Application – Chief of Police – Mar-Mac Police Department

– Step 1 of 21

Application Instructions and Contact Information

Application Instructions

Complete all applicable sections accurately and fully. Required fields are marked with an asterisk (*). Enter “N/A” only where permitted.

Upload the required supporting documents in the designated section before submitting your application. Review your responses and attachments before selecting Submit. Incomplete applications may not be considered.

This application is used for initial qualification and selection review. Applicants who advance may be required to complete a separate background questionnaire and provide additional records and authorizations.

Do not include Social Security numbers, medical or genetic information, or financial-account information in your responses or attachments. Additional information will be requested separately when appropriate.

Application Instructions Acknowledgment *

I have read and understand the application instructions.

Full Legal Name *

First

Middle

Last

Current Residential Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone Number *

Applicant Email Address *

Are you a United States citizen? *

Will you be at least 21 years of age on the date of appointment? *

Do you possess a valid driver's license? *

Driver's License Issuing State *

Driver's License Number *

Are you requesting consideration for veterans’ preference under Iowa Code chapter 35C? *

If Yes, the District will provide instructions for submitting documentation to determine eligibility and applicability.

Page 2 — Position Requirements and Law Enforcement Certification

Position Requirements and Certification

Review the position requirements below and provide your current law enforcement certification information. Include certifications previously held in Iowa or another state

If appointed, will you establish and maintain your principal residence within the City of Marquette, the City of McGregor, or within five roadway miles of either city’s corporate limits, as soon as practicable and no later than one year after appointment? *

After reviewing the Chief of Police job description, can you perform the essential functions of the position, with or without reasonable accommodation? *

Can you meet the scheduling and availability requirements of the Chief of Police position? *

The position includes evenings, weekends, holidays, municipal and District meetings, court proceedings, emergencies, training, community events, on-call responsibilities, and other duties outside regular administrative hours as operational needs require.

Law Enforcement Certification

Iowa Law Enforcement Certification Status *

Active – currently operational or in use
Inactive – not currently in use or operational
Never Certified – has not received certification
Other – please specify

Iowa Certification / ILEA ID Number *

Original Iowa Certification Date *

Provide the original certification date if known.

If appointed, will you obtain or maintain the Iowa law enforcement certification required for this position within the applicable certification deadlines? *

Do you currently hold, or have you previously held, a law enforcement officer certification or license issued by another state? *

Out-of-State Law Enforcement Certifications

Add one entry for each state in which you currently hold or previously held law enforcement certification.

Issuing State *

Certifying Agency or Authority *

Certification or License Number

Provide if known.

Original Certification Date

Provide if known.

Current Certification Status *

Active
Inactive
Expired
Suspended
Revoked
Surrendered
Other

Explain any suspended, revoked, surrendered, or other certification status. Otherwise, leave blank.

Additional Certification Information

Provide any additional information about certification eligibility, reactivation, reciprocity or equivalency, or a pending certification application. Leave blank if not applicable.

Page 3 — Education

Education

Provide your high school or equivalency credential and any post-secondary education. Include completed and ongoing studies. Report law enforcement academy and professional training in the applicable training section.

Do you possess a high-school diploma, GED, or other high-school equivalency credential recognized under applicable Iowa Law Enforcement Academy standards? *

School or Credential-Issuing Organization *

City and State or Country *

Credential Type

High School Diploma
GED / High School Equivalency
Other Credential — Explain

Post-Secondary Education

Have you attended, or are you currently attending, a college, university, technical school, or other post-secondary institution? *

Select the highest degree awarded to you. Report degrees still in progress in the education entries below. *

No post-secondary degree
Associate degree
Bachelor’s degree
Master’s degree
Doctoral or professional degree
Other degree — please specify

If Other, describe the degree or credential.

Post-Secondary Education Details

Add one entry for each institution attended. Include studies in progress and attendance that did not result in a degree. List the most recent institution first.

Institution Name *

City and State or Country *

Are you currently attending this institution? *

Dates Attended *

Enter month/year to month/year. If currently attending, enter ‘Present’ as the ending date. Approximate dates are acceptable.

Major or Field of Study *

If you did not declare a major, enter ‘Undeclared’ or ‘General Studies,’ as applicable.

Degree or Credential Earned / Study Status

Coursework only — no degree or credential earned
Degree or credential in progress
Certificate or diploma earned
Associate degree earned
Bachelor’s degree earned
Master’s degree earned
Doctoral or professional degree earned
Other — explain

College Credits Earned, if Known

If provided, identify semester or quarter credits. Leave blank if unknown or not applicable.

Page 4 — Law Enforcement Experience

Law Enforcement Experience

Summarize your sworn law enforcement experience and provide your agency employment history. Include full-time, part-time, reserve, and volunteer sworn service. Describe supervisory and administrative responsibilities sufficiently to show the scope of your experience.

Do you have current or previous sworn law enforcement experience? *

Enter experience in years and months. Within each category, count overlapping service periods only once. The same period may count toward more than one category when applicable. Enter “0 years, 0 months” if none. Identify full-time, part-time, reserve, or volunteer service in the agency entries below.

Total Sworn Law Enforcement Experience *

Enter total combined experience in years and months.

Sworn Experience with Governmental Law Enforcement Agencies *

Enter total combined experience in years and months. Include sworn service with municipal, county, state, tribal, federal, or other governmental law-enforcement agencies, as applicable.

Total Law Enforcement Supervisory Experience *

Enter total combined experience in years and months.

Police Administration or Management Experience at Sergeant Rank or Higher *

Enter total combined experience in years and months. Do not include periods served at Sergeant or higher that did not involve administrative or management responsibilities.

Sworn Law Enforcement Employment History

List each agency where you have served in a sworn capacity, beginning with your current or most recent agency. Include full-time, part-time, reserve, and volunteer sworn service. Use a separate entry for each distinct period of employment with an agency. Explain changes in rank or service type within the applicable entry.

Agency Name *

Agency City and State or Country *

Do you currently serve with this agency? *

Type of Sworn Service — Select All That Apply *

Full-Time
Part-Time
Reserve
Volunteer
Other

If your service type changed, select each applicable type and explain the corresponding periods in Primary Responsibilities.

Employment Start Date *

Month / Year

Employment End Date *

Month / Year; enter Present if currently employed

Highest Rank or Position Held *

Dates Served at Sergeant Rank or Higher *

Identify each applicable rank and month/year range. Identify acting or temporary assignments as such. Enter N/A if none.

Dates Performing Administration or Management Duties at Sergeant Rank or Higher *

Identify the month/year periods during which you performed these duties. Describe the duties in Command and Administrative Responsibilities below. Enter N/A if none.

Approximate Authorized Sworn Staffing During Your Service *

Provide an approximate number or range, if known.

Largest Number of Personnel You Directly Supervised at One Time *

Count personnel who reported directly to you, rather than everyone within your command. Enter 0 if none. Describe indirect command responsibility below.

Primary Responsibilities *

Briefly describe your principal duties and assignments. Include changes in rank or service type and the corresponding periods, if applicable.

Command and Administrative Responsibilities *

Describe any supervisory, command, budgeting, personnel, policy, training, scheduling, disciplinary, accreditation, reporting, or other administrative responsibilities. Enter N/A if none.

Page 5 — Other Employment History

Other Employment History

List employment held during the preceding 10 years that you have not already reported in the sworn law enforcement section. Include paid employment, self-employment, business ownership, and contract work. Begin with your current or most recent employment.

During the preceding 10 years, have you held any employment or performed self-employment or contract work not already reported in the sworn law enforcement section? *

Other Employment Details

Add one entry for each employer or business. Include employment that began more than 10 years ago if you continued working there during the preceding 10 years. For self-employment, identify your business or describe the work performed.

Employer or Business Name *

For self-employment without a business name, enter ‘Self-employed’ and identify the type of work

City and State or Country *

Position or Title Held *

Is this employment or self-employment ongoing? *

Start Date *

Enter month/year. Approximate dates are acceptable.

End Date *

Enter month/year, or enter ‘Present’ if ongoing. Approximate dates are acceptable.

Primary Duties and Responsibilities *

Briefly describe your principal duties. Include relevant supervision, management, budgeting, personnel, public service, or other responsibilities that help demonstrate your qualifications for Chief of Police.

Page 6 — Leadership and Professional Training

Leadership and Professional Training

Identify completed or ongoing training relevant to leading and administering a law enforcement agency. Include leadership, supervision, command, executive development, internal affairs, professional standards, accreditation, and management programs.

Have you completed, or are you currently enrolled in, leadership, supervisory, command, administrative, or other professional training relevant to the Chief of Police position? *

Leadership and Professional Training Details

Add one entry for each relevant course or program, beginning with the most recent. For a program consisting of multiple courses, list the overall program and identify its components in Additional Training Information, or list the courses individually. Avoid reporting the same training hours twice.

Course or Program Name *

Training Categories — Select All That Apply *

Leadership / Supervision
Command / Executive Development
Internal Affairs / Professional Standards
Accreditation
Management / Administration
Other Relevant Professional Development

Training Provider or Sponsoring Organization *

Identify the organization that provided or administered the training.

Program Status *

Completed
In Progress
Enrolled — Not Yet Started

Completion or Expected Completion Date *

Enter month/year. For training not yet completed, provide the expected completion date if known. If only the year is known, enter the year.

Certificate or Credential Awarded

Identify any certificate or credential already awarded for this training. Leave blank if none has been awarded.

Training Hours Completed, if Known

Enter the hours you have completed for this entry. Do not include anticipated hours or hours already reported in another entry.

Additional Training Information

If helpful, identify program components, subject areas, an expected credential, or other information needed to explain this entry. Explain any selection of Other Relevant Professional Development here.

Page 7 — Chief-Specific Qualifications

Qualifications and Experience

The following questions address experience and qualifications relevant to the Chief of Police position. Please provide concise responses sufficient for the Public Safety Commission to evaluate your experience. You may reference your résumé, but each response should contain enough information to evaluate the area identified. Some areas reflect preferred qualifications or responsibilities of the position and are not, by themselves, minimum qualifications. If you do not have direct experience in an area, state “None” and, where appropriate, identify relevant transferable experience.

A. Supervisory / Command Experience *

Describe your experience supervising or commanding law-enforcement personnel, including scheduling, training, performance evaluation, employee development, discipline, mentoring, and supervision of full-time, part-time, or reserve personnel. If you have no direct supervisory experience, state “None” and describe any relevant leadership experience.

B. Executive / Small-Agency Experience *

Describe your experience in a small or comparably structured law-enforcement agency where administrative or command responsibilities were combined with patrol, investigations, emergency response, court responsibilities, on-call coverage, community engagement, or other operational duties. If you do not have direct small-agency experience, describe comparable experience demonstrating your ability to perform both executive and operational responsibilities.

C. NIBRS Experience *

No direct NIBRS experience
User / Data Entry
Report Reviewer
NIBRS Validator / Administrator
Agency Reporting / Compliance Oversight

Select the highest level that best describes your NIBRS experience.

Describe your NIBRS responsibilities, including any experience with offense classification, report review, validation, error correction, data-quality review, submission, or agency reporting oversight.* 1,500-character limit *

Describe your NIBRS responsibilities, including experience with offense classification, report review, validation, error correction, data-quality review, submission, or agency reporting oversight.

Describe any related report-review, records, UCR, data-quality, or compliance experience and how you would develop NIBRS proficiency during onboarding. *

D. Law-Enforcement Technology Experience *

Shieldware Records Management System (RMS)
Shieldware Computer-Aided Dispatch (CAD)
Iowa TraCS
Axon Body-Worn Camera
Axon Fleet / In-Car Camera
Axon Evidence
Lexipol
Guardian Tracking
iCrimefighter
PMI Digital Evidence Management
CJIS Administration / Security
ALPR systems
No direct experience with the listed systems.
Other

Select all systems or technology areas with which you have direct experience. If you have no direct experience with any of the listed systems, select only “No direct experience with the listed systems.”

Identify any other law-enforcement technology or platform with which you have direct experience. *

Briefly describe your level of responsibility with the systems or technology identified above, including experience as a user, reviewer, administrator, implementation lead, trainer, policy administrator, or agency-level supervisor. If you have no direct experience with the listed systems, describe comparable law-enforcement technology experience and your approach to learning and administering unfamiliar systems. *

E. Accreditation / Policy / Professional Standards *

Describe your experience with law-enforcement accreditation, policy development or administration, special orders or directives, training standards, internal investigations, disciplinary processes, professional standards, employee development, strategic planning, or organizational risk management. If you have no direct experience in one or more areas, focus on those in which you have experience.

F. Budget / Grants / Contracts / Procurement *

Describe your experience preparing, presenting, or administering public-sector or law-enforcement budgets; managing grants, contracts, procurement, equipment, or other agency resources; and working with governing officials or financial staff. Include approximate budget responsibility where appropriate.

G. Municipal Government / Governance *

Describe your experience working with governing boards or commissions, city councils, elected or appointed municipal officials, Chapter 28E organizations, public meetings, public records, public budgeting, or public-sector personnel administration.

H. Service to Diverse Communities *

Describe your professional experience serving and working with communities or populations with diverse backgrounds and needs. Include, where applicable, experience involving community engagement, equitable service delivery, problem solving, outreach, conflict resolution, or partnership development.

I. Community Relations / Crisis Response / Youth Programs *

Describe your experience with community policing, Crisis Intervention Team practices, behavioral-health response, de-escalation, school partnerships, youth programs, D.A.R.E., public education, community outreach, or similar programs. If you have no direct experience in a particular area, identify relevant transferable experience.

J. Written / Oral / Media / Public Presentation Experience *

Describe your experience preparing professional written materials and communicating with governing bodies, elected or appointed officials, news media, community organizations, law-enforcement partners, and the public, including public presentations or media interviews where applicable.

K. Investigative / Operational Experience *

Describe your law-enforcement experience involving patrol operations, criminal investigations, search or arrest warrants, evidence handling, court proceedings, critical incidents, or interagency operations. Highlight any responsibilities involving case review, investigative supervision, or operational decision-making. 2,000-character limit

Page 8 — Driving Record / Professional Conduct

Driving Record / Law Enforcment Certification Eligibility

The District will evaluate driving history under the standards contained in the adopted Chief of Police Job Description. The questions below address current applicant eligibility requirements. Applicants who advance in the selection process may be required to provide additional driving, employment, disciplinary, and professional-conduct information as part of the background investigation.

During the three years immediately preceding the date of this application, have you had four (4) or more moving violations? *

Briefly identify the approximate date, jurisdiction, violation, and disposition of each applicable moving violation. *

During the one year immediately preceding the date of this application, have you had three (3) or more moving violations? *

Briefly identify the approximate date, jurisdiction, violation, and disposition of each applicable moving violation. *

During the five years immediately preceding the date of this application, has your driver's license been suspended or revoked, or have you been convicted of operating while intoxicated (OWI), reckless driving, or another major moving violation? *

Briefly identify the approximate date, jurisdiction, license suspension or revocation or applicable offense, and final disposition. *

Professional Conduct

Have you ever had a law-enforcement officer certification or license denied, suspended, revoked, surrendered, restricted, or otherwise formally acted upon by a certifying authority, or have you ever been the subject of a decertification proceeding? *

If Yes, identify the certifying jurisdiction or authority, approximate date, type of action or proceeding, and final disposition or current status. *

Page 9 — Professional References

Preferred Phone Number *

Email Address, if available

Page 10 — Current Employer Contact

Current Employer Contact

The District recognizes that contacting a current employer may affect an applicant’s present employment. Please identify whether and when the District may contact your current employer regarding your candidacy. If you listed an individual from your current employer as a professional reference, the District will treat that individual as an authorized reference contact unless you expressly state otherwise below.

May the Mar-Mac Public Safety Commission or its authorized representative contact your current employer as part of the selection and reference-check process? *

When may your current employer be contacted? *

After I have been notified that I am advancing to the finalist stage
Before final selection, provided I receive advance notice
At another point in the process — please explain

Date suspended, Responsibilities

Briefly identify when or under what circumstances the District may contact your current employer. *

Page 11 — Background Investigation Questionnaire / Residential History

Background Investigation Questionnaire

The following sections collect personal-history information used in evaluating suitability for appointment and conducting the background investigation for the Chief of Police position.

Answer each question completely and accurately. Unless otherwise stated, an affirmative response does not automatically disqualify an applicant. Information will be evaluated based on the circumstances, applicable law, established qualification requirements, and its relevance to the position.

Information provided in this portion of the application may be verified through records, former employers, references, law-enforcement agencies, educational institutions, licensing or certification authorities, and other lawful sources as part of the selection and background-investigation process.

Do not provide medical, disability-related, genetic, pregnancy-related, or other protected health information in response to these questions unless specifically requested at a legally appropriate later stage of the hiring process.

Acknowledgment of Background Questionnaire Instructions *

I have read and understand the background-investigation questionnaire instructions and agree to provide complete and accurate information.

Residential History

List every residence where you have lived during the preceding ten (10) years. Include your current residence and account for the entire ten-year period without gaps. If you maintained more than one residence at the same time, include each residence.

Residential Address

Address *

Address Line 1

Address Line 2

City

State

Zip Code

From *

Month / Year

To *

Month / Year; enter “Present” for your current residence.

Residence Status *

Owned
Rented
Lived with family or friends
Employer or government housing
Other

Residence Verification Contact Name, if applicable *

Provide a landlord, property manager, roommate, family member, housing official, or other person who can reasonably verify your residence. Enter N/A if no verification contact is applicable or known.

Relationship / Role *

Examples: landlord, property manager, roommate, family member, employer housing representative.

Verification Contact Phone, if known

Verification Contact Email, if known

I have listed all residences for the preceding ten (10) years and have accounted for the entire period without intentional gaps or omissions. *

Acknowledgment

Page 12 — Employment Background Details

Employment History and Professional Conduct

The employment history previously provided in this application will be used as part of the background investigation. For the following section, provide one entry for each employer or law-enforcement agency with which you were employed or served during the preceding ten (10) years, including employers already identified elsewhere in this application. Include concurrent employment, self-employment, business ownership, contract work, and law-enforcement service. Information requested below supplements the earlier employment-history sections and is intended to assist with verification and suitability review. Unless otherwise stated, an affirmative response does not automatically disqualify an applicant.

Employment Background Details

Provide one entry for each employer, business, or law-enforcement agency during the preceding ten (10) years. Include employers already reported in the earlier employment-history sections.

Employer / Agency / Business Name *

Employment Dates *

Enter month/year to month/year. Enter “Present” if currently employed or serving.

Position(s) / Title(s) *

Identify the primary position or positions held during this period.

Employer / Agency Address *

Address Line 1

City

State

Zip Code

Immediate Supervisor / Employer Representative *

Identify the person who directly supervised you or another representative who can verify your employment. For self-employment, enter “Self-Employed.”

Supervisor / Employer Phone, if known

Supervisor / Employer Email, if known

Reason for Leaving / Current Status *

Briefly state why the employment or service ended. If currently employed or serving, enter “Current.”

To your knowledge, are you eligible for rehire or reappointment by this employer or agency? *

Yes
No
Unknown
Not Applicable — Self-Employment / Business Ownership / Currently Employed

Rehire Status Explanation *

If you selected No or Unknown, briefly explain what you know about your rehire status. Otherwise enter “N/A.”

During this employment, did you receive formal written discipline; a disciplinary suspension or demotion; a last-chance agreement; a formal performance-improvement plan; or other formal corrective or disciplinary action? *

Formal Discipline / Corrective Action Category *

N/A — No formal disciplinary or corrective action
Written Reprimand
Suspension
Demotion
Performance-Improvement Plan
Last-Chance Agreement
Formal Counseling / Corrective Action
Other Formal Discipline

Select the category that best describes all formal disciplinary or corrective action. If more than one category applies to the same occurrence, select the primary action and identify any additional action in the explanation field. Select “N/A” if no formal disciplinary or corrective action occurred during this employment.

Disciplinary / Corrective Action Details *

If applicable, identify the approximate date, nature of the action, and final disposition or current status. If none, enter “N/A.

Did this employment end because you were terminated or discharged, or because you resigned, retired, or otherwise separated after being advised that termination or discharge was being considered or would occur? *

Termination / Separation Category *

N/A — Employment did not end under the circumstances described above
Terminated / Discharged
Resigned in lieu of termination or discharge
Retired in lieu of termination or discharge
Separated after being advised termination or discharge was being considered
Other comparable involuntary or compelled separation

Select the category that best describes the separation. If more than one category applies, select the primary category and explain the circumstances below. Select “N/A” if this employment did not end under any of these circumstances.

Termination / Separation Details *

If applicable, identify the approximate date, circumstances of the separation, whether any disciplinary or investigative matter was involved, and the final disposition or current status. If none, enter “N/A.”

Did you resign, retire, or otherwise separate from this employer while you were the subject of a pending administrative, internal-affairs, professional-standards, disciplinary, or similar workplace investigation? *

Investigation at Separation — Details *

If Yes, identify the approximate date, general nature of the investigation, its status when you separated, and the final disposition or current status, if known. If No, enter “N/A.” Do not provide confidential investigative documents unless specifically requested.

Are you currently the subject of a pending formal administrative, internal-affairs, professional-standards, disciplinary, or similar employment investigation by a current or former employer? *

If Yes, identify the employer or agency, general nature of the matter, approximate date initiated, and current status. Do not upload confidential investigative materials unless specifically requested. *

Identify the employer or agency, approximate date the matter began, the general nature of the investigation, and its current status. Do not upload confidential investigative materials unless specifically requested.

During the preceding ten (10) years, have you had any period of 30 consecutive days or longer that is not otherwise accounted for by employment, education, military service, or another activity identified in this application? *

Period Not Otherwise Accounted For

From *

To *

General Activity / Status *

Examples: Unemployed, Seeking employment, Student, Caregiving, Travel, Other

I have identified all employment, law-enforcement service, self-employment, business ownership, and contract work required by this application for the preceding ten (10) years and have accounted for any applicable periods of 30 consecutive days or longer not otherwise reported. *

Acknowledgment

Page 13 — Financial Responsibility

Financial Responsibility

The following information is requested as part of the background investigation because the Chief of Police position involves significant public trust and responsibility for public funds, purchasing, contracts, equipment, and other District resources. The existence of debt, bankruptcy, collection activity, or other financial obligations does not automatically disqualify an applicant. Information will be evaluated based on the circumstances, including financial responsibility, resolution efforts, candor, and relevance to the position. Do not provide account numbers, Social Security numbers, bank-account information, or other financial-account identifiers.

Are you currently delinquent on any financial obligation for which you are legally responsible? *

Current Delinquent Obligation(s) — Explanation *

Identify the general type of obligation, approximate amount currently delinquent, how long it has been delinquent, and any payment, repayment, dispute, or resolution arrangement. Do not provide account numbers.

Within the preceding seven (7) years, have any financial obligations for which you were legally responsible been referred to a collection agency or charged off as uncollectible? *

Do you currently have any unsatisfied civil judgment, tax lien, court-ordered restitution obligation, or similar legally enforceable financial obligation that remains delinquent or unresolved? *

During the preceding seven (7) years, have you had property repossessed or been subject to a completed foreclosure because of an unpaid financial obligation for which you were legally responsible? *

Financial Information Acknowledgment *

I have answered the financial-responsibility questions completely and accurately and understand that the existence of financial difficulties does not, by itself, necessarily disqualify me from consideration.

Page 14 — Criminal History and Law-Enforcement Contacts

Do not disclose a record that applicable law expressly permits you to treat as nonexistent or prohibits you from disclosing. If you are uncertain whether a particular sealed or expunged matter must be reported, you may identify that you have a disclosure question without providing protected details.

Criminal History and Law-Enforcement Contacts

The following information is requested as part of the background investigation and verification of eligibility for appointment as an Iowa law-enforcement officer. Answer each question completely and accurately. An arrest, citation, or criminal charge, standing alone, does not establish that the underlying conduct occurred and does not automatically disqualify an applicant. Convictions, adjudications, underlying conduct, disposition, recency, and relevance to the duties and eligibility requirements of the position will be evaluated as applicable. Certain convictions or juvenile adjudications may affect eligibility for appointment under Iowa Law Enforcement Academy standards.

As an adult, have you ever been arrested, cited for a criminal offense, formally charged with a criminal offense, convicted, entered a plea of guilty or no contest, received a deferred judgment or similar disposition, or are you currently the subject of a pending criminal charge? *

Adult Criminal History

Approximate Date *

City and State / Jurisdiction *

Law-Enforcement Agency *

Offense / Charge *

Type of Matter *

Arrest
Criminal Citation
Criminal Charge
Conviction
Deferred Judgment
Comparable Disposition
Pending Criminal Matter
Other

Final Disposition / Current Status *

Convicted / Guilty
Deferred Judgment / Comparable Disposition
Dismissed
Acquitted / Not Guilty
Pending
Other

Court / Case Number, if known

Explanation *

Briefly describe the circumstances and final disposition or current status. You may identify information you believe is relevant to understanding the occurrence.

Other law-enforcement contacts

Other than matters already reported elsewhere in this application, have you had any significant non-employment-related contact with a law-enforcement agency in which you were investigated, detained, questioned as a possible suspect, issued a warning for suspected unlawful conduct, or otherwise the subject of a law-enforcement investigation? *

Other Law-Enforcement Contact

Approximate Date *

Law-Enforcement Agency *

City and State / Jurisdiction *

Nature of Contact *

Were you suspected of unlawful conduct?

Disposition / Outcome *

Explanation *

Criminal History and Law-Enforcement Contact Acknowledgment *

I have completely and accurately disclosed the criminal-history and law-enforcement contact information required by this section, subject to any lawful restriction applicable to sealed, expunged, or otherwise protected records.

Page 15 — Detailed Driving History

Driving History

Provide the driving-history information requested below for the preceding five (5) years. Include incidents occurring in any state or jurisdiction. Information reported earlier in this application concerning the Chief of Police driving-record qualification standards should also be included here when responsive. An individual traffic violation or accident does not necessarily disqualify an applicant unless it falls within an established qualification or disqualification standard.

During the preceding five (5) years, have you been cited for or convicted of any moving traffic violation? *

Moving Violation / Traffic Citation

Provide one entry for each moving violation or traffic citation during the preceding five (5) years. Do not include parking violations.

Approximate Date *

State / Jurisdiction *

Violation / Offense *

Disposition / Outcome *

Was this offense related to the operation of a law-enforcement or other employer-owned vehicle? *

Explanation, if needed

During the preceding ten (10) years, has your driver's license or driving privilege been suspended, revoked, canceled, denied, or formally restricted by any state or licensing authority? *

During the preceding five (5) years, have you been the driver of a motor vehicle involved in a crash that resulted in a police report, citation, property damage requiring a report or insurance claim, or personal injury? *

Driving History Acknowledgment *

I have completely and accurately disclosed the driving-history information required by this section and understand that the District may verify my driving record through appropriate licensing and record sources.

Page 16 — Military Service

Military Service

The following information is requested for background-investigation and service-verification purposes. Military service, reserve status, National Guard membership, or future military obligations will not be used adversely in employment decisions except as otherwise permitted or required by law. Applicants requesting veterans’ preference under Iowa Code chapter 35C should also complete the veterans’ preference question and provide applicable documentation when requested.

Have you ever served, or are you currently serving, in the United States Armed Forces, National Guard, or a reserve component?

Military Service History

Branch of Service *

Dates of Service *

Enter month/year, or “Present” if currently serving.

Highest Rank / Grade Held *

Military Occupational Specialty / Rating / Primary Duties *

Identify your primary military occupational specialty, rating, Air Force specialty, or comparable assignment and briefly describe your principal duties.

Character of Service / Discharge *

Honorable
General — Under Honorable Conditions
Other Than Honorable
Entry-Level / Uncharacterized
Other
Not Applicable — Currently Serving

Military Separation / Discharge Explanation *

If your character of service was Other Than Honorable, Entry-Level / Uncharacterized, Other, or otherwise requires clarification, briefly explain the circumstances and final status. Otherwise enter “N/A.”

During your military service, were you ever subject to court-martial, nonjudicial punishment, formal administrative separation proceedings based on alleged misconduct, or other formal military disciplinary action? *

Military Disciplinary Action — Details *

Identify the approximate date, branch or component, general nature of the action, and final disposition. Do not provide medical or disability-related information unless specifically requested at a legally appropriate later stage.

Military Service Acknowledgment *

I have completely and accurately reported the military-service information required by this section and understand that applicable service records may be verified as part of the background investigation.

Page 17 — Prior Law-Enforcement Applications and Background Investigations

Prior Law-Enforcement Applications

Provide information concerning prior applications for sworn law-enforcement positions as requested below. This information may be used to verify application history and identify prior background-investigation records or other job-related information relevant to the current selection process. Do not disclose medical, psychological, disability-related, genetic, or other protected health information when explaining the outcome of a prior application.

Have you ever been disqualified, removed, or informed that you were ineligible to continue in a law-enforcement hiring or appointment process because of a background-investigation finding, truthfulness or candor concern, criminal or driving history, employment conduct, certification issue, falsification or omission, or another non-medical suitability or eligibility issue? *

Prior Hiring-Process Disqualification — Details *

Identify the agency, approximate date, position, general reason provided, and final outcome. Do not disclose medical, psychological, disability-related, genetic, or other protected health information.

Have you ever withdrawn from a law-enforcement hiring process after an agency informed you of a non-medical background, integrity, conduct, certification, criminal-history, driving-history, or employment-related concern that could affect your continued eligibility?

Identify the agency, approximate date, nature of the non-medical concern, and outcome. *

Prior Application History Acknowledgment *

I have completely and accurately reported the prior law-enforcement application and background-investigation information required by this section.

Page 18 — Integrity, Conduct, and Other Suitability Information

Integrity, Conduct, and Other Suitability Information

The following questions address conduct and background information that may be relevant to the integrity, judgment, honesty, or suitability expected of a Chief of Police. Do not repeat information already fully disclosed elsewhere in this application unless necessary to clarify your response. An affirmative response does not automatically disqualify an applicant. Information will be evaluated based on the circumstances, accuracy and completeness of disclosure, relevance to the position, applicable law, and established appointment requirements.

Have you ever been suspended, expelled, placed on disciplinary probation, or otherwise formally disciplined by a high school, college, university, technical school, or other educational institution? *

Other than matters already disclosed in this application, have you ever knowingly provided materially false or misleading information, falsified a record or document, or intentionally omitted material information in connection with law-enforcement duties, public employment, an official investigation, court proceeding, professional licensing or certification, or an employment application? *

Other than matters already disclosed, have you ever knowingly accessed, used, disclosed, or disseminated confidential, restricted, criminal-justice, law-enforcement, personnel, or other protected information for an unauthorized purpose? *

Other than matters already disclosed, have you ever knowingly misappropriated, stolen, improperly converted, or used employer, government, client, or organizational money, property, equipment, evidence, or other resources for an unauthorized personal purpose? *

Other than matters already disclosed in this application, have you knowingly engaged in conduct that you reasonably believe constituted a serious criminal offense, whether or not you were arrested, cited, charged, or convicted? *

Is there any material information concerning your conduct, employment, education, law-enforcement history, certification history, financial responsibility, driving history, military service, or other background that has not been disclosed elsewhere in this application and that you reasonably believe may be relevant to your suitability for appointment as Chief of Police or may reasonably be discovered during the background investigation? *

Describe the information and provide sufficient context for the District or background investigator to understand the matter. Do not provide medical, disability-related, genetic, pregnancy-related, or other protected health information. *

Integrity and Suitability Acknowledgment *

I have answered the questions in this section completely and accurately and have disclosed material information required by this section to the best of my knowledge.

Page 19 — Background Investigation Authorization and Release

Background Investigation Authorization

The Mar-Mac Unified Law Enforcement District conducts a thorough background investigation of applicants being considered for appointment as Chief of Police. The investigation may include verification of information provided in this application and inquiries concerning employment, education, law-enforcement service, professional qualifications, references, certification or licensing, driving history, criminal history, military service, and other lawful job-related background information.

Any information obtained will be considered only to the extent permitted by applicable law and relevant to eligibility or suitability for appointment.

Authorization to Conduct Background Investigation *

I authorize the Mar-Mac Unified Law Enforcement District, the Mar-Mac Public Safety Commission, and any person or entity specifically authorized by the District to conduct my background investigation to verify information provided by me and to make lawful inquiries concerning my qualifications, eligibility, integrity, and suitability for appointment as Chief of Police.

Authorization to Obtain and Verify Background Information *

I authorize, to the extent permitted by law, current and former employers; law-enforcement agencies; governmental agencies; educational institutions; military authorities; law-enforcement certification or licensing authorities; professional references; persons identified during the background investigation; and other appropriate record custodians to provide job-related information requested by the District or its authorized background investigator for purposes of this selection process.

Information That May Be Verified

Subject to applicable law and the nature of the source, the background investigation may include verification or review of:

• dates and positions of employment or service;
• duties, responsibilities, performance, attendance, and eligibility for rehire;
• employment separation and disciplinary history;
• administrative, internal-affairs, or professional-standards matters where lawfully available and relevant;
• education, degrees, credentials, and training;
• law-enforcement certification, licensing, reciprocity, and decertification information;
• professional and developed references;
• driving, criminal, and other lawful public records;
• military-service information lawfully available for employment background purposes; and
• other job-related information reasonably necessary to evaluate eligibility or suitability for appointment.

Current Employer Contact

Any authorization provided on this page is subject to the current-employer contact preference identified earlier in this application. The District will not treat this authorization as permission to contact the applicant’s current employer earlier than the applicant authorized on that page, except where otherwise required by law.

Protected Information

This authorization does not authorize the release of medical records, psychological records or examination results, genetic information, family medical history, disability-related information, workers’ compensation medical information, or other protected health information as part of the pre-offer background investigation.

Medical, psychological, or other post-offer information will be requested only at the legally appropriate stage of the selection process.

Checkboxes *

I understand that certain agencies, employers, institutions, or record custodians may require their own authorization or release form, and I agree to complete reasonable additional authorizations necessary to conduct the lawful background investigation.
I understand that the background investigator may contact persons not specifically listed by me as references when reasonably identified through employers, references, records, or other lawful investigative sources, for the purpose of obtaining job-related information concerning my qualifications and suitability.
I understand that information obtained during the background investigation may be compared with information I provided in this application and that I may be asked to clarify apparent discrepancies, omissions, or conflicting information.

This authorization applies to the recruitment, selection, and background-investigation process for this Chief of Police vacancy and remains effective until that process has concluded, unless a separate authorization provides otherwise.

Background Investigation Authorization — Electronic Signature

By entering my full legal name below, I acknowledge that I have read and understand the authorization above and voluntarily authorize the background investigation described on this page.

Applicant's Full Legal Name *

First

Middle

Last

Date / Time *

Date

Time

Page 20 — Application Documents

Application Documents

Upload the documents identified below. Required documents must be submitted before the application is complete. Documents identified as applicable are required only when relevant to your qualifications, certification status, or claimed veterans’ preference. Do not upload Social Security numbers, medical or psychological records, financial-account information, or other sensitive personal information unless specifically requested by the District through an authorized process.

Cover Letter *

Drag & Drop Files, Choose Files to Upload

Upload a cover letter describing your interest in the Chief of Police position and your leadership philosophy.

Professional Résumé *

Drag & Drop Files, Choose Files to Upload

Upload a current professional résumé reflecting your employment, law-enforcement experience, supervisory or command experience, education, training, and other relevant professional qualifications.

Applicable Law-Enforcement Certification(s)

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Upload copies of current or prior law-enforcement officer certifications or licenses identified in this application, if available.

Educational Credential(s) — Optional

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

You may upload diplomas, degrees, transcripts, certificates, or other documentation supporting education identified in this application. Do not upload documents containing Social Security numbers or other unnecessary sensitive identifiers.

Leadership / Command Training Certificates — Optional *

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

You may upload certificates or credentials supporting leadership, supervisory, command, executive-development, accreditation, professional-standards, internal-affairs, or comparable training identified in this application.

Veterans’ Preference Documentation

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Upload documentation necessary to establish the veterans’ preference requested in this application, such as an applicable DD Form 214 or other official documentation. Redact any Social Security number before uploading.

Other Supporting Documentation — Optional

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

You may upload other documents directly relevant to your qualifications for the Chief of Police position that are not otherwise requested above. Do not upload medical or psychological records, Social Security numbers, financial records, personal-history statements, or other sensitive information unless specifically requested by the District.

Document Upload Acknowledgment *

I have uploaded the documents required by this application and have reviewed the uploaded files to ensure they do not contain unnecessary Social Security numbers, medical information, financial-account information, or other sensitive information not requested by the District.

Page 21 — Selection Process and Applicant Certification

Selection Process and Applicant Certification

Selection and Background Process

Submission of this application does not guarantee advancement or appointment. Depending upon an applicant’s qualifications, certification status, and progression through the selection process, the District may use some or all of the following:

Review of this application and supporting documents
Minimum-qualification and preferred-qualification review
Structured interview(s)
Written, oral, practical, or other job-related assessment exercises
Public Safety Commission interview(s)
Verification of education, employment, law-enforcement experience, professional training, and certifications
Professional and developed-reference checks
Background investigation and verification of information provided in the background questionnaire
Fingerprint-based criminal-history and other authorized record checks
Driving-record verification
Law-enforcement certification and decertification verification
Additional lawful records, documentation, releases, or authorizations reasonably necessary to determine eligibility or suitability for appointment
Applicable Iowa Law Enforcement Academy testing or other appointment requirements

Following a Conditional Offer of Employment

Applicants receiving a conditional offer may be required to successfully complete:

Psychological testing and evaluation required for appointment
Medical examination, including applicable physical, vision, and hearing requirements
Drug screening
Any other lawful post-offer examination or verification required for appointment

Selection Process Acknowledgment *

I have read and understand the selection and background process described above. I understand that the specific steps applicable to me may depend on my qualifications, certification status, progression through the selection process, and other lawful appointment requirements.

Reasonable Accommodation

The Mar-Mac Unified Law Enforcement District provides reasonable accommodations to qualified applicants with disabilities in accordance with applicable law. An applicant who requires a reasonable accommodation to participate in the application or selection process may contact the District to request assistance.

Equal Employment Opportunity

The Mar-Mac Unified Law Enforcement District is an equal opportunity employer and considers applicants without unlawful discrimination on the basis of any status protected by applicable federal or Iowa law.

Applicant Certification *

I certify that the information provided in this application, including the background-investigation questionnaire and all attachments submitted with it, is true, complete, and accurate to the best of my knowledge. I understand that a material false statement, intentional misrepresentation, or material omission may result in disqualification from the selection process or, if discovered after appointment, may result in disciplinary action up to and including termination, consistent with applicable law, District policy, and any applicable employment agreement.

Continuing Accuracy of Application *

I understand that if I discover a material error or omission in this application, or if material information provided in this application changes while I remain under consideration, I should promptly notify the District and provide accurate supplemental information.

I understand that submission or acceptance of this application does not constitute an offer, promise, or guarantee of employment or appointment.

Applicant's Full Legal Name — Electronic Certification *

First

Middle

Last

By entering your full legal name and submitting this application, you electronically certify the application, background questionnaire, authorizations, acknowledgments, and statements made above.

Date of Certification *

Date

Time

Before submitting, review each section of the application and confirm that all required information and applicable supporting documents have been provided. After submission, retain a copy of any documents you uploaded for your records.

Application Instructions and Contact Information

Page 2 — Position Requirements and Law Enforcement Certification

Position Requirements and Certification

Law Enforcement Certification

Out-of-State Law Enforcement Certifications

Page 3 — Education

Education

Post-Secondary Education

Post-Secondary Education Details

Page 4 — Law Enforcement Experience

Law Enforcement Experience

Sworn Law Enforcement Employment History

Page 5 — Other Employment History

Other Employment History

Other Employment Details

Page 6 — Leadership and Professional Training

Leadership and Professional Training

Leadership and Professional Training Details

Page 7 — Chief-Specific Qualifications

Qualifications and Experience

Page 8 — Driving Record / Professional Conduct

Driving Record / Law Enforcment Certification Eligibility

Professional Conduct

Page 9 — Professional References

Professional References (Minimum of Five)

Professional References

Professional References #2

Professional References #3

Professional References #4

Professional References #5

Page 10 — Current Employer Contact

Current Employer Contact

Page 11 — Background Investigation Questionnaire / Residential History

Background Investigation Questionnaire

Residential History

Residential Address

Page 12 — Employment Background Details

Employment History and Professional Conduct

Employment Background Details

Period Not Otherwise Accounted For

Page 13 — Financial Responsibility

Financial Responsibility

Page 14 — Criminal History and Law-Enforcement Contacts

Criminal History and Law-Enforcement Contacts

Adult Criminal History

Other law-enforcement contacts

Other Law-Enforcement Contact

Page 15 — Detailed Driving History

Driving History

Moving Violation / Traffic Citation

Page 16 — Military Service

Military Service

Military Service History

Page 17 — Prior Law-Enforcement Applications and Background Investigations

Prior Law-Enforcement Applications

Page 18 — Integrity, Conduct, and Other Suitability Information

Integrity, Conduct, and Other Suitability Information

Page 19 — Background Investigation Authorization and Release

Information That May Be Verified

Current Employer Contact

Protected Information

Background Investigation Authorization — Electronic Signature

Page 20 — Application Documents

Application Documents

Page 21 — Selection Process and Applicant Certification

Selection Process and Applicant Certification

Equal Employment Opportunity

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