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. cs FRST MIDDLE Last David Wayne Anders [STREET ADDRESSP.0. BOX NO. cerryrrown STATEAP FC Lake Charles Louisiana 70614 OME TELEPHONE NUMBER (WITH AREA CODE) OFFICE TELEPHONE NUMBER (WITH AREA CODE) a () 37) 491-1311 Fon scr oe Seo ono ITIZEN OF THE UNITED STATES? pavers ucexse no; pre ves: EXAMINATION FOR WHICH YOU ARE APPLYING (FILE A SEPARATE APPLICATION FOR EACH EXAMINATION) Chief of Police RACE/SEX INFORMATION [Te Fedral gevenrert ques tat we requat fw foloning ron ad er Ivomatin fo este! rparng pups Camploton oie elon evar, and yur apton wl tb ected yo hone ot np tne 1 mae Towne Teck LTetspenic Jam. inatan asian Female Dorner: _ ‘SPECIAL INSTRUCTIONS FOR DOCUMENTATION YOU MUST ATTACH In addlion to these requirements, the local eee oetseres nper neste a oes aes peace ee Jiro mat any ou roe Ree a gaa Fe era aaa eee Trt tutu rr ts cnet demas ped fede noe bard bm end ron ae seep ore eee [Pec team nee at ober eaten at pot by tec eaice toto Be admit othe exam= AUTHORITY FOR RELEASE OF INFORMATION. HAVE COMPLETED THIS APPLICATION ITH THE KUOWIEOGE AND UNDERSTANDING THAT ANY OR AL TEMS CONTAINED HEREN NAY BE SUBJECT TO -rIVESTIGATION PRESCRIBED BY LAW, AND | CONSENT TO THE RELEASE OF INFORMATION CONCERNING MY CAPACITY AND FITNESS BY EMPLOYERS, EDUCATIONAL NSTTUTIONS, LAW ENFORCEMENT AGENCIES, AND OTHER INDIVIDUALS AND AGENCIES, TO DULY ACCREDITED INVESTIGATORS, CML ERVICE BOARD MEMBERS AND OTHER AUTHORIZED EMPLOYEES OF THE GOVERNMENT FOR THAT PURPOSE. {FOERTIFY TAT THE ANSWERS | HAVE GIVEN To ALL QUESTIONS IN THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE. | KNOW TAT AXY| MIGREPRESENTATION HEREIN MAY CAUSE KY APPLICATION TO BE REJECTED, MY NAME REMOVED FROM THE EUGIBLE LIST ANDIOR MAY SUBLECT ME TO 'SMISSAL FROM EMPLOYMENT. Val ZY. "6 26s) en auel) Lordr2 FOR USE OF CIVIL SERVICE BOARD-ONLY c VERIFICATION THAT APPLICANT MEETS THE BOARD'S REQUIREMENTS 1.8, Citizen G Age G Educationr [G. Drivers'License. | Veteran Pref. Ec (f-2 requirement) « Chairman 2: Viee chairman 3. 4, 5. BACKGROUND INFORMATION 1. WITHIN THE PAST 5 YEARS, HAVE YOU BEEN TERMINATED, OR RESIGNED IN LIEU OF TERMINATION, FROM ANY POSITION FOR REASONS OTHER, ‘THAN A REDUCTION IN FORCE? vesL_] - 12, Have Vou EVER BEEN CONVICTED OF A FELONY? [ vesL] I 3. HAVE YOU BEEN CONVICTED OF A MISDEMEANOR DURING THE LAST 3 YEARS? vesL] nol] NOTE: F YOU ANSWERED “YE” TO EITHER OFTHE ABOVE QUESTIONS, PLEASE PROVIDE AN EXPLANATION INTHE EXPLANATION BLOCK BELOW, A CONVICTION WL NOT NECESSARILY BISQUALIF YOU FROM THE JOB FOR WHICH YOU ARE APPLYING. A CONVICTION WILL BE JUDGED ON ITS OW [ens wnt respect ro TME, CIRCUMGTANGES, AND SERIOUSNESS EXPLANATION. PLEASE USE THE SPACE PROVIDED BELOW TO EXPLAIN ANY "YES" ANSWERS TO THE ABOVE THREE QUESTIONS. ATTACH ADDITIONAL PAGES IF NECESSARY. NA [© GTRAININGIEDUGATION - “A. HIGH SCHOOL Tei os Si OHLONE SE ETN A Sulphur High Schoo! WY cron on cunneny saree 400 Sycamore St, pare neceven 05/15/1980 _ Sulphur, LA 70663 —B COLLEGE moon | com | roms | om “— Jniversity of Virgina (FBI National Academy) Crim Justice c McNeese State University 2005 6 NA Crim Justice ee ——= Fo. OTHER FORMAL TRAINING ‘canon gum, | sere | scorn (QUSINESS, TRADE, MIUTARY, ETC, CLASSES OR SEMINARS) “TITLE OF INSTRUCTION OR CLASS (ATTACH ADOMIONAL PAGES IF NECESSARY) FBI LEEDA's Executive Leadership Institute - Trilogy Award Lake Charles, La, ‘Aug 2017 FBI LEEDA’s Command Leadership Institute Lake Charles, La. | Aug 2016 | [= 40 FBI LEEDA’s Supervisor Leadership Institute Lake Charles, La} Dec 2018 40 FBI National Academy Class 219 Quantico, Va. | Deo 2004 40 (enc AOOMONAL Paes cen No.1 /UCENSE OF TYPE OF raroaema nonin [5s res Sart SsSsSsSssms9..0 om ‘SPECIAL QUALIFYING EXPERIENCE; CERTIFICATIONS, OR LICENSES. NO. 2 [ieicieiecat tin arose Tse 7.