Tulsa Police Department
Recruit Contact Screening Form

Use the TAB key to move from field to field.  Do NOT use the ENTER key!
 
 

I.  PERSONAL INFORMATION
 I am applying for

Full Legal Name (last, first, middle)

  Social Security Number

List all other Names (Include any Maiden Names and Legal Name Changes, List Date and Reason for Change)
Drivers License State Class Expiration Year Date of Birth Birthplace
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Residence Address

City

State

Zip

Home Phone Number Work Phone Number Pager Number
( ) ( ) ( )
Alternate Message Number Fax Number Cellular Number
( ) ( ) ( )
Are you a  citizen of the United States?      If naturalized, List Date, Location and Judge
  Yes   No

II.  EMPLOYMENT HISTORY

Your Current Employer
From To Address Telephone
Hrs. Worked/Week Shift Supervisor Salary/Wage
Job Title and Duties
Reason For Leaving     If Other, Please Explain
  Laid Off   School Quit  Fired Forced   Other
Have you ever attended a Law Enforcement Academy or been certified as a Law Enforcement Officer? Yes   No
If Yes, List when and where

III.  EDUCATION HISTORY
Are you currently enrolled in any School, College or University?   Yes   No Projected Graduation Date 

The most recently attended/currently enrolled school, including business colleges, technical/vocational, correspondence and military schools.

College/Universities
School Name Address From To
Year Graduated Degree Obtained Hours Earned GPA Additional Comments

Vocational/Technical/Military or other Post Secondary Schools
School Name Address From To
Year Graduated Degree Obtained Hours Earned GPA Additional Comments

 


 

 Tulsa Police Department
Recruit Contact Screening Form

IV.  MILITARY HISTORY
Have you ever served in the military? Yes   No    If yes, list branch and units below
Branch Type of Unit MOS Job Title/Description
Date of Enlistment Dates of Active Duty Highest Rank on Active Duty
Type of Discharge or Separation
 Honorable   Dishonorable Bad Conduct  General-Under Honorable General-Under Other than Honorable  
Date of Discharge Rank at Discharge Date of Rank Total Amount of Military Service
Years  Months  Days 
Unit Name and Address   Commanding Officer Name and Phone Your Current Rank

V.  CRIMINAL AND DRIVING HISTORY
List all official contact you have had with any law enforcement agency or court system.  This includes Municipal, County, State and Federal Agencies or Court Systems, including Military Courts, Military Police and Military Investigative Units.  List all incidents where you have been questioned, warned, issued a summons, detained, arrested or convicted.  This includes all infractions, ordinance violations, misdemeanors and felonies.
NOTE:  The existence of an arrest record and/or conviction is NOT an automatic disqualifying factor.  Giving a false answer  IS a disqualifying factor.
    Date Agency or Court Charge Sentence Officer Disposition
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4.

Have you ever been questioned, detained, arrested, investigated, warned or issued a citation for any misdemeanor or felony, other than traffic, either as an adult or juvenile?  		  Yes   No

VI.  DRUG AND ALCOHOL USE

Do you currently use ANY drug?  		 
Yes   No

If Yes, List what drug and to what extent

Do you now, or have you ever, used, possessed, supplied or sold any narcotic or controlled substance such as but not limited to Marijuana, Hashish, Cocaine, LSD, Methamphetamine, Heroin, Steroid Pharmaceuticals or drugs of a similar nature ?  		  Yes   No

VII.  CREDIT AND FINANCIAL HISTORY
  List all banking institutions where you have an account
   Name of Bank Address Savings Account # Checking Account #
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 Tulsa Police Department
Recruit Contact Screening Form

VIII.  FAMILY INFORMATION AND MARITAL STATUS
Current Marital Status
 Married    Unmarried  Widowed    Annulled  Divorced   Engaged   Separated    Other
If Other explain
Date Married Location (Country, State, County and City)
Spouse's full name before marriage (Maiden Name) Spouse's Birth Date Spouse's Social Security Number
Spouse's Former Address Spouse's Place (or former place) of Employment
Spouse's Current Job Title Spouse's Work Phone Spouse's Work Hours

List all children and/or other dependents (include foster, step or adopted).
   Child's Full Name Date of Birth Birth/Legal Parent Present Address
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My email address is  In order to use the online application you must provide a valid email address.  If the email address is not valid, the application will not be processed.  If you do not wish to provide an email address please contact a recruiter to fill out a paper questionnaire.   
 PRIVACY POLICY.

The City of Tulsa Police Department is an Equal Opportunity Employer

By clicking on the Submit button I hereby certify that there are no willful misrepresentations, omissions or falsifications in the questionnaire and that all answers are true and correct to the best of my knowledge and belief.  I understand that if at any time during the background investigation questions should arise concerning this questionnaire I could be required to submit to a polygraph examination.