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BECOMING A POLICE OFFICER:
Information & Application
Civil Service Personnel Department
City of Muskegon, Michigan
933 Terrace Street P. O. Box 536
Muskegon, MI 49443-0536
Telephone (231) 724-6716
Fax (231) 724-4405
Website:
http://www.muskegon-mi.gov
APPLICATION DEADLINE : APPLICATIONS ACCEPTED UNTIL FURTHER NOTICE.
MINIMUM REQUIREMENTS FOR APPLICATION ACCEPTANCE :
To be considered for employment as a Police Officer for the City of Muskegon, an applicant must:
BE A U.S. CITIZEN
HAVE NO FELONY CONVICTIONS (INCLUDES EXPUNGED CONVICTIONS)
HAVE A VALID MOTOR VEHICLE OPERATOR LICENSE + AN ACCEPTABLE DRIVING RECORD
PASS A COMPREHENSIVE BACKGROUND CHECK
BE AT LEAST 18 YEARS OF AGE + HIGH SCHOOL DIPLOMA OR G.E.D.*
*(MCOLES requires that an applicant be an MCOLES Police Academy graduate; academy
graduate; academy admission requires an associate degree.)
AND
BE CURRENTLY EMPLOYED AS A CERTIFIED POLICE OFFICER IN THE STATE OF MICHIGAN;
OR
BE A GRADUATE OF AN MCOLES-APPROVED POLICE ACADEMY AND CERTIFIABLE AS A
POLICE OFFICER IN THE STATE OF MICHIGAN.
OR
BE ELIGIBLE FOR MCOLES* RE-CERTIFICATION AS A POLICE OFFICER IN THE STATE OF
MICHIGAN;
OR
BE ELIGIBLE FOR RECIPROCAL CERTIFICATION IN THE STATE OF MICHIGAN IF A CERTIFIED
POLICE OFFICER IN ANOTHER STATE;
CONVICTIONS OF LAW VIOLATIONS AND/OR CIVIL INFRACTIONS :
Conviction of law violations or civil infractions may serve as a basis for rejection of your
application. Your total record will be evaluated. The pattern of law violations, their
seriousness, surrounding circumstances, number and recentness will be considered
(including expunged convictions).
MCOLES is the Michigan Commission on Law Enforcement Standards. Please visit the MCOLES website at
www.mcoles.org or call (517) 322-6627 for further information.
Thank you for your interest in becoming a Police Officer for
the City of Muskegon.
Applications are accepted year-round. Every candidate is notified by mail whether or
not his/her application has been accepted. When the City establishes a testing date,
and your application is accepted, you will be notified by mail of the testing date and
time. Assessments are given to determine placement on the Police Officer eligibility
(hiring) list. The eligibility list is valid for one year from its establishment date, and
an applicant's name must be on the eligibility/hiring list for further employment
consideration. As vacancies occur during the life of the eligibility list, applicants in
the top three rankings on the list are referred for a departmental interview with the
Public Safety Director and his staff.
Additionally, any candidate receiving a contingent offer of employment must
successfully pass all pre-employment exams, including physical and psychological
assessments and an in-depth background and character investigation, prior to hire.
Please note that the recruitment procedure is subject to review and revision at any
time and that a new application must be completed and submitted for every
recruitment.
The Civil Service Commission reserves the right to amend or waive examination
parts.
Final Appointment:
1. For final appointment as a Police Officer for the City of Muskegon, an applicant must
be considered as possessing good character as determined by a favorable
comprehensive background investigation covering all aspects of the applicant's
education, employment, credit history, home environment, character, general
reputation, and integrity. Consideration will be given to all law violations, including
traffic and conservation law convictions.
2. Candidates also must pass comprehensive pre-employment exams, which may
include a physical exam, back x-ray, drug/alcohol screen, and psychological exam.
Additional MCOLES Requirements:
Disorders, Diseases or Defects :
Be free from any physical defects, chronic diseases, organic diseases, organic or functional
conditions which may tend to impair the efficient performance of a law enforcement officer's
duties or which might endanger the lives of others or the law enforcement officer.
Hearing :
Pure tone air conduction sensitivity thresholds for each ear, as shown on the pure tone
audiogram, shall not exceed a hearing level of 20 decibels at any of the following frequencies:
500, 1000, 2000, 3000, and 4000 Hertz.
Height/Weight :
Height and weight in relation to each other as indicated this by accepted medical standards.
Mental/Emotional Disorder:
Be free from mental or emotional instabilities which may tend to impair the efficient performance
of a law officer's duties or which might endanger the lives of others or the law enforcement
officer.
Physical Integrity :
Be free from any impediment of the senses, physically sound, and in possession of extremities.
Color Vision :
Possess normal color vision.
Corrected Vision :
Possess 20/20 corrected vision in each eye.
Normal Vision Functions :
Possess normal visual functions in each eye.
Reading & Writing :
Pass the MCOLES reading and writing examination or an approved agency equivalent
examination. Once passed, you need not retest.
Physical Fitness :
Pass the MCOLES physical skills performance examination or an approved agency equivalent
examination. Results are good for 180 days (6 months).
Police Training :
Successfully complete the MCOLES mandatory basic training curriculum. Admission to an
MCOLES academy requires possession of a two-year college degree (associate degree).
Certification Examination :
Pass the MCOLES certification examination upon the completion of basic training.
Medical Examination :
Examination by a licensed physician to determine that the applicant meets all medical standards.
Fingerprinting :
Fingerprint the applicant with a search of state or federal fingerprint files to disclose criminal
record.
Oral Interview :
Conduct an oral interview to determine applicant's acceptability for a law enforcement officer
position and to assess appearance, background, and the ability to communicate.
Drug Testing :
Cause the applicant to be tested for the illicit use of controlled substances.
The City of Muskego n is an Equal Opportunity Employer.
101303
030404
031706
030408
CITY OF MUSKEGON
EMPLOYMENT OPPORTUNITY
Open Competitive Announcement
POLICE OFFICER
DEPARTMENT: Police Department UNION: Police Officers Labor Council
SALARY $33,753 Annually (Licensed Police Officer) + Full Benefits Package
(Increases to $50,556 over four years; rate subject to change with new contract)
DESCRIPTION OF WORK: Under the supervision of a command officer, Police Officers serve the citizens of
the city by protecting life and property, enforcing the law, and preserving the peace by addressing citizen
complaints and neighborhood problems related to crime and disorder; or performs a specialized police activity
such as criminal investigations, undercover surveillance, or community officer.
QUALIFICATIONS : U.S. Citizen
No
felony
convictions
Minimum 18 years of age or older + High School Diploma/G.E.D.*
Valid Motor Vehicle Operator License with satisfactory driving record
Able to pass a thorough Muskegon Police Department background investigation AND
Be a licensed Police Officer or MCOLES Police Academy Graduate eligible for licensing
(MCOLES licensing eligibility requires that an applicant be an MCOLES Police Academy graduate; academy
admission requires an associate degree*)
Anyone offered employment as a Police Officer with the City of Muskegon must pass mandatory pre-employment
exams, which may include a physical exam, back X-ray, drug/alcohol screen, and psychological evaluation.
EXAMINATION PARTS AND WEIGHTS: Written Examinations - 100%
Note: A minimum score of 60% on the exam(s) is required to qualify for placement on the eligibility list.
THE CIVIL SERVICE COMMISSION reserves the right to modify and/or waive examination parts.
PURPOSE: The purpose of this examination is to establish eligibility/hiring list from which to fill vacancies in the
City classified system during the term of the list.
SPECIAL NOTE: Where a question arises regarding the administration of any portion of a Civil Service
examination, such questions must be directed to the Civil Service Personnel Director (or designee) for possible
resolution before an appeal is made to the Civil Service Commission. The City will provide reasonable
accommodation to individuals with disabilities upon 24-hour notice to the City of Muskegon. Please contact Civil
Service Department, 933 Terrace Street, Muskegon, MI 49443-0536 or by calling (231) 724-6716.
LAST DATE FOR FILING APPLICATIONS: Applications accepted on a year-round basis. Testing
will be scheduled as needed.
NOTICE DATED: Tuesday, March 4, 2008
FOR FURTHER INFORMATION, CONTACT:
City of Muskegon
Civil Service Personnel Department
933 Terrace Street, Room 206
P O Box 536
Muskegon, MI 49443-0536
Telephone (231) 724-6716
Web: www.m uskegon-mi.gov
(Police Officer Application Available on Web Site)
The City of Muskegon is an Equal Opportunity/Affirmative Action Employer
(Civil/Common/Word/Announce/PolOfficer.doc)
EMPLOYMENT INFORMATION
CONSIDERATION OF YOUR APPLICATION DEPENDS UPON THE FOLLOWING:
1. FULLY COMPLETED EMPLOYMENT APPLI CATION SUBMITTED BY THE DEADLINE , IF APPLICABLE !
If mailed, it must be postmarked on or before the deadline date.
If faxed, it must be received no later than 5:00 p.m. on the deadline date.
If e-mailed, it must show that it was sent no later than 5:00 p.m. on the deadline date.
If submitting by fax or e-mail, call (231-724-6716) to verify that your application was received.
Please be certain to provide all requested information.
Incomplete applications may be disqualifie d from further employment consideration.
2. OUT-OF-STATE APPLICANTS:
Your Driving Record : You must obtain your driving record from the state issuing your license.
Mail the driving record report to the Civil Service address on the front page of the application.
The driving record report must be on file by the application deadline date.
3. WHETHER OR NOT YOU MEET THE POSITION REQUIREMENTS, AS STATED ON THE JOB ANNOUNCEMENT .
The driving record report must be on file by the application deadline date.
If you do not qualify, pass the testing, and/or obtain employment, you may re-apply at the next
opportunity.
FOLLOWING AN APPLICATION DEADLINE , YOU WILL BE MAILED INFORMATION ABOUT THE STATUS OF YOUR APPLICATION .
Please allow sufficient time to receive the notice of your application status, depending on the recruitment type.
Whether or not your application is accepted for employment consideration, you will be notified by mail of your
status. If your application is accepted, your letter also will inform you of any test date(s) and location(s).
CANDIDATES PROGRESS IN THE RECRUITMENT AS FOLLOWS :
Those passing the practical/written exam(s), if given, will move on to the oral exam.
The oral exam is a graded panel interview; it is not a hiring interview but rather part of the recruitment.
Additional practical (hands-on) tests may be given for select positions. Generally these are pass/fail exams.
SCORES FROM YOUR ORAL EXAM AND WRITTEN TEST ARE AVERAGED TO DETERMINE YOUR FINAL SCORE .
Your final score is used to determine your placement on the eligibility (hiring) list.
Candidates' names generally remain on eligibility lists at least one year.
AS OPENINGS OCCUR, CANDIDATES IN THE HIRING LIST'S TOP 3 RANKINGS ARE REFERRED FOR DEPARTMENT INTERVIEWS .
Candidates are notified by mail of the interview opportunity.
This is the hiring interview! (Refusal of this interview may result in removal of your name from the hiring list.)
A candidate is hired from this group to fill a vacancy.
Employment opportunities are posted on the City's web site at http://www.muskegon-mi.gov/
or contact
City of Muskegon Civil Service Personnel Office
933 Terrace Street, Room 206
P O Box 536
Muskegon, MI 49443-0536
Telephone Number (231) 724-6716
A COMPLETED APPLICATION IS REQURED FROM ALL CANDIDATES; THE CITY DOES NOT
SOLICIT OR RECOGNIZE A RESUME ONLY AS AN APPLICATION
APPLICATIONS REMAIN ON FILE FOR ONE YEAR FROM DATE OF RECEIPT
092105
030806
030508
If you require special accommodation(s) in t esting due to a legally defined disability,
please notify the Civil Service Department in writing at the time of application.
CITY OF MUSKEGON Application for Position of:
933 Terrace Street POLICE OFFICER
P. O. Box 536 _____________________________________________
Muskegon, MI 49443-0536
Telephone (231) 724-6716
Fax
(231)
724-4405 _________
The City of Muskegon is an equal opportunity employer and shall consider all qualified applicants without regard to race,
color, sex, religion, national origin, age, height, weight, marital status, veteran status, handicap, or any other protected cl ass.
PERSONAL INFORMATION :
_________________________ _______________________________________________
Home Phone Number Other Contact (Cell number, e-mail address, etc.)
___________________________________ ___________________ ______ ___________
Street Address City State ZIP
Date available for work: ______/_____/______ Available for Full-time Part-time
Temporary Seasonal
Middle Do you have a valid, unrestricted driver/operator license? Yes No
If no, please explain ________________________________________________________
Have you had your driver's license suspended, revoked, or restricted in the past three
years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
If yes, please explain _______________________________________________________
___________________________________________________ _____________________
Driver License Number State of Issue
Do you have a valid commercial driver license? . . . . . . . . . . . . . . . . . . . . Yes No
If yes, type and endorsement(s) __________________________________
Have you ever worked for the City of Muskegon? . . . . . . . . . . . . . . . . . . . Yes No
If yes, position held: ___________________________________________
First Name Employment date(s) ___________________________________________
Do you have friends and/or relatives employed by the City? . . . . . . . . . . Yes No
If yes, please list ______________________________________________
Are you 18 years of age or older? . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Are you on layoff? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
If on layoff, are you subject to recall? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Are you lawfully authorized to work in the U.S.? . . . . . . . . . . . . . . . . . . . . Yes No
(Proof of employment eligibility will be required upon hire.)
MILITARY SERVICE:
Have you had any experience in the Armed Forces of the United States
of America or in a State National Guard? . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
If yes, Branch _______________________ Discharge Rank _______________________
Service Dates_____________________________________________________________
Last Name
EDUCATION:
Do you possess a high school diploma or G.E.D.? . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Please give school/trade school/college information below:
School Name & Location Credits
Earned Graduate Curriculum
(High School) Yes/No
(College or Trade School) Yes/No
(College or Trade School) Yes/No
(Other) Yes/No
EMPLOYMENT:
Have you ever been discharged or forced to resign from any position? . . .. . . . . . . . Yes No
If yes, please explain: _________________________________________________________________
Do you believe you can perform the job duties related to the position(s ) for which you applied with
or without accommodation? . . . Yes No (Note: Job description available upon request.) . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If no, please explain: __________________________________________________________________
YOU MUST COMPLETE THIS PART EVEN IF SUBMITTING A RESUME:
Please list your employment and/or unemployment history. Start with your present job status and
work backward, chronologically accounting for time periods.
Employer Name & Address: Dates Work Performed :
From To
Telephone Number: Hourly Rate/Salary
Start Final
Job Title:
Supervisor's Name:
Full-time
Reason for leaving:
Part-time ________ hours per week
Employer Name & Address: Dates Work Performed :
From To
Telephone Number: Hourly Rate/Salary
Start Final
Job Title:
Supervisor's Name:
Full-time
Reason for leaving:
Part-time ________ hours per week
EMPLOYMENT HISTORY (Cont'd.)
Employer Name & Address: Dates
Work Performed :
From To
Telephone Number: Hourly Rate/Salary
Start Final
Job Title:
Supervisor's Name: Full-time
Reason for leaving: Part-time ________ hours per week
Employer Name & Address: Dates
Work Performed :
From To
Telephone Number: Hourly Rate/Salary
Start Final
Job Title:
Supervisor's Name: Full-time
Reason for leaving: Part-time ________ hours per week
Employer Name & Address: Dates
Work Performed :
From To
Telephone Number: Hourly Rate/Salary
Start Final
Job Title:
Supervisor's Name: Full-time
Reason for leaving: Part-time ________ hours per week
Employer Name & Address: Dates
Work Performed :
From To
Telephone Number: Hourly Rate/Salary
Start Final
Job Title:
Supervisor's Name: Full-time
Reason for leaving: Part-time ________ hours per week
LAW ENFORCEMENT BACKGROUND : (Please check the appropriate box)
I am currently employed as a certified Po lice Officer in the state of Michigan.
I have successfully completed an MCOLES-approved police academy and am certifiable as
a Police Officer in the state of Michigan.
I am eligible for re-certification by MCOLES as a Police Officer in the state of Michigan.
I am eligible for reciprocal certification in the state of Michigan as I am a certified Police
Officer in the state of _____________________________________________.
TRAINING AND SKILLS :
Describe below any specialized trai ning, apprenticeships, in ternships, skill such as equipment operation,
licenses, certificates, and extra -curricular activities that pertain to the position(s) for which you are applying:
____________________________________________________________________________________
CRIMINAL RECORD:
Have you ever been convicted of a crime or are you currently under charges for any felony?
Yes No If yes, provide an explanation on a separate indicating the date of the offense, the
violation with which you were charged; name and location of the court(s), action taken/penalty imposed:
Have you had any driving citation(s) related to alcohol or drugs? Yes No
If yes, provide an explanation on a separate indicating the nature of offense, date of offense, location and
outcome:
Have you had any driving conviction(s) on your record other than parking tickets?
Yes No
If yes, provide an explanation on a separate indicating the nature of offense, date of offense, location and
outcome:
(A conviction will not necessarily be a bar to employment. The nature and circumstances of a conviction will be considered in any
employment-related decision.)
REFERENCES: (Please list three references; do not include relatives.)
Name
Address Telephone
1. _________________________________________________________________________________
__________________________________________________________________________________
2. __________________________________________________________________________________
__________________________________________________________________________________
3. __________________________________________________________________________________
__________________________________________________________________________________
CITY OF MUSKEGON
FAIR CREDIT REPORTING ACT AUTHORIZATION & WAIVER
I authorize and request my former employers, references, educational
institutions, and any credit agencies or reporting services that have information about
me to give the City of Muskegon any information and/or opinions about me in their
possession and which may lawfully be disclosed. I hereby waive written notice of such
release of information and opinions, and I release such former employers, references,
educational institutions, and credit agencies or reporting services from any liability or
claim relating to such release of information and opinions. I also authorize and request
federal, state, and local governmental agencies to release to the City of Muskegon any
information requested concerning any criminal convictions on my record. A photocopy
of this signed authorization and waiver will be valid as an original.
I agree that the City of Muskegon may obtain a consumer credit report about me
in connection with my application for employment.
If your application is denied on the basis of information contained in a consumer
credit report, or if an adverse action is taken against you regarding your employment
based on information contained in a consumer credit report, you may request copy of
the report and description of your rights under the Fair Credit Reporting Act.
__________________ ___________________________________________________
Date Applicant's Signature
041902
011505
CITY OF MUSKEGON
BOARD OF CIVIL SERVICE COMMISSIONERS
Civil Service Personnel Department
933
Terrace
Street
P.
O.
Box
536
Room
206 Muskegon,
MI
49443-0536
APPLICATION FOR VETERAN'S EMPLOYMENT PREFERENCE
The City of Muskegon provides for veteran's preference for applicants who have been in active service in the armed
forces of the United States during a recognized war period or other recognized conflict as de l law.
fined by federa
Applicant's Name ______________________________________________________________________________
Last Name M.I. First Name
I was discharged un . (If you checked this option, you are
der less than honorable conditions
not eligible for veteran's preference points.)
I was discharged under honorable conditions.
I wish to claim Veteran's Preference in Employment.
NOTE: In order to claim Veteran's Preference, you must fill out this form and return it with your
completed City of Muskegon employment application form.
Documentation substantiating your veteran's preference claim must be furnished at the time of
application AND include a copy of your DD 214, Certificate of Discharge or Separation from
Active Duty, or if you are currently enlisted, include a copy of your military enlistment papers.
Service Entry Date ______ - ______ - ______ Discharge Date ______ - ______ - ______
I wish to claim Veteran's Preference based on the following active duty:
World War II: 12/7/41 to 4/28/52
Korean Conflict: 6/27/50 to 1/31/55
Vietnam Conflict: 2/28/61 to 5/7/75
Grenada Expedition: 10/25/83 to 11/21/83
Persian Gulf War: 7/24/87 to present
Other _________________________________________________________
I certify that all information provided is true, correct, and complete to the best of my knowledge. I also
understand that discovery of misrepresentation or omission of facts herein will make me ineligible for
employment or be cause for immediate dismissal.
_________________________________ _____________________________ ________________
Printed Name Signature Date
071304/011405
VETERAN'S PREFERENCE:
Recognizing that sacrifices are made by those serving in the Armed Forces, veterans
may receive preference over non-veterans in City hiring practices. Preference does not have as
its goal the placement of a veteran in every vacant job; this would be incompatible with the merit
principle of public employment. Veteran's preference points may be added to a passing final test
score used for an open competitive referral for City employment. Entitlement to veteran's
preference does not guarantee a job.
VETERAN'S PREFERENCE POINTS: 5 Points.
To claim veteran's preference, eligible veterans must meet the minimum training and
experience requirements for the City position; must be capable of performing the essential
duties of the job, with or without accommodation; and pass the City's Civil Service examination
required for appointment. Veteran's preference may be used only once in gaining initial
employment with the City of Muskegon
WHO IS ELIGIBLE?
The veteran must have served on full-time active duty* for 90 or more consecutive days
in the United States Army, Navy, Air Force, Marines, or Coast Guard and have been in active
service during a recognized war period or other recognized conflict as defined by federal law
AND have received a form of honorable discharge/separation from the service prior to taking the
civil service exam.
Anyone discharged or separated under less than honorable is NOT entitled to veteran's
preference points.
*Note: Active duty for training CANNOT be counted as part of the 90-day service requirement
for veteran's preference points, such as Guard and Reserve active duty for training.
WAR ERA VETERANS:
World
War
II 12/07/41
to
4/28/52
Korean
Conflict 6/27/50
to
1/31/55
Vietnam
Conflict 2/28/61
to
5/7/75
12/31/60
to
5/7/75
Bosnia
11/20/95
to
present
El
Salvador
1/1/81
to
2/1/92
Grenada
Expedition 10/25/83
to
11/21/83
Lebanon Peacekeeping Mission 6/1/83 to 12/1/87
Panama
Expedition 12/20/89
to
1/31/90
Persian Gulf War 7/24/87 to 8/1/90
12/1/95
to
present
Iraq
1/1/97
to
present
The above are examples of campaigns and expeditions and not an exhaustive listing of qualifying service.
071404
AGREEMENT AND UNDERSTANDING
(Read carefully and sign below if you agree to these terms of employment.)
I certify that the information on this application is true, complete, and correct to the best of my knowledge and understand
that falsification, misleading, misrepresentation, or omission of any information submitted in connection with my application or
interview, whether in this document or not, may result in rejection of my application or, if hired, in dismissal.
In consideration of my employment, I agree to conform to the rules and regulations of the City of Muskegon as they may
be amended from time to time. I also agree that the contents of any office, locker, desk, or equipment or other City property I may
use, and any of my own property I bring onto the City's premises (including, without limitation, cars, packages, and purses) may
be inspected by the City at any time, and I waive any claims against the company or its agents relating to such inspection. I
understand City employment is at will unless otherwise stated in a written City document.
I waive written notice from my current employer and from any of my former employers regarding the disclosure of
disciplinary reports, letters of reprimand, or other notices of disciplinary action contained in my personnel records. This waiver is
made pursuant to the BullardPlawecki Employee Right-to-Know Act.
I authorize my references and current and former employers listed in this application to give you any and all information
concerning my current and previous employment and any pertinent information that they may have and release all parties from any
liability for any damages that may result from furnishing same to you.
I authorize the City of Muskegon to release any information relating in any way to my employment, including
disciplinary reports, letters of reprimand, or other notices of disciplinary action when such information is required by any
prospective or subsequent employers without any obligation by them or you to give me any notice of such disclosure.
I understand that any employment offer is conditional upon the drug screening test results and the post-offer pre-
employment medical examination, and I agree to submit to physical examinations permitted by law before and during my
employment, at the request and expense of the City, and I agree to disclose all information lawfully requested at such examinations
about my physical and mental condition and medical history. I waive any claims against the City or its agents relating to any such
testing, or from lawful decisions made regarding my employment or termination of employment based upon the results of such
testing or analysis.
If employed, I understand that if I am or become in need of accommodation(s) for employment, I must notify the City of
Muskegon in writing within 182 days after the need is known or reasonably should have been known to me. Failure to properly
notify the City will preclude any claim that the employer failed to make accommodation.
I have read, understand, and agree to the terms of each of the above statements.
___________________ ____________________________________________________________________________
Date Signature of Applicant
PRE-EMPLOYMENT DRUG TESTING CONSENT FORM
I, ____________________________, understand that the City of Muskegon, Michigan has a policy against the use, sale,
possession, or distribution of illegal drugs or being under the influence of illegal drugs by its employees and applicants for
employment. I further understand that the City has adopted a pre-employment drug-testing program as a method of implementing
that policy.
I hereby consent to the taking of my urine, hair, blood, or breath by the City or its agents for the purpose of the above
drug-testing program, and the testing of such samples by a testing laboratory designated by the City. I hereby further consent to the
release of any test reports on such samples to the City and to the use of all such reports by the City in its assessment of my
employment application. I understand that my refusal to consent to such testing will result in my disqualification from further
consideration for employment with the City.
I also understand that determining my suitability or fitness for employment is within the sole discretion of the City, and
that a positive test finding will result in my disqualification from further consideration for employment.
It is understood that certain medications may be identified in any drug testing, and I have completed or will complete the
attached "Confidential Prescription/Non-Prescription Medication Form," to the best of my recollection and belief for use in the
drug test. This form will be completed by me and placed in a sealed envelope for the sole and exclusive use of the testing
laboratory to help ensure the accuracy of the testing procedures.
I release the City and the testing facility selected by the City, and the officers, directors, employees, and agents of each of
the aforementioned, from any and all claims or potential claims or actions relating to such testing, including the taking of samples,
the testing process, procedures, analysis, disclosure and utilization of the test results in considering my employment with the City.
Finally, I understand that, if hired, I am required to comply with the City's "Drug-Free Workplace Policy," and that my
violation of said policy may result in disciplinary action, up to and including immediate termination.
My signature below acknowledges that I have read and understand this consent form, and I agree to be considered for
employment with the City on the conditions set forth above.
_____________________ _________________________________________________________________________
Date Signature of Applicant 011805
THE CITY OF MUSKEGON, MICHIGAN IS AN
"EQUAL OPPORTUNITY/AFFIRM ATIVE ACTION EMPLOYER"
YOU ARE NOT REQUIRED TO COMPLETE THIS FORM
The information you provide on this form is used only to study recruiting and employment patterns of the City of
Muskegon and to determine whether information about City job opportunities is reaching all segments of the
community. Your answers are used only to assist in future recruitment efforts.
Thank you,
MUSKEGON BOARD OF CIVIL SERVICE COMMISSIONERS
==============================================================================================
Title of job(s) applied for _____________________________________________________________________
Male Female
Highest
level
of
education
attained:
Race/Ethnic Group: High School Diploma
American Indian or Alaskan Native G.E.D.
Asian 1-3 years of college
Black or African American Bachelor's degree in _______________________
Hispanic or Latino MA/MS degree in _________________________
Native Hawaiian or other Pacific Islander Doctorate degree in ________________________
Two or more races Other degree in ___________________________
White (Not of Hispanic Origin)
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How did you learn about this City employment?
City Employee City job announcement Walk-in applicant
The Muskegon Chronicle City web site Professional Publication
Internet listing on ____________________ Career fair at __________________________________________
School placement office at ____________________________________ Other ______________________
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Date of Birth: __________________________________________
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Please indicate below the nature of any reasonable accommodation(s) you may require in order to perform the essential
job functions, as you understand them to be, of the position for which you applied:
_______________________________________________________________________________________________
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Your zip code ________________________________________ Today's date ________________________________