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LARAMIE POLICE DEPARTMENT Personal History Statement **This form must be completed and returned with your application** All applicants for the Laramie Police Department are required to answer the following questions to be considered for employment. An initial screening will be made of the application and personal history statement to ensure that the applicant meets the minimum requirements. All statements are subject to verification. Inaccurate statements or omissions may disqualify you from further participation in the selection process. Any other name(s) under which records might be found (alias or maiden Yes No 1. I am at least 21 years of age 2. I am a U.S. Citizen 3. I am Wyoming P.O.S.T. certified If you answered NO to any of questions 1-3, please attach a separate piece of paper and provide an explanation. Yes No 4. Have you ever been arrested for or convicted of a felony? 5. Have you ever been arrested for or convicted of a misdemeanor, petty offense, or received a traffic citation? 6. Have you ever been arrested for or convicted of domestic violence? 7. Are you under indictment, or have you been served with any information alleging any offense where the punishment may be confinement in the penitentiary? 8. Have you ever used, sold or grown marijuana? 9. Have you ever used, sold or manufactured other illegal drugs? 10. Have you ever taken prescription drugs other than as prescribed by a physician? 11. Has your driver's license ever been suspended, revoked or denied? 12. Have you ever been arrested for driving under the influence or driving while impaired by drugs or alcohol? 13. Have you ever participated in criminal activity and not been caught? 14. Have you ever driven under the influence of drugs or alcohol and not been caught? If you answered YES to any of the questions 4-14, please attach a separate piece of paper and provide explanations, including specific dates, times, locations and any other relevant information. For drug related questions, list specific drugs used, date of first use and date of last use. CERTIFICATION I hereby certify that all statements made in this application are true and complete. I understand that any false answers, statements or misrepresentations by omission made by me as part of my application will be sufficient for rejection of my application or for my immediate discharge should one be discovered after I am employed. I acknowledge that I have read and understand the preceding statement.