V. MILITARY RECORD 1. Did you register with the Selective Service System as required. Yes No If yes, provide the following: Registration Number Location (City, State, Zip Code) If no, provide reason: 2. Have you served on active duty in the United States Forces? Yes No If yes, attach a copy of each DD-214 received and proceed to question 3. If no, proceed to Part VI. 3. Branch of military service: 4. Dates of active duty (Month, Date, Year) ž žžFrom: To: From: To: 5. Military Serial Number or SSAN: 6. Are you a member of the Reserve? Yes No Ready Standby Branch of Service: 7. Was any disciplinary action taken against you while you were in the service? Yes No If applicable, be sure to include nonjudicial punishment and Article 15s. If yes, provide details. 8. Have you served in the National Guard? Yes No If yes, provide dates, unit location, and name of Commanding Officer. 9. a. Do you claim Veterans Preference? Yes No b. If yes, indicate dates of service and attach DD-214. c. If claiming Veterans Preference, in addition to your DD-214, you must provide a Standard Form 15 (Application for 10-point Veteran Preference) with appropriate documentation. VI. REFERENCES/SOCIAL ACQUAINTANCES List three people who know you well and live in the United States. They should be good friends, peers, colleagues, college roommates, etc., whose combined association with you covers as well as possible the last 10 years. Do not list your spouse, former spouse, or other relatives, and try not to list anyone who is listed elsewhere on this form. 1. Complete Name (Last, First, Middle) Home Address (City, State, Zip Code) Home Phone (Including Area Code) Business Address Business Phone (Including Area Code) Yrs. Acq. Occupation DOB or Approximate Age 2. Complete Name (Last, First, Middle) Home Address (City, State, Zip Code) Home Phone (Including Area Code) Business Address Business Phone (Including Area Code) Yrs. Acq. Occupation DOB or Approximate Age 3. Complete Name (Last, First, Middle) Home Address (City, State, Zip Code) Home Phone (Including Area Code) Business Address Business Phone (Including Area Code) Yrs. Acq. Occupation DOB or Approximate Age
XIII. COTENANTS List all individuals with whom you have resided in the last 5 for a period of 30 days or more. Do not include relatives listed in section XII above (Attach additional sheets if necessary.) 1. Name (Last, First, Middle) (Maiden) 2. Name (Last, Middle) (Maiden) Current Address (City, State, Zip Code) Current Address (City, Zip Code) Home Telephone Number Home Telephone Number Name of Firm or Employer Name of Firm or Employer Address of Employer (City, State, Zip Code) Address of Employer (City, State, Zip Code) Work Telephone Number Work Telephone Number Date of Birth Place of Birth Date of Birth Place of Birth Dates of Residence From: (Month, Day, Year) To: (Month, Day, Year) Dates of Residence From: (Month, Day, Year) To: (Month, Day, Year) XIV. CITIZENSHIP OF RELATIVES/COTENANTS Are any close relatives or cotenants naturalized or non-United States citizens? Yes No If yes, provide the information below. (You do not need to list this information for in-laws unless they currently reside with you). Attach additional pages, if necessary. Full Name Name Used When Entering U.S. Relationship to Applicant Registration Naturalization Number, Date, and Number Place of Naturalization (City, State, Zip Code) XV. FRIENDS OR ACQUAINTANCES EMPLOYED BY THE SOUTH CHICAGO HEIGHTS POLICE Full Name Location Length of Acquaintance 1. Height Without Shoes XVI. PHYSICAL DATA 3. Persons with a disability who require an accommodation to complete the application process are required to notify the South Chicago Heights Police of their need for the accommodation. 2. Weight Without Clothes