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2. General Instructions

   This application must be completed, electronically signed, and submitted along with payment via credit card in the amount of $35.00 (non-refundable administrative fee). Applications submitted without payment will not be processed. Application for Written Examination MUST be received no later than 4:00 p.m. on August 5, 2022. In the case of a tie score, the time of receipt of application will be the determining factor.

3. 
5. Note

   Incomplete or unsigned applications, applications received after the 4 p.m. on August 45, 2022 deadline, and/or applications submitted without the requisite payment will result in the applicant being ineligible to participate in the testing process.

7. The written examination will be conducted on Saturday, August 20, 2022 at 9:00 a.m. at the Pottstown Senior High School (Washington Street Entrance), located at 748 N. Washington Street, Pottstown, PA. Registration will be held from 8:00 a.m. until 9:00 a.m. The written examination will commence at 9:00 a.m. Persons not registered by 9:00 a.m. will be ineligible for testing. When reporting for the written examination each candidate must bring two pencils (#2) and photo identification, which is required for registration. A driver's license or Real ID are the preferred forms of photo identification. No other items will be permitted to be in your possession during the written examination. No entry to the testing area will be permitted after 9:00 a.m.

9. Last Name*
10. First Name*
11. Middle Name*
13. Street Address*
15. City*
16. State*
17. Zip Code*
19. Telephone - 1*
20. Telephone - 2
22. Email Address*
23. Drivers License Number*
24. State Issued*
26. US Citizen*
    -- Select One --YesNo
27. Naturalization Number, if applicable
28. Date of Naturalization, if applicable
    Date of Naturalization, if applicable
30. Have you served in the US Armed Forces?*
    -- Select One --YesNo
31. Do you claim Veteran's Preferance?*
    -- Select One --YesNo
32. If yes, attach copy of DD214
33. If you have not yet been discharged, what is the expected date of discharge?
35. Have you attended the PA Municipal Police Officer's Training Academy?*
    -- Select One --YesNo
36. If yes, date of graduation.
37. Have you ever been convicted of any violation of law (misdemeanor, felony, or other)?*
    -- Select One --YesNo
39. Essential Job Functions
    The essential job functions for a Pottstown Police Officer are, including but not limited to, running for several hundred yards, climbing over obstacles, crawling, pushing motor vehicles, pulling or carrying accident/crime victims, using physical force to apprehend or subdue other persons, withstanding prolonged exposure, as long as 12 hours or more, to extreme weather conditions, withstanding prolonged periods of standing or sitting, withstanding frequent exposures to stress-producing situations such as encountering persons injured or killed, dealing with domestic disputes, dealing with verbal and physical abuse of the officer, including taunts, insults, and threats to the officer and their family members or fellow police officers, communicate effectively with persons suffering from trauma, testify in court, operate a motor vehicle for long periods of time, use a firearm effectively, and complete written, verbal, and oral reports in a clear and concise manner.
41. Please choose one of the following:*

    1. I can fully perform all duties without reasonable accommodations.
    2. I can full perform all duties with reasonable accommodations.
    3. I cannot fully perform all duties, even with reasonable accommodations.
42. If accommodations are required, please specify:
44. Are you now, or have you ever been, a member of any organization, association, movement, group. or combination of persons which advocates the overthrow of our Constitutional form of government, or which has adopted a policy of advocating or approving the commission of acts of force or violence against other persons, or any actions which deny other persons their rights guaranteed under the Constitution of the United States or which seeks to alter the form of government of the United States by an unconstitutional means?*
    -- Select One --YesNo
46. Are you, or have you ever been, affiliated or associated with any organization of the type described above as an agent, official, or employee?*
    -- Select One --YesNo
47. Are you now associating with, or have you associated with, any individuals, including relatives, who you know, or have reason to believe are or have been involved with any organization as described above?*
    -- Select One --YesNo
49. Have you ever been involved or engaged in any of the following activities of any organization of the type described above: Distribution of literature or products, leafleting, attendance at or participation in any organizational, social, or other activities of said organization or for any project sponsored by them; the sale, gift, or distribution of any written, printed, or other matter prepared, produced, reproduced, or published by them or any of their agents or instrumentalities? *
    -- Select One --YesNo
51. I verify that the facts set forth in this prelimary application are true and correct to the best of my knowledge or information and belief. This verification is made subject to the penalties of Section 4909 of the Crimes Code (18PA C.S. 4909) relating to Unsworn Falsification to Authorities.*

    1. I do
    2. I do not
53. Further, by typing my full name below, I am electronically signing this application.
55. Full Name*
56. Date*
    Date
58. Physical Fitness Examinations will be scheduled at a later date and time. Successful written test candidates will be notified by email as to where and when to report for the Physical Fitness Examination. Applicants who score successfully on the Written Examination and who pass the Physical Fitness Examination will be afforded the opportunity to participate in additional testing at a later date.
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60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field