Human Resources Department

City of Big Spring

310 Nolan Street
Big Spring, Texas 79720
(432) 264-2345

Dear Applicant:

The City of Big Spring appreciates your interest in our vacant position. We are excited
about receiving more information from you and would like you to complete the enclosed
employment application packet. Please follow all the instructions in the
application packet and make sure that the application is fully complete.
Please return completed packet to the Human Resource Department at your earliest
convenience.

YOU ARE REQUIRED TO INCLUDE THE FOLLOWING WITH YOUR

PACKET

• Ensure that you have included your job history for the past five (5)
employers. If your five (5) listed employers do not cover a time period of at
least ten (10) years, please use the supplemental employment page to record
your remaining employment history. Use additional pages as necessary (the
format MUST include all requested information).

• Proof of highest education (diploma, General Educational Development

[GED], college degree(s) and/or transcript(s)).

• A DD-214 Member 4 (long form) [if you have been in the military].

• NGB Form 22 (if you have been in the National Guard).

Again, thank you for your interest with the City.

Sincerely,

John Medina
John Medina
Human Resource Director
www.mybigspring.com

1
 POLICE OFFICER – CERTIFIED AND NON-CERTIFIED
Department: Police Department
Salary: $16.253/$15.470 per Hour
FLSA Classification: Non-Exempt
Shift(s): Twelve (12) hours
6:00 a.m. thru. 6:00 p.m. & 6:00 p.m. thru. 6:00 a.m.
The shifts work as follows:
A shift works:
Sunday, Wednesday, Thursday on week 1
and
Monday, Tuesday, Friday, Saturday week 2
Rotating Every 28 Days

JOB SUMMARY:
This position is responsible for the enforcement of federal, state, and local laws, the
protection of life and property and preserving the peace.

MINIMUM QUALIFICATIONS:
You must be twenty one (21) years of age to hold a Texas Peace Officers License; thus,
that translates to, you must be at least be twenty one (21) years of age the Day You
Take the Test to become a Texas Certified Police Officer. In-addition to the following:
Graduation from High School or GED. In-addition, accordance with the TEXAS
COMMISSION ON LAW ENFORCEMENT STANDARDS, applicants with a GED requires
twelve (12) hours of College Credits to be qualified to enroll in a Police Academy to
meet TEXAS COMMISSION ON LAW ENFORCEMENT STANDARDS, along with the ability
to meet other current requirements set forth by the Texas Commission of Law
Enforcement Officers Standards and Education. Possession of or ability to readily obtain
a valid driver’s license issued by the State of Texas for the type of vehicle or equipment
operated. Ability to read, write and perform mathematical calculations at a level
commonly associated with the completion of high school or equivalent. No experience
requirements. No illegal drug use, No arrest record with higher than a class C
misdemeanor, Meets or exceed the physical agility requirements of the department.
Demonstrate proficiency with handgun, and shotgun during scheduled testing with the
department.

MAJOR DUTIES:
Attendance is an essential job function to perform the duties of this position. Patrols an
assigned zone on foot, on bicycle, and by vehicle to detect and deter criminal activity
and traffic violations. Responds to calls relayed by communications officers, including
domestic disputes, assaults, burglaries, traffic accidents, lost or missing persons
searches, public service duties, stranded motorists, and others. Conducts preliminary
investigations into traffic accidents and other incidents, including interviewing victims,
complainants and witnesses, gathering information and evidence, and securing crime
scenes. Apprehends, arrests, and processes offenders, including fugitives; subpoenas
witnesses; serves warrants. Provides assistance and backup support to other officers
and emergency service providers as necessary. Assists motorists. May provide first-aid
and CPR to victims as necessary. Provides traffic direction as needed for special events
2
such as parades, funerals, athletic events, and school crossings. Testifies in judicial
proceedings as necessary. Completes all required reports and forms, including accident
and incident reports. Inspects and maintains assigned patrol car, uniform, and
equipment. May serve as Hazardous Materials Technician. Serves criminal and court-
related paper work. Attends ongoing training classes as required. May serve as a
member of the department’s SORT team, as a field training officer for the department,
as School Resource Officer/DARE Officer; provides DARE instruction to school children.
Performs other related duties as assigned.

SKILL, KNOWLEDGE AND ABILITIES REQUIRED BY THE POSITION:

Knowledge of relevant federal and state laws, criminal and traffic codes, search and
seizure laws, city ordinances, and department policies and procedures. Knowledge of
traffic accident investigation techniques and procedures. Knowledge of the geography
and streets of the city. Knowledge of first-aid and CPR techniques. Knowledge of the
court system and judicial procedures. Skill in operating police vehicles, firearms, and
emergency equipment. Skill in operating radios and communications equipment. Skill in
operating radar equipment. Skill in evidence packaging. Skill in restraining persons
without causing physical harm. Skill in controlled substance field-testing. Skill in the use
of a computer. Skill in oral and written communication.

SUPERVISORY CONTROLS:
The Sergeant - Patrol assigns work in terms of general instructions. Work is reviewed
for accuracy, compliance with established procedures, and the nature and propriety of
the final results.

GUIDELINES:
Guidelines include state and federal laws, traffic laws, city ordinances, court rulings,
constitutional guidelines, training manuals, department policies and procedures, and
supervisory instructions. These guidelines are generally clear and specific, but require
some interpretation in application.

COMPLEXITY:
The work consists of related law enforcement duties. The varied nature of calls and the
potential for emergencies contribute to the complexity of the work.

SCOPE AND EFFECT:

The purpose of this position is to protect life and property and enforce federal, state,
and local laws. Successful performance helps ensure the safety and well-being of
citizens and contributes to the efficient and effective operation of the department.

PERSONAL CONTACTS:
Contacts are typically with co-workers, other city employees, other emergency service
providers, court system personnel, attorneys, judges, medical personnel, law
enforcement officers from other agencies, and the general public.

PURPOSE OF CONTACTS:
Contacts are typically to give or exchange information, provide services, interview
persons, resolve problems, and negotiate or settle matters.
3
PHYSICAL DEMANDS:
The work is typically performed while sitting, standing, walking, running, bending,
crouching or stooping. The employee occasionally lifts light or heavy objects, uses
equipment requiring a high degree of dexterity, and must be able to distinguish
between shades of color and use the physical force necessary to arrest and restrain
persons.

WORK ENVIRONMENT:
The work is performed indoors, in a vehicle, and outdoors. The employee may be
exposed to inclement weather, infectious diseases, and life-threatening situations. The
work requires the use of protective clothing and devices.

SUPERVISORY AND MANAGEMENT RESPONSIBILITY:

This position may serve as relief supervisor in the absence of the Sergeant.

4
 ENTRY LEVEL PHYSICAL AGILITY TEST

Each event is timed and applicants must complete the event within the prescribed time limit to
proceed to the next event and remain eligible for employment consideration. No applicant will
be permitted to re-take any portion of the physical agility they may fail until the next testing
time. Persons who are unable to meet the time limits are to contact the City Human Resources
Department for the next testing date and time. Physical agility testing will consist of the
following events in the below order.

1. TRIGGER PULL: 15 seconds per hand – Using a departmental issue weapon, the
applicant will pull the trigger thru 12 times with the strong hand using the index
finger. Weapon will be held at shoulder point, away from the body. Exercise
repeated with weak hand. (Applicant may use his/her own personal weapon.
Prior departmental approval of the weapon by the departmental armorer is
required).

2. SHOTGUN LOAD: 30 seconds – Using a department Remington 870 shotgun, the

applicant will load the shotgun with four (4) dummy rounds and cycle all shells
through the weapon while at shoulder point.

3. 220-YARD RUN: 42 seconds – The applicant will run 220 yards over a designated
course

4. 165 LB DUMMY DRAG: 35 seconds – The applicant will begin seated in a police
vehicle with the door closed. The applicant will exit the vehicle, run to a
simulated person weighing 165 lbs., and drag the dummy completely past the
front bumper of the vehicle. Distance is 75 feet.

5. OBSTACLE COURSE: 80 seconds – Applicant will drive a police vehicle to a

specified location, stop and secure it. Applicant will exit the vehicle running to
and proceeding through the tires, hitting each tire. Applicant will then proceed
to and through a tunnel. Upon exiting, they will proceed to a set of four (4) foot
bars, going over the first bar. They will then zigzag between the remaining bars,
not touching the bars. The applicant will proceed to the incline wall, climbing it
and touching the top rung, crossing to the opposite side, climb down and
proceed to a four (4) foot wall, go over it and run past the finish line. During the
obstacle course, the applicant will be expected to locate and identify verbally,
three (3) items. A five (5) second penalty will be accessed for each item not
located.

YOU MUST BRING TENNIS SHOES & GYM CLOTHES FOR PHYSICAL AGILITY TESTS.

Lonnie Smith
Chief of Police

400 East 4th, Big Spring, Texas 79720-2635 (432) 264-2550 Fax (432) 264-2415

5
 POLICE DEPARTMENT’S
APPLICANT PACKET CHECKLIST

APPLICANT’S FULL LEGAL NAME: LAST FIRST MIDDLE

SOCIAL SECURITY #: TODAY’S DATE:

Initials
City of Big Spring Original Employment Application

City of Big Spring Drug & Alcohol Policy Form

City of Big Spring EEO Compliance Form

Authorization for Release of Information Agreement

(to be signed in the presence of a Notary Public)

Pre-Employment Psychological Evaluation Waiver of Confidentially

(Only for Police, Communication and Jailer Applicants)

Willingness Questionnaire
(Only for Police Officer Applicants)

Copy of High School Diploma or GED Certificate

(Plus Highest Level completed ie. Associates, Bachelors, Masters, Doctorates)

Military DD214 Member 4 copy and/or NGB FORM 22 (If applicable)

Copy of Valid State Driver’s License

Copy of Social Security Card

Certified Copy of Law Enforcement Academy Certification (Location)

Personal History Questionnaire

(to be submitted upon successful completion of testing)

NOTES:

6
 WILLINGNESS QUESTIONNAIRE
TO BE COMPLETED BY POLICE OFFICER APPLICANTS ONLY

FULL LEGAL NAME: TODAY’S DATE:

Please complete the following questions concerning the Police Officer position for which you are
applying:
Yes or No
1. Are you willing to stand in the middle of a busy intersection directing traffic, wearing a
helmet in 110 degree weather?
2. Are you willing to physically examine a dead body for signs of injury?
3. Are you willing to work or legal holidays (i.e. Christmas Day, Thanksgiving, July 4th)?
4. Are you willing to work on rotating shifts with days off?
5. Are you willing to report for duty upon short notice or on days off – sacrificing personal
plans?
6. Are you willing to investigate accidents in the rain, snow, sand storm, etc.?
7. Are you willing to arrest a friend if it is necessary?
8. Are you willing to spend hours writing reports while on overtime?
9. Are you willing to work 13 hours in a row if necessary?
10. Are you willing to handle situations that involve the possibility of injury to yourself?
11. Are you willing to accept a court decision that runs contrary to your own wishes?
12. Are you willing to subject yourself to intense public scrutiny and criticism?
13. Are you willing to accept being told exactly what to do?
14. Are you willing to maintain your composure while being insulted or sworn at?
15. Are you willing to observe an autopsy if required?
16. Are you willing to notify a citizen that a member of their immediate family has just been
killed?
17. Are you willing to investigate situations involving abused or molested children?
18. Are you willing to undergo four (4) months of intensive training before being able to
work on your own?
19. Are you willing to take another human’s life if necessary and appropriate?
20. Are you willing to deal with suicide victims and their families?
21. Are you willing to search a dark building for a dangerous suspect if necessary?
22. Are you willing to risk your life for the safety of a citizen or fellow officer?
23. Are you willing to enforce laws that you do not agree with?

If you answered “NO” to any of the above questions, please reconsider applying for this
position.

7
 310 Nolan Ph. (432) 264-2346
Big Spring, TX 79720 Fax (432) 264-2387

Attached is information concerning the Big Spring Police Department’s recruiting

process and an application for employment as a Police Officer. Please read the
enclosed information carefully before completing the application. You must meet the
minimum qualifications and not meet any of the listed disqualifications. The completed
application must be signed and notarized then returned in person or by mail to:

CITY OF BIG SPRING

HUMAN RESOURCES DEPARTMENT
310 Nolan
Big Spring, TX 79720

Upon receipt, your application will be reviewed to determine if you qualify for the next
step in the application process. You will be notified of this decision by mail or
telephone.

It is not necessary for you to contact the City of Big Spring regarding any job openings
after you have completed and returned your application. If you are among the most
qualified applicants for a position, an interview will be arranged.

Note: After you have completed and returned the application, you are required to
inform the Human Resources Department of any changes (address, phone number,
application with other departments, etc.). Failure to do so may result in disqualification
of your application.

APPLICANT INSTRUCTIONS
Your interest in employment with the Big Spring Police Department is appreciated. In
order to gain a better understanding of your background and work history, we ask that
you answer all questions completely and to the best of your knowledge. Use the
abbreviation “NA” if a particular provision or section in the form is not applicable to you.
Incomplete applications will not be considered. The application must be
handwritten in ink by the individual applying.

Employment decisions are made solely on the basis of qualifications to perform the
work for which you are applying. Qualifications include education, training, work
experience and other factors which are relevant in determining job performance. All
information provided in this application will be verified through schools, former
employers, licensing/certification agencies or other sources if applicable.

8
APPLICANT INFORMATION
Requirements
Must be at least 21 years of age.
Must have 20.20 vision (correctable with lenses).
Must have a High School Diploma or GED Certificate with college hours as required by Texas
Commission on Law Enforcement Standards and Education (TCLEOSE).
Must have a valid and current Texas driver’s license or obtain one by time of employment.

Disqualifications
Any of the following will disqualify an applicant from further consideration at any stage of the
process:
⌦ Having a conviction for, being under indictment for, or currently charged with any felony
offense.
⌦ Having a conviction for or currently charged with any misdemeanor offense that would be
considered as one involving moral turpitude.
⌦ Having a conviction for Driving Under the Influence (DUI or DWI).
⌦ Currently being on probation for any offense.
⌦ Inability to comply with Texas Commission on Law Enforcement Officer Standards and
Education (TCLEOSE) requirements.
For all of the above, a person is convicted of an offense when a court of competent
jurisdiction enters an adjudication of guilt on the offense against the person whether or
not:
• the sentence is subsequently probated and the person is discharged from probation
including deferred adjudication;
• the accusation, complaint, information or indictment against the person is dismissed
and the person is dismissed and released from all penalties and disabilities resulting
from the offense; or
• the person is pardoned for the offense, unless the pardon is expressly granted for
subsequent proof of innocence.

⌦ Having habitually used excessive amounts of alcoholic beverages in the past.

⌦ Having illegally used marijuana within three (3) years preceding the written examination.
Any previous use of a powder or liquid controlled substance is prohibited.
⌦ Having illegally used any controlled substance or dangerous drug to the extent beyond
“experimental”.
⌦ Having illegally furnished any controlled substance or dangerous drug to another person.
⌦ Having an excessive record of traffic convictions or negligent traffic collisions as defined in
the City of Big Spring Personnel Policies and Procedures.
⌦ Not being of good moral character; or being known to habitually associate with those of
questionable moral character.
⌦ Having a series of delinquent payments or not meeting financial obligations or repeated
occurrences of issuing checks without sufficient funds, when there are no extenuating
circumstances present to explain the situation.
⌦ Having been discharged from military service with a dishonorable discharge or having been
convicted of any offense tries before a general court martial (discharge must meet TCLEOSE
standards).
⌦ Being a member of any organization, that advocates the overthrow of the government by
force or violence.
⌦ Having been discharged from any commissioned or recruit position within a law
enforcement agency for disciplinary reasons, resigning to avoid suspension or discharge or
having resigned during a disciplinary investigation without a final judgment having been
rendered.
9
⌦ Failing to cooperate fully with and keep all scheduled appointments with staff personnel
involved in the selection process. Failing to provide added personal information as needed
or failing to submit information within 15 days of the change. Refusal to submit, if
requested, to a polygraph exam to resolve any conflict(s) that may arise during the
background investigation.
⌦ Making any false statement of fact, being deceptive by statement or omission in the written
application or by any means in any part of the selection process.
⌦ Where evidence exists to indicate that in any official matter or in any significant business
transaction the applicant has made false statements, falsely sworn to statements or in any
other manner falsified testimony.
⌦ Without being specifically enumerated in the above disqualifications, if circumstances exist
that indicate the applicant is clearly unsuited for a career with the Big Spring Police
Department; the application will be rejected.
The Chief of Police or his designee will make all interpretations regarding these
requirements.

APPLICANT PROCESS
The following is an outline of the hiring process. Each stage must be successfully completed
before proceeding to the next step.

Preliminary Application
To be considered for employment with the Big Spring Police Department, a candidate must
complete the preliminary application. The application must contain truthful and complete
responses. “NA” or “None” must be written in each blank that does not apply. The
applications must be printed.
Written Examination
Applicants will be notified by mail or telephone if they are to progress to the written
examination. The written examination is designed to test the relative skills and capacity of
each applicant.
Applicants who pass the written examination are required to complete the following two
procedures as scheduled: Physical Agility Test and Oral Interview
Oral Interview
Applicants who successfully complete the physical agility test will be required to appear
before a panel of department staff for interview. The interview will cover information
learned about the applicant during the previous stages. The applicant will be asked
questions designed to demonstrate certain knowledge, skills and abilities considered basic
for effective performance as a police officer with the Big Spring Police Department.
Personal History Questionnaire
Applicants who pass all of the above stages will be given a Personal History Questionnaire.
This document must be completed, notarized and returned to the Human Resources
Department within the time frame established by that department. Each applicant is also
required to sign an “Agreement Authorizing Release of Information”.
Background Investigation
A thorough background investigation is conducted to establish evidence of good moral
character, a well-adjusted personality and a pattern of conduct acceptable to the Big Spring
Police Department.
Polygraph
Polygraphs are performed on all candidates to ensure truthfulness.

10
Applicants who pass the above will receive a conditional offer of
employment and continue the next stages.
Psychological Review
Applicants who pass the oral interview will be scheduled for a psychological review. The
review is designed to assess the candidate’s mental and emotional fitness to function
successfully as a Big Spring Police Officer.
Medical Assessment
Upon successful completion of the drug screen (a negative result), a prospective employee
will complete a Medical History and Mobility Evaluation form and will be examined by a
designated physician. The physician will assess each candidate’s physical condition to
ensure he/she can function safely as a Big Spring Police Officer. Prospective police officers
that pass the medical assessment will receive final offers of employment depending on the
number of open positions.
Firearms
Applicants who successfully complete the background investigation stage will be required to
pass a course established by department guidelines with a score of eighty percent (80%).

11
 POLICE EMPLOYMENT APPLICATION
City of Big Spring / 310 Nolan, Big Spring, Texas 79720
PHONE: (432) 264 - 2346 FAX: (432) 264 - 2387

The City of Big Spring is an Equal Opportunity Employer and encourages applications from eligible and
qualified persons regardless of race, color, religion, sex, age, national origin or physical disability.

Your interest in employment with the City of Big Spring is appreciated. In order to gain a better understanding of your background and
work history, we ask that you answer all questions completely in your own handwriting and to the best of your knowledge. Information
provided is subject to verification. Incomplete applications will not be considered.

POSITION APPLYING FOR: _____________________________________________DATE:______________

PERSONAL INFORMATION
Last Name First Middle

Street Address Social Security #

City State ZIP

Phone Alternate Phone: Email:

Are you at least 21 years of age? YES NO

Are you legally eligible for employment in the United States? YES NO

Do you work for or have you ever worked for the City of Big Spring before? YES NO If yes, please give dates and positions
held:

Are you related by blood or marriage to any City Council member or employee of the City of Big Spring? YES NO If yes,
whom?

Name________________________________________ Relationship________________________ Department________________________

Name________________________________________ Relationship________________________ Department________________________

Have you ever been discharged from the Armed Forces under other than honorable circumstances? (You must attach a copy of your
DD 214 long form) YES NO If yes, please explain:

Have you ever been convicted of, plead guilty to, received deferred adjudication, or any form of court supervision for any criminal offense
(misdemeanors and felonies) other than minor traffic violations within the last ten (10) years? YES NO If yes, please explain:

NOTE: Prior to employment, applicant will be investigated for prior convictions of criminal offenses. A prior conviction will not automatically
disqualify an applicant for employment but will be considered only as it relates to the job under consideration.

EMPLOYMENT DESIRED

Check all types of work that you will accept: FULL TIME PART TIME TEMPORARY

DAYS NIGHTS SHIFTS

When are you available to begin work? ________________________

Have you read and do you understand the requirements of the job for which you have applied? YES NO
Can you perform the essential functions of this job with or without a reasonable accommodation? YES NO
All City of Big Spring employees must live within a thirty (30) commute to their workstation. This provision must be met by the end of the
employees six (6) month probationary period. Does this pose a problem to you? YES NO

12
EDUCATION, TRAINING, AND SKILLS

Do you have a high school diploma? YES NO Do you have a GED? YES NO

Diploma or GED certificate received from ________________________________ City and State______________________________

College, Post Graduate, Technical, or Vocational School:

Location Years Degree
Name Course of Study
Address, City, State Completed Received

Describe any other specialized training, apprenticeships, professional licenses:

List any other skills related to the job for which you are applying:

Do you have a valid Texas driver’s license? YES NO License # _____________________________

Type of License: Operators Class A CDL Class B CDL Class C CDL

Has your driver’s license ever been suspended or revoked? YES NO If yes, please explain:

13
EMPLOYMENT HISTORY

Beginning with the most recent, list all employment. ALL APPLICABLE BLANKS MUST BE COMLETED. Resumes may not be submitted in
place of employment history, but may be attached as a supplement to your application.

If any employment was under a different name, indicate name: ___________________________________________

Employer Phone ( )

Position Employment
Held Dates
Address
Salary $
City, State
Type of
Supervisor
Business

May we contact this employer? YES NO

Brief descriptions of duties:

Reason for leaving:

Employer Phone ( )

Position Employment
Held Dates
Address
Salary $
City, State
Type of
Supervisor
Business

May we contact this employer? YES NO

Brief descriptions of duties:

Reason for leaving:

14
Employer Phone ( )

Position Employment
Held Dates
Address
Salary $
City, State
Type of
Supervisor
Business

May we contact this employer? YES NO

Brief descriptions of duties:

Reason for leaving:

Employer Phone ( )

Position Employment
Held Dates
Address
Salary $
City, State
Type of
Supervisor
Business

May we contact this employer? YES NO

Brief descriptions of duties:

Reason for leaving:

Please explain any periods of unemployment:

Have you been discharged or asked to resign from a job in the last five (5) years? YES NO If yes, please explain:

15
PERSONAL REFERENCES
List three people whom you have known for at least three years – do not include relatives or former employers.

Full Name Relationship

Address Phone ( )

How long have you known this person? Occupation

Full Name Relationship

Address Phone ( )

How long have you known this person? Alt. Phone ( )

Full Name Relationship

Address Phone ( )

How long have you known this person? Alt. Phone ( )

OTHER

How did you learn of this job opening? (Check one)

Newspaper Ad Which Newspaper? __________________________________________________

Workforce Commission City of Big Spring Website City Employee Walk In Other _________________________

PLEASE READ CAREFULLY BEFORE SIGNING

Hereby certify that all information given on this application is true, correct, and complete to the best of my knowledge. I understand that
discovery of misrepresentation or omission of facts herein will make me ineligible for employment and is cause for immediate dismissal.

I hereby authorize any corporation, former employer, educational institutions, law enforcement agencies, city, county, state, and federal
courts and military services to release information about my background including, but not limited to, information about employment,
education, criminal record, driving record and general reputation. I agree to furnish any additional information required to complete the
background check. I release all relevant parties from all liability resulting from furnishing such information. I indemnify the City of Big
Spring against any liability which may result from making such inquiries.

I also understand that employment with the City of Big Spring is contingent upon the results of an employment physical and drug alcohol
screen.

I further understand that this is an application for employment and that no employment contract, whether express or implied, is being
offered. I also understand that, if employed, such employment is for no fixed or definite period and is subject to change in wages,
conditions, benefits and operating policies. Any employment is “at will” and may be terminated at any time, with or without notice.

__________________________________________________ _____________
Signature of Applicant Date

Subscribed and sworn to before me, by said ___________________________________________, this ______ day of________, 20____ to
certify which witness my hand and seal of office.

____________________________________________
Notary Public

16
 DRUG AND ALCOHOL POLICY
APPLICANT’S OVERVIEW FORM
The City of Big Spring has a commitment to a drug-free workplace as a leader in promoting a drug-free
work force.

All applicants, upon a conditional offer of employment for regular full or part-time
positions and temporary positions, will be required to submit a urine sample for the
purpose of a drug screen. A job applicant who refuses to consent to a drug and alcohol
test, fails to report to the collection site, or fails (tests positive) for such test will be
denied employment for at least two (2) full years.

If a sample is positive the applicant will be given the opportunity to report any
medications that have been recently used to the Medical Review Officer (MRO).

A positive test result will be confirmed by a second test using a gas

chromatography/mass spectrometry (GC/MS) test, using a portion of the same sample.
The Human Resource Director will notify by telephone and in writing applicants who are
disqualified based upon a positive test result. Applicants may appeal the disqualification
by submitting a written statement to the Human Resource Department within seventy-
two (72) hours from first notification of disqualification, and providing the necessary
funds to complete the second (2nd) test. If the second (2nd) test is negative the City will
reimburse the applicant.

All employees are subject to a Drug and Alcohol Policy depending upon their jobs,
which may include testing under the following conditions: post-vehicle accident, post-
incident, reasonable suspicion, random and firearm discharge.

I certify that I have read the above overview of the City of Big Spring Drug and Alcohol
Policy and consent to comply with all provisions of the policy.

Social Security Number

Printed Name

Signature

Date

Revised 10/01/06

17
 PRE-EMPLOYMENT PSYCHOLOGICAL EVALUATION
WAIVER OF CONFIDENTIALITY

I understand that after a conditional offer of employment has been made for a Police
Officer, Communications Officer, or Jailer with the City of Big Spring, I will be examined
by a physician or qualified psychologist and be found to be free of any emotional or
mental condition which might adversely affect my ability as a Police Officer,
Communications Officer, or Jailer. Such examination or examinations will include, but
not necessarily be limited to, the Minnesota Multiple Personality Inventory (MMPI) and
not less than one clinical interview session with the physician or qualified psychologist.

I further understand that the results of my psychological examination or examinations

will be reviewed by personnel of the City of Big Spring for determination of the
suitability of my mental or emotional condition for Police Officer, Communication
Officer, or Jailer duties with or without reasonable accommodation with the American’s
with Disabilities Act (ADA).

Therefore, I waive any privilege of confidentiality of “physician-patient relationship,” or

psychotherapist-patient relationship,” to the extent that the results of the examination
herein before described may now or at any future time be released to the City of Big
Spring, its officers, agents or assigns, for the purpose of assessing my emotional and
mental suitability for detention officer duties and authorize such physicians,
psychologists, their agents or employees, to release such records.

Dated this day of , 20 , in the County of Howard, State

of Texas.

Printed name of person giving consent

Signature of the person giving consent

18
 APPLICANT EEO DATA FORM

The information requested is optional and is being collected for the purpose of reporting to Federal and Equal
Employment Opportunity Agencies and will not be considered as part of the application for employment.
It will be separated from the application.

1. Position Applying 2. Social Security No. 3. Last Name (Type or Print) First Middle

4. Address City State ZIP Code 5. Home Phone 6. Work Phone

7. Sex 8. Birth Date 9. Ethnic Origin (Check mark preferred)

__ Male Asian/Pac. Am.Ind/
__ Female __ White __ Black __ Hispanic __ Islander __ Alaskan __ Other

10.Veteran 11. Spouse of Veteran 12. Orphan of Veteran

__ Yes __ Yes __ Yes
__ No __ No __ No

13. How did you find out about this job?

__ Other City Employee __Newspaper __WorkIn Texas.com

__Job Fair __College/University Career Day __Other (specify)

__Presentation Publication __Human Resource/Personnel Officer

__Recruitment Poster __Radio

__Television __City Web Site - Internet

Signature-Applicant Date

White (Not of Hispanic origin) - All persons having origins in any of the original peoples of Europe, North
Africa, or the Middle East.
Black (Not of Hispanic origin) - All persons having origins in any of the Black racial groups of Africa.
Hispanic - All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish
culture or origin, regardless of race.
Asian or Pacific Islander - All persons having origins in any of the original peoples of the Far East,
SoutheastAsia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example China, India,
Japan, Korea, the Phillippine Islands, and Samoa.
American Indian or Alaskan Native - All persons having origins in any of the original peoples of North
America, and who maintain cultural identification through tribal affiliation or community recognition.

An Equal Opportunity Employer

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 Human Resource Dept.
City of Big Spring
310 Nolan
Big Spring, TX 79720
(432) 264-2345

AGREEMENT AUTHORIZING RELEASE OF INFORMATION

TO WHOM IT MAY CONCERN: I, , am an applicant
for a position with the City of Big Spring Police Department. The City of Big Spring
needs to thoroughly investigate my employment background and personal history to
evaluate my qualifications to hold the position for which I applied. It is in my and the
public’s interest that all relevant information concerning my personal and employment
history is disclosed to the above department, (except for information covered by the
Americans Disabilities Act, “ADA”).

I hereby authorize any representative of the City of Big Spring bearing the release to
obtain any information in your files pertaining to my employment records and I hereby
direct you to release such information upon request of the bearer. I do hereby
authorize a review of and full disclosure of all records, or any part there of, concerning
myself, by and to any duly authorized agent of the City of Big Spring, whether said
records are of public, private, or confidential nature. The intent of this authorization is
to give my consent for full and complete disclosure. I reiterate and emphasize that the
intent of this authorization is to provide full and free access to the background and
history of my personal life, for the specific purpose of pursuing a background
investigation that may provide pertinent data for the City of Big Spring to consider in
determining my suitability for employment with that City. It is my specific intent to
provide access to personal information, however personal or confidential it may appear
to be.

I consent to your release of any and all public and private information that you may
have pertained to me, my work background and reputation, my military service records,
educational records, my criminal history record, including any arrest records, any
information contained in investigatory files, efficiency ratings, complaints or grievances
filed by or against me, the records or recollections of attorneys at law, or other counsel,
whether representing me or another person in any case, either criminal or civil, in which
I presently have or have had an interest, attendance records, polygraph examinations,
and any internal affairs investigations and discipline, including any files which are
deemed to be confidential, and/or sealed.

Applicants Initials

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I hereby release you, your organization, and all others from liability or damages that
may result from furnishing the information requested, including any liability or damage
pursuant to any state or federal laws. I hereby release you as the custodian of such
records of the City of Big Spring, including its officers, employees, and other 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 my associates
because of compliance with this authorization and request to release information, or
any attempt to comply with it. I direct you to release such information upon request of
the duly accredited representative of the City of Big Spring regardless of any agreement
I may have made with you previously to the contrary. The Personal Representative
requesting the information pursuant to this release will discontinue processing my
application if you refuse to disclose the information requested.

For and in consideration of the City of Big Spring’s acceptance and processing of my
application for employment, I agree to hold the City of Big Spring, its agents and
employees harmless from any and all claims and liability associated with my application
for employment or in any way connected with the decision whether or not to employ
me with the City of Big Spring. I understand that should information of a serious
criminal nature surface as a result of this investigation, any such information may be
turned over to the proper authorities.

I understand my rights under Title 5, United States Code, Section 552a, the Privacy Act
of 1974, with regard to access to disclosure of records, and I waive those rights with
the understanding that information furnished will be used by the City of Big Spring in
conjunction with employment procedures. I further agree that I shall not have the right
to read or otherwise review any information received by the City of Big Spring as a
result of inquiries pursuant to this Agreement Authorizing Release of Information.

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

This waiver is valid for a period of twelve (12) months from the date of my signature.

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

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

Applicants Initials

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THIS SECTION TO BE COMPLETED IN THE PRESENCE OF A NOTARY:

Printed Name of Person Giving Request

Signature

Date of Birth

Current Address

City State Zip Code

( ) ( )
Primary Phone # Secondary Phone #

STATE OF TEXAS
COUNTY OF HOWARD

SUBSCRIBED AND SWORN TO before me this____day of _, 20 ,

by .

Notary Public

My Commission Expires:

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 THE CITY OF BIG SPRING
POLICE DEPARTMENT
PERSONAL HISTORY QUESTIONNAIRE
Based on the detailed personal information contained in this questionnaire, we are
including it in our envelope for your completion. However, do not submit this
questionnaire with the application packet. The background officer, upon your
successful completion and passing of the following, will request it:
1. Completed application
2. Motor Vehicle/Drivers’ License check and
Criminal History

Upon successful completion of the above items, you are eligible to test for Police Officer
vacancy. You will receive a phone call, and be scheduled for the following steps.
3. Written test, upon scoring a passing grade
4. Physical agility test, upon successful completion
5. Oral boards
At this time, a detailed background and personal history will be conducted and you will
be requested to submit this Personal History Questionnaire.

WARNING!!
This is not part of the application packet. This questionnaire is desired to
obtain relevant information of your character and other related history to
ensure the safety of the public and to provide the legal system (the Courts)
with Police Officer’s qualified to testify under oath in a Court of Law.

PAGE 1 OF 6
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 PERSONAL HISTORY QUESTIONNAIRE
(Please Print)

IDENTIFICATION

NAME:________________________________________________________________________
Last First Middle

SOCIAL DATE
SECURITY NUMBER:_____________________________ OF BIRTH:_____________

NICK-NAME(S), MAIDEN NAME, OR OTHER NAMES BY WHICH YOU HAVE

BEEN KNOWN:________________________________________________________________
PLACE OF BIRTH:______________________________________________________________
City County State
ARE YOU A U.S. CITIZEN? [ ] YES [ ] NO

DRIVER’S LICENSE #: ___________________ STATE OF ISSUE: ___________________

COLOR OF EYES: __________________ COLOR OF HAIR: ____________________

SCARS, TATTOOS OR OTHER DISTINGUISHING MARKS: _______________________________

_____________________________________________________________________________

BLOOD TYPE: ____________________

RESIDENCES: List ALL addresses where you have lived during the past 10 years, beginning
with present address. List date by month and year. Attach extra page if necessary.

FROM TO ADDRESS

____________ ____________ _______________________________________________

____________ ____________ _______________________________________________

____________ ____________ _______________________________________________

____________ ____________ _______________________________________________

____________ ____________ _______________________________________________

___________ ____________ _______________________________________________

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 MILITARY

U.S. VETERAN? [ ] YES [ ] NO

DATES OF SERVICE: FROM ____________TO____________

BRANCH MILITARY
OF SERVICE:_____________________________ SERVICE NUMBER:_____________

WERE YOU EVER DISCIPLINED WHILE IN THE MILITARY SERVICE? (Include Court Martial,
Captain’s Masts, Company Punishment, Etc.) [ ] YES [ ] NO
CHARGE AGENCY DATE AGE AT TIME DISPOSITION
__________ __________ _______ _____________ _______________________

__________ __________ _______ _____________ _______________________

__________ __________ _______ _____________ _______________________

__________ __________ _______ _____________ _______________________

PLEASE GIVE COMPLETE DETAILS OF YOUR MILITARY DISCHARGE:

MARITAL AND FAMILY HISTORY

ARE YOU? [ ] SINGLE [ ] ENGAGED [ ] MARRIED

[ ] SEPARATED [ ] DIVORCED [ ] WIDOWED
IF ENGAGED: NAME OF FIANCE: _____________________________________________
ADDRESS:______________________________________________________________
IF MARRIED: SPOUSE’S NAME: (with maiden name)________________________________
DATE OF MARRIAGE: ___________CITY AND STATE:_______________________
IF DIVORCED, ANNULLED, WIDOWED:
DATE OF MARRIAGE: ___________CITY AND STATE: _______________________
DATE OF DIVORCE, ANNULMENT, DECEASED:____________________________
SPOUSE’S NAME (with maiden name) AND ADDRESS: ________________________
________________________________________________________________________
COURT AND STATE OF DIVORCE, ANNULMENT:___________________________

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LIST ALL CHILDREN RELATED TO YOU OR YOUR SPOUSE: (Natural, step-children, adopted
and foster children):

NAME RELATION BIRTHDATE ADDRESS SUPPORTED BY

DO YOU HAVE OTHER DEPENDENTS? If so, please list:

LIST RELATIVES IN THE FOLLOWING ORDER: FATHER, MOTHER (include maiden name),
BROTHERS, SISTERS (if deceased so indicate):

NAME ADDRESS & PHONE # RELATION AGE

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 FINANCIAL HISTORY

SOURCES OF INCOME: _________________________________________________

________________________________________________________________________
WHAT IS YOUR PRESENT SALARY OR WAGE?:____________________________
DO YOU HAVE ANY INCOME FROM ANY SOURCES OTHER THAN YOUR PRINCIPAL
OCCUPATION? [ ] YES [ ] NO
IF YES, HOW MUCH? ______________________ HOW OFTEN?_________________
THE SOURCE? __________________________________________________________
DO YOU HAVE ANY REAL ESTATE? [ ] YES [ ] NO
VALUE $________________ LOCATION __________________________________

DO YOU OWN ANY CORPORATE STOCK? [ ] YES [ ] NO VALUE $_________

DO YOU HAVE A BANK ACCOUNT? [ ] YES [ ] NO

SAVINGS – AVERAGE BALANCE $________________________________________

NAME AND ADDRESS OF BANK: _________________________________________

CHECKING – AVERAGE BALANCE $ ______________________________________

NAME AND ADDRESS OF BANK: _________________________________________

FINANCIAL OBLIGATIONS: Give name and addresses of the individuals, companies or

others to whom you are indebted and the extent of your debt. Include rent, mortgages, vehicle
payments, charge accounts, credit cards, loans, child support payments, and any other debts
and payments, include account numbers where applicable. Continue on separate sheet if
needed.

CREDITOR NAME REASON FOR DEBT MONTHLY PMT.

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 ORGANIZATIONS

LIST ALL ORGANIZATIONS YOU ARE CURRENT AND PAST, YOU ARE OR HAVE BEEN A
MEMBER OF (i.e.: Social, Fraternal, Professional, etc.):

NAME ADDRESS TYPE FROM TO

PERSONAL DECLARATIONS

IF IT BECOMES NECESSARY TO TAKE HUMAN LIFE IN THE COURSE OF YOUR DUTIES AS A

POLICE OFFICER, WOULD ANY BELIEFS PREVENT YOU FROM DOING SO? [ ] YES [ ] NO
IF YES, PLEASE EXPLAIN: _______________________________________________
________________________________________________________________________
________________________________________________________________________
I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements
and answers to questions. I am fully aware that any such willful misrepresentations, omissions, or falsifications may
be grounds for immediate rejection or termination of employment.

____________________________________
Signature of Applicant
Date:___________________________

Subscribed and sworn to before me, by the said _________________________________

this the ___________ day of _____________________, 200__ to certify which witness
my hand and seal of office.

____________________________________
Notary Public in and for the State of Texas
My Commission expires:_______________

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