Instructions: Complete ALL Sections and Electronically Sign the application before submitting. This information is strictly confidential and maintained within the Hampton Police Department for the employment application process. This information is not shared with or sold to any other public or private entity. Your contact information (Email, Address, Phone) will be used to notify you about the application process.

Full Name:                                Social Security Number:
                                  ^{(First M. Last)                                                                               (Last 4 digits only)}

Street:            City:            State:            Zip:

Home Phone:                      Work Phone:
                     ^{(###-###-####)}

Email Address:                      Verify Email Address:

U.S. Citizen? Yes No N/A                      Naturalized? N/A Yes No                      Do you speak a second language? No Yes

High School Graduate? Yes No N/A                      Location: (City, State)

G.E.D Equivalency? N/A Yes No                          Location: (City, State)

College? Yes No N/A                      Graduate? Yes No N/A

School:             Major:             Location:

1.   From: - To:             Position:             Salary:

Employer:             Address: (City, State)

Reason for leaving:

2.   From: - To:             Position:             Salary:

Employer:             Address: (City, State)

Reason for leaving:

3.   From: - To:             Position:             Salary:

Employer:             Address: (City, State)

Reason for leaving:

If you have ever been convicted of a crime (Felony or Misdemeanor) that has not been Officially annulled by a court, You must complete the following section, give the date, location and nature of the Felony or Misdemeanor conviction. If you leave these spaces blank, You are certifying that you have no current record of conviction.

I certify that the information provided in or attached to this application is complete, accurate and up-to-date on the date specified below. I certify that I have the legal right to accept employment in this State, and that I will produce, at or before the date of hire, proof of that right to accept employment. I further certify that there are no willful misrepresentations of the above statements and answers to questions herein, and that I have made no omissions of material fact with respect to any of my answers to the questions presented. I understand that if an investigation should disclose such misrepresentations or omissions, my application may be rejected. Finally I understand that if I should be employed at the time of such investigation and disclosure, my services may be immediately terminated.

I authorize investigation of all statements contained in this application for employment. I authorize the release of all information concerning my criminal records, motor vehicle records, employment records as well as any other pertinent information these sources may have, personal or professional. I hereby release all liability for any damage that may result for furnishing this information to the Hampton Police Department

Type your Full Name in the Text Box below to accept and complete this agreement affirmation.

Applicants Electronic Signature:          (Before submitting)

Click the Submit Button once to file your application.