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1. Notice to Applicants(current) This section is complete This section is incomplete
2. I. Personal Data This section is complete This section is incomplete
3. II. Education This section is complete This section is incomplete
4. III. Employment History This section is complete This section is incomplete
5. IV. Police Contact History This section is complete This section is incomplete
6. V. Driving History This section is complete This section is incomplete
7. VI. Family History This section is complete This section is incomplete
8. VII. General Information This section is complete This section is incomplete
9. VIII. Any other information that you need to add or that you feel would be important to this application? This section is complete This section is incomplete
10. IX. Release of information and liability This section is complete This section is incomplete

Notice to Applicants

Bloomfield Police Cadets Post # 1244
1 Municipal Plaza, Bloomfield, NJ 07003
Community Policing Division (973) 337-5897
Pre-Screening Application Form
Notice to applicants:
Your pre-screening application will be reviewed by the Bloomfield Police Department. It will be reviewed as a part of your background investigation to determine if you meet the minimum qualifications to become a Law Enforcement Cadet. This review process may take several weeks. Once the application process is started, you will be contacted for an interview. Untruthful information on this application automatically disqualifies you for the Bloomfield Police Cadets Post #1244.
QUESTIONS regarding the application process can be forwarded to Lt. Naomi Zepeda at (Email Link) or (973) 337-5897.
Date of application*
Date of application
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I. Personal Data

First Name*
Last Name*
Middle Name
Gender*
Nickname or Alias
Email Address*
Date of birth*
Social Security Number*
Phone Number*
Address*
Mailing Address (If Different From Above)
You Must Live in Bloomfield*
State*
Zip Code*
Cell Phone Number*
Other Phone Number
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II. Education

List current school you are enrolled.
Date
School Name
City, State
Grade / Level
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III. Employment History

Are you currently working?*
1. Yes
2. No
Have you ever been dismissed or fired from a job?*
1. Yes
2. No
Month and Year (From - To)
Employer
Job Title
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IV. Police Contact History

The following information pertains to your contact with law enforcement in general.
A. Have the Police ever been called to your home for any reason?*
B. Have you ever been convicted of a crime or act or juvenile delinquency?*
C. Have you ever been issued a traffic citation or any other ticket?*
D. Have you ever been suspended from school for any reason?*
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VI. Family History

Parent or Guardian Name*
Parent or Guardian Name
Address*
Address
Phone Number*
Phone Number
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VIII. Any other information that you need to add or that you feel would be important to this application?

Please explain.
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IX. Release of information and liability

I affirm that this questionnaire contains no misrepresentations or falsifications, omissions, or concealment of material fact(s), and that information given by me is true and complete to the best of my knowledge and belief. I am aware that statements made by me on this questionnaire are subject to a background investigation. I am further aware that should any investigation disclose misrepresentation, falsification, omission or concealment of material fact, my application may be rejected and my name removed from the eligible list(s). If already appointed, I may be dismissed.
I authorize the Bloomfield Police Department to make inquiry of employers, schools and references listed on the questionnaire regarding my integrity, reputation and character. I authorize the Bloomfield Police Department Cadet Post Advisor to inquire and check my current G.P.A . (Grade Point Average) to remain eligible.
I realize that it is necessary for the Bloomfield Police Department to thoroughly investigate all aspects of my personal background and qualifications, and by applying to be a volunteer with the Bloomfield Police Cadet Post #1244, I expressly waive all my legal rights and causes of action to the extent that the Department investigation (for purposes of evaluating my suitability for acceptance into the Bloomfield Police Department Cadet Post #1244 program) may violate or infringe upon these aforementioned legal rights and causes of action of mine.
The undersigned further agrees to hold harmless and release from liability under any and all possible causes of legal action the Township of Bloomfield, Bloomfield Police Department, their officers, agents and employees for any statements, acts or omissions in the course of the investigation into my background, family, personal habits and reputation, and my mental and physical health. I understand that the Bloomfield Police Department may make video tape of and/or photograph Cadet activities and such video footage or picture images may be shown on television, posted to the department’s website, posted to the department’s social media or given to the media.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Type Name of Child*
Electronic Signature (Child)*
Date*
Date
(If applicant is under the age of 18 years old, the parents or legal guardian must complete the following.)
We, the parents/guardian have read the application for the Bloomfield Cadet Post and do also agree with the above-mentioned statements. I also agree to allow my son/daughter to participate in Cadet activities if he or she is accepted into the Cadet Post. We also agree to exonerate and hold harmless the Bloomfield Police Department, its officers, advisors and Cadets in the event of any accident or injury, which may occur as a result of his/her participation in Cadet activities with this organization.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree. Parents or Guardian Signature(s):
Type Name of Parent / Guardian
Electronic Signature (Parent / Guardian)
Date
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Bloomfield Police Cadets Pre-Screening Application

Steps

Notice to Applicants

I. Personal Data

II. Education

III. Employment History

IV. Police Contact History

V. Driving History

VI. Family History

VII. General Information

VIII. Any other information that you need to add or that you feel would be important to this application?

IX. Release of information and liability

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