Print Application Form (5 Pages)                         Return to previous page

CORPORATION OF THE CITY OF NEW WESTMINSTER
		New Westminster Police Service
		Application for Employment
		Police Constable				Reserve Constable
1.     PERSONAL DATA
	Mr.	Miss
Name:	Mrs.	Ms.
			(Surname)			(First)		(Middle)
Previous Surname or other names used:
Address:
	(Street)					(Suite)
	(City)				(Province)		(Postal Code)
Telephone:
	(Home)			(Work)			(Other)
Canadian Citizen:		Yes	No		Landed Immigrant:		Yes	No
Date of Birth:					Social Insurance Number:
		(Day)	(Month)	(Year)
2.     EDUCATION AND TRAINING
(Additional pages may be attached; please follow this format)
a)  High School Graduation							Year Completed:
			(Name/Location of High School)
b)  Degree, Diploma and/or Certificate Attained
	Name/Location of Institute			Course of Study		Degree, Diploma or		Start/Finish Dates
						Certificate
c)  Additional Courses or Training; Ongoing or Incomplete Programs
	Name/Location of Institute			Course of Study		Number of Credits		Start/Finish Dates
						earned to date
2.     EDUCATION AND TRAINING (cont'd)
d)  First Aid Training
	Type of First Aid Certificate			Training Institution		Issue Date		Expiry Date
3.     EMPLOYMENT HISTORY
a)  Police Constable Experience (please include Reserve/Auxiliary Police under Volunteer Experience)
Name of Police Agency			Dates of Service			Rank Attained		Present/Last Location
Duties:
Reason for Leaving:
b)  Employment History - please start with the most recent and work back
(additional pages may be attached; please follow this format)
Name of Employer							Phone
Address
Type/Nature of Business
Supervisor's Name						Supervisor's Title
Start Date				End Date			Full-time	Part-time
Duties
If Part-time, average # of hours per month					Reason for Leaving
Name of Employer							Phone
Address
Type/Nature of Business
Supervisor's Name						Supervisor's Title
Start Date				End Date			Full-time	Part-time
Duties
If Part-time, average # of hours per month					Reason for Leaving
b)  Employment History (cont'd)
Name of Employer							Phone
Address
Type/Nature of Business
Supervisor's Name						Supervisor's Title
Start Date				End Date			Full-time	Part-time
Duties
If Part-time, average # of hours per month					Reason for Leaving
c)  Please note any employers you do not wish us to contact at this time
4.     APPLICATIONS WITH OTHER POLICE AGENCIES
(Please list all applications made within the past five years - additional pages may be attached)
Name of Police Agency				Status of Application			Date Terminated
POPAT	Yes	No			Assessment Centre		Yes	No
Date					Date
Score					Score
Sponsoring Dept.					Sponsoring Dept.
Please attach copies of the following documents to this page:								Please do not write in
								this area:
1.  Proof of Canadian citizenship or landed immigrant status (if not born in Canada)
2.  Birth Certificate
3.  Valid B.C. Driver's License
4.  Education Transcripts (proof of high school graduation plus post-secondary
	courses completed)
5.  Valid First Aid certificate
5.     OFFENCE RECORD
Have you ever been charged with a federal, provincial, or municipal offence (other than minor driving
offences)? If a criminal pardon has been granted, attach a copy of the pardon to this page.
Note:Conviction of an offence does not necessarily preclude consideration for the position of Police
Constable.
	Yes	No		If yes, give date and particulars of each charge and/or conviction:
6.     DRIVING HISTORY
List all driver's licenses held in Canada at any time
Driver's License Number				Province		Class		Restrictions
Have you ever had any driver's license suspended?					Yes	No
If yes, when?					Reason
7.     MEDICAL HISTORY
Have you experienced any type of illness, injury or accident which may affect your ability to perform the
duties of a Police Constable?			Yes	No
If yes, please explain:
Have you had eye surgery?			Yes	No	If yes, please provide date:
Please provide type of surgery and problem corrected:
8.     VOLUNTEER EXPERIENCE / COMMUNITY SERVICE
(Additional pages may be attached; please follow format)
1. Name of Agency/Club/Service							Phone
Address
Type/Nature of Agency/Service
Supervisor's/Organizer's Name
Your involvement started						Ended
Average # of hours per month that you were able to volunteer
Duties
Reason for "Leaving"
8.     VOLUNTEER EXPERIENCE / COMMUNITY SERVICE (cont'd)
1. Name of Agency/Club/Service							Phone
Address
Type/Nature of Agency/Service
Supervisor's/Organizer's Name
Your involvement started						Ended
Average # of hours per month that you were able to volunteer
Duties
Reason for "Leaving"
9.     LANGUAGE SKILLS (OPTIONAL)
Do you speak a second language				Yes	No
If yes, specify:		Knowledge Type					Level of Fluency
Language		Understand		Speak	Read	Write	Fluent	Day to Day	Basic
Enlistment with the New Westminster Police Service is contingent upon successful completion of all
phases of the recruitment process. False or misleading information will result in the applicant being
disqualified for appointment to the New Westminster Police Service. No information received from inquiries
made concerning statements in this questionnaire will be released to the applicant.
PLEASE FORWARD TO:
Recruiting Officer
New Westminster Police Service					Signature of Applicant
City of New Westminster
555 Columbia Street
New Westminster, BC  V3L 1B2					Date
NOTE: Applications forwarded by E-mail will not be considered