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APPLICATION FOR COMPETITIVE EXAMINATION FIRE AND POLICE CIVIL SERVICE BOARD PLEASE PRINT OR TYPE, FAILURE TO ANSWER ALL THE QUESTIONS IN THIS APPLICATION AND FAILURE TO ATTACH ALL EQUIRED DOCUMENTATION TO THIS APPLICATION MAY CAUSE YOUR APPLICATION TO BE REJECTED. | Richard Wesley Harrell mae ie aera aa _— Lake Gharos La. 70801 ca TELNET AREA CODE GFAGE TELEFON WOMRER TH AREA COD) (on) ( ) (37) 491-1311 ELL TELEPHONE Wn (ATH AREA CODE) Sinaia K es — TAG TE THOTT bie ‘YOU A CITIZEN OF THE UNITED STATES? priver's uicense No: ves] no LL] on i [ examnaTion FoR wich YoU ARE APPLYING (FILE A SEPARATE APPLICATION FOR EACH EXAMINATION) Chiet of Police RACE/SEX INFORMATION ‘The Federal government requires that we request the following race and sex Information for statistical reporting purposes. [Completion of this section is voluntary, and your application will not be rejected if you choose not to provide this information. | A tate [ownite iack — LTwispanie LJam. ican Dassen Fi remaie Downer ‘SPECIAL INSTRUCTIONS FOR DOCUMENTATION YOU MUST ATTACH In accordance with civil eervice law you must be a olizen of the United States, and of leg ‘9@. In addition to these requirements, the local municipal fe and police elvil service board in each jurisdiction has adopted its own qualification requlrements for each of ts compete classes. | Therefore, you must attach the necessary documentation to very that you mest all the requirements of the cll service board to which you are applying. You must attach @ copy of the following documents: Proof that you are a clizen of the United States (Bith Certilicate, US Passport, or Certlicate of Naturalization) Proof that you meet the age requirement of the clvl service board (Birth Cerificate) |, |Proot that you meet the education requirement as posted by the civil service board to be admitted to the exem root that you have a vad driver's license (i hi I requirement of the civil service board to be admitted to the exam) Proof that you meet all other requirements as posted by the civil service board to be admitted to the exam r AUTHORITY FOR RELEASE OF INFORMATION. (RAVE COMPLETED THIS APPLICATION WITH THE KNOWLEDGE AND UNDERSTANOING THAT ANY OR ALL ITEMS CONTAINED HEREIN MAY BE SUBJEGT TO| INVESTIGATION PRESCRIBED BY LAW, AND | CONSENT TO THE RELEASE OF INFORMATION CONCERNING MY CAPACITY AND FITNESS BY EMPLOYERS, :DUGATIONAL INSTITUTIONS, LAW ENFORCEMENT AGENCIES, AND OTHER INDIVIDUALS AND AGENCIES, TO DULY ACCREDITED INVESTIGATORS, civi| SERVICE BOARD MEMBERS AND OTHER AUTHORIZED EMPLOYEES OF THE GOVERNMENT FOR THAT PURPOSE, (CERTIFY THAT THE ANSWERS I HAVE GIVEN TO ALL QUESTIONS IN THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE. | KNOW THAT ANY NSREPRESENTATION HEREIN MAY CAUSE MY APPLICATION TO BE REJECTED, MY NAME REMOVED FROM THE ELIGIBLE LIST ANDJOR MAY SUBJECT ME To DISMISSAL FROM EMPLOYMENT. ae eB 2 FOR USE OF CIVIL SERVICE BOARD ONLY VERIFICATION THAT APPLICANT MEETS THE BOARD'S REQUIREMENTS GUS. Citizen G Age Education 1G. Driver's License Veteran Pref. (if. requirement). | ri. Chairman 2. Vice chairman 3. 4. | BACKGROUND INFORMATION | 1 WN THE PAST 5 YEARS, HAVE YOU BEEN TERMINATED, OR RESINED IN LIEU OF TERMRATION FROM ANY POSTION FOR REASONS OTHER [a neoveron wi poncer vesL] —wolZ] 7 av You EVR BEEN COWCTED OFA FELON? { vel} od 3, HAVE YOU SEEN CONVICTED OF A MISDEMEANOR DURING THE LAST 3 YEARS? I vesl nol¥! NOTE: IF YOU ANSWERED “YES" TO EITHER OF THE ABOVE QUESTIONS, PLEASE PROVIDE AN EXPLANATION IN THE EXPLANATION BLOCK BELOW. A, CONVICTION WILL NOT NECESSARILY DISQUALIFY YOU FROM THE JOB FOR WHICH YOU ARE APPLYING. & CONVICTION WILL BE JUDGED ON ITS OWN MERITS WITH RESPECT TO TIME, CIRCUMSTANCES, AND SERIOUSNESS. | EXPLANATION. PLEASE USE THE SPACE PROVIDED BELOW TO EXPLAIN ANY "YES" ANSWERS TO THE ABOVE THREE QUESTIONS. ATTACH [ADDITIONAL PAGES IF NECESSARY. ‘TRAINING/EDUCATION aan Sa oOr Ta nO nS NF FN ONTO EN Sulphur High School | ccun on caunaancs concert 100 Sycamore St. | Fare nace, 05/23/1991 ‘Sulphur, La. 70663 B COLLEGE wow | ome | cece | ener oe feNaese Stato University 2013-2015] 4p Crim Justice sniversity of Viginia| 2011 = (Grim Justice ‘vcNeese State University 1993 : Gen Studies United States Army 1991-1992] 49 Gen Studies ©, OTHER FORMAL TRAINING — snow cnnen ve crone | {@UBNESS, TRADE, MLTARY, ETC, CLASSES Of SEMINARS) {WT oF n¥TRUCTION OR CLASS (ATTACK ADDITONAL PAGES F NECESSARY) FBI National Academy Quantico, Va. 2011 ‘BI LEEDA Executive Institute BI LEEDA Supervisor Leadership Zachery ta. | 206 | Fle 40 FBI LEEDA Command Institute Georgetown, Tx. | 2014 40 40 Tampa, Fi 2014 Ee [ SPECIAL QUALIFYING EXPERIENCE, CERTIFICATIONS, OR LICENSES | PLEASE LIST BELOW ANY PROFESSIONAL LICENSES OR CERTIFICATIONS THAT ARE RELEVANT TO THE JO8 FOR WHICH YOU ARE APPLYING. [ rman nas ess Ron No. 2 No.3 | ue Srucoie orriee or commeanon [Louisiana P.O.8.7. Haoonnemomns [een | onre ense on csrrmieaven xeaures fogy16/1005 | Not applicable =

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