APPLICANT INFORMATION FORM POLICE OFFICER
(for notification Of Civil Service Exam)

RECRUIT NO. ________________ DATE: ____________________ Processed by: ____________ 

TOP PORTION FOR PERSONNEL USE ONLY 
(This is not an application)



_________________________________________________________________________
Social Security No: _________________________________________________ 

Name: last________________________first_____________________middle_________________ 

Home Address: number________________street_______________________________apt#______ 

city ________________________state_____________________zip______________ 

Telephone Number: home_____________________________other__________________________ 

Drivers License No: ____________________________ State: _____ 

NOTE: The following information is being collected for record keeping and compliance with Federal EEO regulations. This information is not part of the application and will not be used as a basis for making employment decisions. Completion of this section is voluntary and does not affect the application process. 

Have you applied with the City within the last six months? Yes__ No__
Sex: Male ___ Female ____ 
Birthdate: _____/_____/_____ 

Ethnic Group: ___ Black (Not Hispanic)
___ American Indian (Including Alaskan Natives)
___ Asian (Including Pacific Islander)
___ Hispanic (Includes persons of Mexican, Puerto Rican, Cuban, Central or S. American, or other Spanish origin or culture regardless of race)
___ White(Other than Hispanic)


Print and Fax to (972) 721-2582 or mail to: Human Resources, City of Irving, 825 W. Irving Blvd., Irving, Tx. 75060