APPLICANT ELIGIBILITY QUESTIONNAIRE INSTRUCTION SHEET

Option 1:

Complete this form using Adobe Acrobat Reader or Adobe Acrobat and click Submit Form. You can also complete the form, save it to your computer and email it as an attachment to CCPDRecruiter@cctexas.com. Viewers such as Apple Preview and Google Chrome PDF Viewer may not allow you to submit the form electronically. You can obtain the Adobe PDF Reader by clicking here. Once installed you will be able to complete the form and use the Submit Form function. It is recommended that you are logged into your email provider (have it open) when attempting to use the Submit Form function.

Option 2:

Complete the form, print it out and mail it to: Corpus Christi Police Department Attention: Background Investigations P.O. Box 9016 Corpus Christi, TX 78469-9016

If you have any questions please contact the Background Investigations section at 361.886.2626.

The City of Corpus Christi will not discriminate against any applicant or employee based on race, color, religion, sex, pregnancy, age, sexual orientation, gender identity, national origin, military status, citizenship, work related injury or illness, disability, or genetic information.

CORPUS CHRISTI POLICE DEPARTMENT Eligibility Questionnaire

Eligibility Questionnaire

YOUR CONTACT INFORMATION

First Name Last Name Middle Name

Date of Birth Social Security Number

Driver's License Number State Expiration Date

Mailing Address (Street, City, State, Zip Code) Apt. #

Phone Number E-mail Address

Are you a U. S. Citizen?

Yes No

Are you at least 21 years of age?

Yes No

Are you under 45 years of age?

Yes No

Did you graduate from high school with at least a 2.0 GPA?

Yes No

If you answered no to the previous question, do you have a GED with twelve (12) credit hours from an accredited college with at least a 2.0 GPA?

Yes No Not Applicable

Eligibility Questionnaire

Have you served on active duty for a minimum of one hundred and eighty (180) consecutive days in the United States Armed Forces?

Yes No

Have you been discharged from any military branch for receiving a dishonorable discharge or any other discharge based on misconduct?

Yes No

Have you ever been terminated from a job, quit prior to termination or asked to resign in-lieu of termination?

Yes No

Do you have two (2) or more moving violations in the past twelve (12) months?

Yes No

Have your driving privileges been suspended or revoked within the past twenty-four (24) months?

Yes No

Have you had a Driving While Intoxicated (DWI) conviction within the past ten (10) years?

Yes No

Have you ever been arrested, either as an adult or juvenile?

Yes No

Have you ever been convicted of any crime? Not to include traffic tickets/violations.

Yes No

Eligibility Questionnaire

Have you ever been placed on probation, received deferred adjudication or pre-trial diversion for any offense?

Yes No

Have you ever been charged with a crime but later acquitted?

Yes No

Have you used marijuana or any illegal drugs in the last twelve (12) months?

Yes No

Have you used marijuana or any illegal drugs in the last twenty-four (24) months?

Yes No

Have you used marijuana or any illegal drugs in the last thirty-six (36) months?

Yes No

Have you previously applied with our department for the position of Police Officer?

Yes No

If yes to the above question, list the most recent year you applied?

Eligibility Questionnaire - Survey

How did you learn about a career with the Corpus Christi Police Department?

Career Expo/Job Fair

Event/Location: _____________________________________________________

College Fair/Presentation

Event/Location: _____________________________________________________

Current or Retired City Employee Referral

Email Notification

Facebook (Corpus Christi Police Department page)

Indeed

Military Job Fair Newspaper/Magazine Publication

Police One

Radio Station Advertisement

CCPD Recruiter/CCPD Sworn Officer

Twitter (CCPD)

Other

List: _______________________________________________________________

Eligibility Questionnaire

ACKNOWLEDGEMENTS

I have reviewed this Eligibility Questionnaire for completeness and accuracy prior to submitting. I understand that if my application is incomplete, I will not be considered for the position.

I agree

I hereby certify that all statements made in this application are true and complete. I understand that any discrepancies, misstatements, omissions, and/or falsifications will be cause for my disqualification, and my name will be removed from the eligibility list or I will face immediate termination if an appointment has been made.

I agree

I do hereby authorize the release, review and full disclosure of all records concerning myself to the Corpus Christi Police Department, whether said records are of a public, private, or confidential nature. This release is valid for any individual, organization, department, business, or other body as deemed necessary by the Corpus Christi Police Department to determine my eligibility for employment with said department.

I agree

Completion Date

CLICK TO SUBMIT