
creditors name phone # type of debt amount behind
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Have you ever had anything repossessed?
_____yes _____no (if yes, provide date, item, and circumstances.)
Date Item Circumstance
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Have you had any check(s) returned due to insufficient funds in the past
twelve months?
_____yes _____no (if yes, provide the date, amount, and circumstances.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Have you ever filed for bankruptcy?
_____yes _____no (if yes, provide the date, type of bankruptcy, and circumstances.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Membership in Past & Present Organizations
Name of Organization Type of Organization Date of Membership
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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______________________________________________________________________________________
______________________________________________________________________________________
OFFICE OF
Phil Camus, Constable Precinct 5
List your hobbies and recreational activities
Personal Declarations
List all applications you have submitted to other law enforcement agencies.
Provide the current status of each application, if rejected then explain why.
Use a separate sheet of paper if necessary.
Agency Date Submitted Status
Have you ever taken a polygraph examination?
_____yes _____no (if yes, provide the following.)
Agency/Company Date Reason Outcome (pass/fail)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Are you now or have you ever been a member of a radical or subversive group?
____yes _____no (if yes, provide the following.)
Name of Group Dates of Membership
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Are there any incidents in your life not mentioned herein which may influence this
departments evaluation of your suitability for employment?
____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Have you ever been named in an Internal Affairs Investigation or an investigation
conducted by an employer alleging wrongdoing?
____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Have you ever resigned in lieu of termination?
____yes _____no (if yes, explain in detail. Use a separate sheet of paper if necessary.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Personal Statement
State in your own words why you are seeking employment with
Harris County Precinct 5 Constables Office.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
Employment History
List all job history since the age of sixteen (16) starting with current or most
recent position. List all employment regardless of length, including part time,
temporary and seasonal positions. If you were unemployed during any period
of time, list the dates and write unemployed on the line provided for
company name. Be sure there are no gaps. Include month & year. If needed
make additional copies of this section.
From: To:
Name of Employer: _____________________________________ Phone:___________________
Address: ____________________________________________________________________________
Position(s) held: ____________________________________________________________________
Job duties: _________________________________________________________________________
Immediate Supervisor: _________________________________ Phone:___________________
Co-worker:_______________________________________________ Phone:__________________
Salary, beginning: _________________________________ending:_________________________
Were you terminated or asked to resign? _________________________________________
Reason for leaving (explain fully):_________________________________________________
From: To:
Name of Employer: _____________________________________ Phone:___________________
Address: ____________________________________________________________________________
Position(s) held: ____________________________________________________________________
Job duties: _________________________________________________________________________
Immediate Supervisor: _________________________________ Phone:___________________
Co-worker:_______________________________________________ Phone:__________________
Salary, beginning: _________________________________ending:_________________________
Were you terminated or asked to resign? _________________________________________
Reason for leaving (explain fully):_________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
From: To:
Name of Employer: _____________________________________ Phone:___________________
Address: ____________________________________________________________________________
Position(s) held: ____________________________________________________________________
Job duties: _________________________________________________________________________
Immediate Supervisor: _________________________________ Phone:___________________
Co-worker:_______________________________________________ Phone:__________________
Salary, beginning: _________________________________ending:_________________________
Were you terminated or asked to resign? _________________________________________
Reason for leaving (explain fully):_________________________________________________
From: To:
Name of Employer: _____________________________________ Phone:___________________
Address: ____________________________________________________________________________
Position(s) held: ____________________________________________________________________
Job duties: _________________________________________________________________________
Immediate Supervisor: _________________________________ Phone:___________________
Co-worker:_______________________________________________ Phone:__________________
Salary, beginning: _________________________________ending:_________________________
Were you terminated or asked to resign? _________________________________________
Reason for leaving (explain fully):_________________________________________________
From: To:
Name of Employer: _____________________________________ Phone:___________________
Address: ____________________________________________________________________________
Position(s) held: ____________________________________________________________________
Job duties: _________________________________________________________________________
Immediate Supervisor: _________________________________ Phone:___________________
Co-worker:_______________________________________________ Phone:__________________
Salary, beginning: _________________________________ending:_________________________
Were you terminated or asked to resign? _________________________________________
Reason for leaving (explain fully):_________________________________________________
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OFFICE OF
Phil Camus, Constable Precinct 5
From: To:
Name of Employer: _____________________________________ Phone:___________________
Address: ____________________________________________________________________________
Position(s) held: ____________________________________________________________________
Job duties: _________________________________________________________________________
Immediate Supervisor: _________________________________ Phone:___________________
Co-worker:_______________________________________________ Phone:__________________
Salary, beginning: _________________________________ending:_________________________
Were you terminated or asked to resign? _________________________________________
Reason for leaving (explain fully):_________________________________________________
From: To:
Name of Employer: _____________________________________ Phone:___________________
Address: ____________________________________________________________________________
Position(s) held: ____________________________________________________________________
Job duties: _________________________________________________________________________
Immediate Supervisor: _________________________________ Phone:___________________
Co-worker:_______________________________________________ Phone:__________________
Salary, beginning: _________________________________ending:_________________________
Were you terminated or asked to resign? _________________________________________
Reason for leaving (explain fully):_________________________________________________
From: To:
Name of Employer: _____________________________________ Phone:___________________
Address: ____________________________________________________________________________
Position(s) held: ____________________________________________________________________
Job duties: _________________________________________________________________________
Immediate Supervisor: _________________________________ Phone:___________________
Co-worker:_______________________________________________ Phone:__________________
Salary, beginning: _________________________________ending:_________________________
Were you terminated or asked to resign? _________________________________________
Reason for leaving (explain fully):_________________________________________________
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32
OFFICE OF
Phil Camus, Constable Precinct 5
Personal References
List four (4) personal references including current phone numbers.
Do not include relatives.
Name________________________________________________________________________
Home number (________) _____________________________________________________
Work number (________) _____________________________________________________
Cell number (________) _____________________________________________________
Address______________________________________________________________________
Occupation________________________________ Years Known__________________
Phone number and best time reference prefers to be contacted
(_______) ____________________________________________ Time___________________
Name________________________________________________________________________
Home number (________) _____________________________________________________
Work number (________) _____________________________________________________
Cell number (________) _____________________________________________________
Address______________________________________________________________________
Occupation________________________________ Years Known__________________
Phone number and best time reference prefers to be contacted
(_______) ____________________________________________ Time___________________
Name________________________________________________________________________
Home number (________) _____________________________________________________
Work number (________) _____________________________________________________
Cell number (________) _____________________________________________________
Address______________________________________________________________________
Occupation________________________________ Years Known__________________
Phone number and best time reference prefers to be contacted
(_______) ____________________________________________ Time___________________
Name________________________________________________________________________
Home number (________) _____________________________________________________
Work number (________) _____________________________________________________
Cell number (________) _____________________________________________________
Address______________________________________________________________________
Occupation________________________________ Years Known__________________
Phone number and best time reference prefers to be contacted
(_______) ____________________________________________ Time___________________
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33
OFFICE OF
Phil Camus, Constable Precinct 5
Residence History
Beginning with your present address list all addresses where you have lived
including month and year. Attach additional sheets if necessary.
From ________________ To __________________ house________ apartment_______
Address______________________________________________________________________
City ___________________________________ State _____________ Zip ______________
From ________________ To __________________ house________ apartment_______
Address______________________________________________________________________
City ___________________________________ State _____________ Zip ______________
From ________________ To __________________ house________ apartment_______
Address______________________________________________________________________
City ___________________________________ State _____________ Zip ______________
From ________________ To __________________ house________ apartment_______
Address______________________________________________________________________
City ___________________________________ State _____________ Zip ______________
From ________________ To __________________ house________ apartment_______
Address______________________________________________________________________
City ___________________________________ State _____________ Zip ______________
From ________________ To __________________ house________ apartment_______
Address______________________________________________________________________
City ___________________________________ State _____________ Zip ______________
From ________________ To __________________ house________ apartment_______
Address______________________________________________________________________
City ___________________________________ State _____________ Zip ______________
From ________________ To __________________ house________ apartment_______
Address______________________________________________________________________
City ___________________________________ State _____________ Zip ______________