METROPOLITAN POLICE DEPARTMENT · 2019. 7. 22. · PAT and perform the physical activities required...

METROPOLITAN POLICE

RESIDENCY REQUIREMENT

Colonel John W. Hayden, Jr. Police Commissioner

Service, Integrity, Leadership, and Fair Treatment to All

DEPARTMENT City of St. Louis - 1915 Olive Street - St. Louis, MO - 63103

I hearby acknowledge that upon appointment/reinstatement to the City of St. Louis Police Division, I am required to

reside in the City of St. Louis within one hundred twenty (120) days after my working test period. I am aware that

employees who are not city residents at the end of the one hundred twenty (120) day period may be terminated

Applicant's Signature Date

Witness's Signature Date

Service, Integrity, Leadership And Fair Treatment To All

M E T R O P O L I T A N P O L I C E D E P A R T M E N TCITY OF ST. LOUIS ‐ 1915 OLIVE STREET ‐ ST. LOUIS, MISSOURI 63103

EMPLOYMENT RECORD AUTHORIZATION

To Whom It May Concern:

I request and authorize you to furnish to the St. Louis Metropolitan Police Department any and all information and documents, including those of a confidential or privileged nature, in your possession or control concerning me. You are hereby authorized and requested to copy records including but not limited to school transcripts, employment applications, personnel records, employment time records, attendance records, workers’ compensation records, accident reports, information on any law suits filed against me or a previous employer based on my actions, medical records maintained in my personnel file, office records, notations, internal reprimands or discipline, or financial records.

This information is to be used to assist the St. Louis Police Department in determining my qualifications and fitness for the position of police officer.

I hereby release you, your agency, or others from any and all liability or damage which may result from furnishing the information requested.

Applicant's Name: (Please Print)

Applicant's Social Security Number: ‐ ‐

Applicant's Date of Birth:

Date: Applicant's Signature

Date: Witness Signature

MPD Form HUMAN RES‐16 (R‐8) 01/13


METROPOLITAN POLICE


Service, Integrity, Leadership, and Fair Treatment to All

DEPARTMENT City of St. Louis -1915 Olive Street -St. Louis, MO - 63103

ACCESSIBILITY TO CONFIDENTIAL RECORDS

Dear Applicant,

The Revised Statutes of Missouri, Section 610.120 Records to be confidential. accessible to whom ... permits the St.

Louis Metropolitan Police Division, City of St. Louis to consider the complete confidential history of any applicant

to determine the best qualified candidates for the position of Police Officer. This Section in pertinent part states

"Records ... shall be available only to courts, law enforcement agencies and federal agencies for purposes

of ... criminal justice employment ... These Records shall be made available for the above purposes regardless of any

previous statutory provisions which had closed such records to certain agencies or for certain purposes.

Therefore, it is imperative that as an applicant, you list on both the application and background questionnaire all

arrests, citations, traffic violation and tickets which you have received or been issued, whether or not that arrest

or summons resulted in a conviction. Failure to do so could result in the applicant being disqualified for further

procession and/or employment by this Department.

I acknowledge that I have read and understand the above requirement concerning my criminal history and arrest

record. I understand that employment is contingent upon strict compliance.

Applicant's Signature Date

Witness Signature Date

Page 1 of 5 MPD Form HR-90 (R-7) 01/13

Service, Integrity, Leadership And Fair Treatment To Al l

M E T R O P O L I T A N P O L I C E D E P A R T M E N T

HUMAN RESOURCES DIVISION CITY OF ST. LOUIS – 1915 OLIVE STREET - ST. LOUIS, MISSOURI 63103

PHONE: (314) 444-5615

FAX: (314) 444-5493

PHYSICAL ABILITIES TEST REQUIREMENTS I, , hereby acknowledge that I have been advised that I must be in good physical condition at the time my application for the position of Probationary Police Officer is submitted. I acknowledge that I have been further advised that, if I am not in good physical condition, I may be at risk of physical injury and/or medical difficulties when participating in the Physical Ability Test and on the job and, therefore, should seek the advice of my physician before proceeding in the examination process. I understand that, for purposes of my employment application, "good physical condition" means: 1. I have no medical condition or risk factor that would be aggravated by exercise or pose an

immediate risk when coupled with exercise, have answered “NO” to all seven questions on the PAR-Q questionnaire presented on Page 3 and have none of the major signs or symptoms of underlying risk factors identified on Page 4.

(If you answered YES to any of the seven questions on the PAR-Q, or have any of the major signs or symptoms listed, you should postpone physical testing until medical clearance is obtained.)

2. I have been evaluated with respect to any known medical condition or risk factor, have received

certification from my physician specifying that participation in a fitness program and the Physical Ability Test poses no significant risk, and have provided notification of my condition/risk factor and physician certification to the SLMPD.

3. I am taking any prescribed medical or health precautions I am required to take to safely

participate in the Physical Ability Test. 4. My weight is within an acceptable range for a person of my height and body structure based

on the height-weight scales and/or body fat percentage standards adopted by the Board of Police Commissioners and presented in the height-weight/body fat chart.

I further acknowledge that, in addition to the requirement that I be in "good physical condition," I will also be required to successfully complete the Board's Physical Abilities Test whenever required to do so during the period in which my application is being processed. I understand that failure to pass the Physical Ability Test at any time during the processing period may result in disqualification from the employment process, or in my application being placed in an "inactive" status until such time as I meet the Board's fitness requirements.

COLONEL JOHN W. HAYDEN, JR. POLICE COMMISSIONER

PHYSICAL ABILITIES TEST REQUIREMENT (Continued)


(Check one)

_____ I am in good physical condition as defined above and wish to proceed with the Physical Ability Test at this time. I acknowledge that I have read and understood the factors that can pose a medical/health risk when taking the Physical Ability Test and the requirements for being in “good physical condition”. I do understand that the Physical Ability Test is physically demanding and, as with any exercise, poses potential risks which I accept. If my participation in the Physical Ability Test (PAT) results in any physical injury or negative consequence to myself, I agree to release and hold harmless the Board of Police Commissioners, the St. Louis Metropolitan Police Department, their employees, agents, or representatives from all liability, claims, lawsuits, costs, and expenses which could be claimed to result from participation in the PAT, with the exception of any workers compensation benefits to which the undersigned would otherwise be legally entitled.

_____ I would like to postpone my participation in the Physical Ability Test until I secure a

physician’s certification indicating that I am medically cleared for participation in the Physical Ability Test and/or until I meet all requirements for being in good physical condition (e.g., height-weight/body-fat).

_____ I do not wish to participate in the Physical Ability Test at any time. I understand that this

decision disqualifies me from further participation in the St. Louis Metropolitan Police Department selection process.

________________ Applicant's Signature Date

Witness Signature Date



Physical Activity Readiness Questionnaire (PAR-Q)1

1. Has a doctor ever said you have a heart condition and recommended only

medically supervised physical activity?

Circle one

YES NO

2. Do you have chest pain brought on by physical activity? YES NO

3. Have you developed chest pain within the last month? YES NO

4. Do you tend to lose consciousness or fall as a result of dizziness? YES NO

5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?

YES NO

6. Has a doctor ever recommended medication for your blood pressure or a heart condition?

YES NO

7. Are you aware, through your own experience or a doctor's advice, of any other physical reason why you should avoid exercising without medical supervision?

YES NO

If you answered YES to any of these seven questions, vigorous exercise and physical testing

should be postponed until medical clearance is obtained.

Question #7 of the PAR-Q is an open-ended question which covers medical and physical problems which make further medical screening necessary. Many individuals may question whether certain conditions are important enough or severe enough to warrant seeing their doctor. The table on the next page provides additional information, including an indication of signs and symptoms suggestive of underlying diseases, risk factors for heart disease which in combination, suggest the need for medical screening, and a list of conditions which may increase the risk of complications during exercise.

1From: Thomas, S., J. Reading, and R.J. Shephard. Revision of the Physical Activity Readiness

Questionnaire (PAR-Q). Canadian Journal of Sport Science 17:338-345, 1992.



Height and Weight The first part of this section identified medical conditions that would pose a risk to candidates while participating in physical activity. In addition to the medical conditions, there are a number of general health factors which can be used to assess your current level of fitness and help determine whether you are ready to participate in the PAT and perform the physical activities required of police officers on the job. One such factor is to review the height and accompanying weight chart presented below. Falling outside of the weight ranges or the body fat percentage, may not prevent you from participating in the PAT but it may be an indicator of potential risks when participating in the fitness program provided in this guide and during the PAT. If you are concerned about your current weight or amount of body fat or exhibit high levels beyond the guidelines suggested, you should seriously consider consulting a physician and or engaging in a weight control program (see next section) prior to initiating a rigorous fitness program and taking the PAT. In addition, if you have numerous warning signs or fall well outside the desired levels, you may need to reconsider whether you are capable of completing a fitness program and the PAT in the near future, and handling the physical demands of serving as a police officer on a daily basis.

HEIGHT AND ACCOMPANYING WEIGHT RANGES*

MALES FEMALES

Height Weight Height Weight

5'0" 106 – 146 5'0" 96 – 138

5'1" 109 – 151 5'1" 99 – 141

5'2" 111 – 155 5'2" 102 - 144

5'3" 114 – 159 5'3" 105 - 149

5'4" 117 – 163 5'4" 108 - 152

5'5" 120 – 167 5'5" 111 - 156

5'6" 124 – 173 5'6" 114 - 160

5'7" 128 – 178 5'7" 118 - 165

5'8" 132 – 183 5'8" 122 - 169

5'9" 136 – 187 5'9" 126 - 174

5'10" 140 – 193 5'10" 130 - 179

5'11" 144 – 198 5'11" 134 - 185

6'0" 148 – 204 6'0" 138 - 190

6'1" 152 - 209 6'1" 142 - 195

6'2" 156 - 215 6'2" 146 - 200

6'3" 160 - 220 6'3" 150 - 205

6'4" 169 - 231 6'4" 154 - 210

6'5" 174 - 238

6'6" 179 - 247

6'7" 184 - 256

*If the desirable weight range is not achieved, you may also want to consider your percentage of body fat. The acceptable percentage of body fat is up to 19% for men and up to 23% for women.

PHYSICAL ABILITIES TEST REQUIREMENT (COMPONENTS)


Run the perimeter of the Police Academy Gymnasium (approximately 230 yards), then negotiate the following obstacles: Jump over a one (1) foot hurdle, Jump over a two (2) feet hurdle, Negotiate around a cone, Jump a four (4) feet long jump, Negotiate around cone, Walk down a six (6) inch by six (6) inch by eight (8) feet beam, Negotiate around a cone, Approach a mat, drop down and touch chest to the floor, stand up and touch shoulder blades to the floor, stand up, Negotiate around cone, Jump or climb over a four (4) feet wall, Negotiate around a cone, Go up stairs (6 up and 6 down), Repeat stairs, Advance to power training machine, push 75 pounds, walk in a semi-circle, pull 75 pounds, walk in a semi-circle, Drag 150 lb. dummy 50 feet, Sprint 50 feet, and Dry fire weapon five (5) times with each hand. The test is approximately 444 yards or 1/4 of a mile in length. Performing all portions of the test properly and finishing in three (3) minutes and thirty (30) seconds or less will be considered a passing score. Although the test may appear relatively easy, you are encouraged to thoroughly condition yourself before attempting to take the test. Cardiovascular fitness, strength and endurance would be of particular benefit to you.

BACKGROUND QUESTIONNAIRE

POLICE DIVISION

CITY OF ST. LOUIS

POLICE OFFICER POSITION

INSTRUCTIONS

Read every question carefully and answer each question accurately and completely. An applicant could be disqualified from further processing if he/she intentionally makes a false statement of a material fact, practices or attempts to practice any deception or fraud on this questionnaire. An extensive background investigation will be conducted of your character and reputation. All information is verified; therefore, accuracy is essential. All entries, except signature, must be typed or printed legibly in ink. If space is not sufficient, or you wish to provide a more complete answer, use the "Additional Information" pages. If a question or the information requested does not apply, indicate that by inserting "N/A" (Not Applicable).

Please ensure that all addresses include the zip codes and all phone numbers have the area code listed on the questionnaire.

All spaces must be completely filled out before the application can be processed. An incomplete application will not be reviewed.

If, for any reason, you do not understand any question contained in this questionnaire, call the Department of Personnel, Police Division at 314-444‐5615 for further explanation and assistance.

DATE:

1

MPD FORM HUMAN RES‐74 (R‐4) (6/18)

2

BACKGROUND QUESTIONNAIRE

POLICE DIVISION

CITY OF ST. LOUIS, MISSOURI

A. PERSONAL DATA

1. Name(Last) (First) (Middle)

2. List all other names you have, or have used (including maiden name, nicknames, and aliases):

3. Race Gender Age _________

4. Date of Birth(Month) (Date) (Year)

5. Place of Birth(County) (State) (Country)

6. Present Address(Street Number and Name) (Apartment Number)

(City) (County) (State) (Zip Code)

7. How long have you lived at this address?(Years) (Month)

(City)

3

8. List your previous addresses or residences for the past 10 years, excluding your present address, but includingextended periods of stay (longer than one month) at school, for military service, for employment, etc.

FROM TO LOCATION

1. (Month/Year) (Month/Year) (Street Number and Name) (City) (State) (Zip Code)

(County of Residence) (Local Police Department))


(County of Residence) (Local Police Department)


(Local Police Department) (County of Residence)

9. Are you a citizen of the United States? Yes No

10. If you are a naturalized citizen, please furnish the following information concerning your naturalization:

Certificate Number Date(Month) (Day) (Year)

Place(City) (County) (State)

11. Social Security Number ______________‐______________‐_______________

12. Telephone Numbers: Home ( ) ________ Business ( ) Area Code Phone Number Area Code Phone Number

Other contact number ( ) Area Code

13. Height Weight Hair Color

Phone Number

14. Marital Status? (Please Check One) Single Married Widowed Divorced

Separated Domestic Partner

Eye Color

4

15. With whom do you reside?

(Name) (Relationship) (Birth Date) (Place of Birth)



MARITAL INFORMATION

If you are now, or have ever been married, please furnish the following information concerning each marriage, including information concerning the termination of the marriage (death, annulment, separation, divorce, etc.) Please list current marriage or last marriage first.

MARRIAGE:

(Name) (Social Security #)

Date

(Birth Date)

Place

(Address)

(Month) (Day) (Year) (City) (County) (State)

How Terminated Date (Death, Divorce, etc.) (Month) (Day) (Year)

Location (City) (County) (State) (Country)

16. Are you required to pay child support? Yes No

If so, in what city and state are you required to pay child support?

17. Are you now or have you ever been delinquent in child support payments? If yes, please explain:

5

18. Do you have any close friends or relatives employed by this department? Yes No

If yes, please indicate names and relationships:

Name Position/Job Title Relationship

Name Position/Job Title Relationship

19. Have you ever received any police academy training? Yes No

If yes, please provide details:

EMPLOYMENT

List below your previous employers for the last five years starting with your present position and working backwards. Include all periods of unemployment, part‐time employment, temporary or seasonal employment, military service, employment while a member of military service, periods in school, and volunteer service. Account for all of your time, and do not leave any lapses. Indicate the complete name of the company/firm, exact address (include number and name of street, city, state and zip code). If you need to add additional employment information, continue on page 11.

1. / Company/Firm Name Position/Job Duties FROM TO

Month/Year Month/Year

( )Supervisor/Contact Person Reason For Leaving Salary Phone Number

_ Address City State Zip Code



Supervisor/Contact Person Reason for Leaving Salary Phone Number

Address City State Zip Code

)(

6



( ) Supervisor/Contact Person Reason for Leaving Salary Phone Number




Supervisor/Contact Person Reason for Leaving Salary Phone Number




______ ____________ ( )_____________ Supervisor/Contact Person Reason for Leaving Salary Phone Number


20. May we discuss your application with your present or previous employers? Yes No

21.Were you ever dismissed or asked to resign from any employment? Yes No

If yes, give details of dismissals or forced resignations below:

Employer Address Date Reason For Dismissal

__________________

) (

7

22.Were you ever subjected to disciplinary action in connection with any employment? Yes No

If yes, give details of each account:

23. Have you ever applied for employment with this department or any other police department, with theCity of St. Louis, or with any other governmental agencies? Yes No

If yes, give details, position(s) sought, dates and agencies:

MILITARY SERVICE

24. Have you ever served on active duty in the Army, Air Force, Coast Guard, Marine Corps, Navy,R.O.T.C., or any other military organization? Yes No

If yes, indicate below all active military service:

_____________ _______ Branch/Organization Primary Duty Rank

____________ Date Entered Date Discharged Type of Discharge

25. Are you now or have you ever been a member of any Reserve or National Guard? Yes No

If yes, indicate the complete name and address of the unit:

Name of Unit Address City State Zip Code

8

ARRESTS, SUMMONSES AND CONVICTIONS

26. Were you ever, either as an adult or certified as an adult, arrested, taken into custody, or imprisoned? Haveyou ever received a summons or citation, excluding traffic? Have you ever been arrested, where the originalcharge was reduced to a lesser crime? (Exclude all parking and other minor traffic violations) AN ARRESTHISTORY/CONVICTION WILL NOT NECESSARILY EXCLUDE YOU FROM THE EXAMINATION PROCESS. EACHAPPLICANT’S HISTORY IS REVIEWED ON A CASE BY CASE BASIS. Yes No

If yes, give full details of each and every incident:

_______

_______

27.Were you ever, as an adult or certified as an adult, convicted of a crime? Yes No

What crime(s)? Give details:

28. Indicate below all arrests as an adult or certified adult:

Date Charge Location Court Police (City, County, State) Disposition Agency

29. Have the police ever been called to your residence (your current and all former residences) for anyreason? Yes No

If yes, explain in full detail:

9

30.Were you ever summoned or subpoenaed to court in a civil action or proceeding; or were you ever aparty (plaintiff or defendant) in a civil action, in this state or elsewhere? Yes No

If yes, indicate below:

________ Date Action/Proceeding Plaintiff/Defendant/Witness Court Disposition

_______ Date Action/Proceeding Plaintiff/Defendant/Witness Court Disposition

Date Action/Proceeding Plaintiff/Defendant/Witness Court Disposition

Action:

Outcome:

Details:

REFERENCES

31. Give three social acquaintances:

1.Full Name (Birth Date) Numeric Street Address (Include City/State/Zip)

Occupation Business Address (Include City/State/Zip)

Years Known Phone Number Business Phone Number

2.Full Name (Birth Date) Numeric Address (Include City/State/Zip)



10

3.Full Name (Birth Date) Numeric Address (Include City/State/Zip)



32. Please list all active and inactive email addresses:

33. Please provide all active and inactive social network accounts, include your username (i.e. Facebook,MySpace, Twitter, Instagram, Youtube, Bebo, etc.) information:

DRIVING RECORD

34. Indicate below your driver's license information:

License Number State Expiration Date

CHECK ONE: Operator's License Chauffeur's License

35. Did you ever possess an operator's / chauffeur's license issued by any state other than Missouri?

Yes No

If yes, indicate the state issuing the other license and expiration date:

36.Was your license (check one) Surrendered Suspended Revoke

If suspended or revoked, state reason:

37. Is your current license suspended or revoked? Yes No

If yes, please state reason:

11

38. List all vehicles which you and your spouse own, lease, or have for your personal use (includingmotorcycles):

Year Make Model License Plate Number State ____________

39. Do you have any knowledge or information, in addition to that specifically called for in the precedingquestions, which is or which may be relevant, directly or indirectly, in connection with the investigation ofyour eligibility or fitness for appointment to the Police Division? This would include, but not limited to,knowledge or information concerning your character, temperament, habits, employment, education, family,criminal record, traffic violations, residence or otherwise? Yes No

If yes, give details:

Use the following section for any additional information. List the question number to which the additional information applies. Sign your name at the bottom of this page.

Attach additional pages if needed.

SIGNATURE

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METROPOLITAN POLICE DEPARTMENT · 2019. 7. 22. · PAT and perform the physical activities required...

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