updated 1/24/2017

POLICE DEPARTMENT
Applications accepted for posted positions ONLY.
A new application must be completed for each posting.
Completed applications must be returned to
City Hall, 215 N Broad St, 1st floor, Monroe, GA 30655

EMPLOYMENT APPLICATION
AN EQUAL OPPORTUNITY EMPLOYER
Read below before continuing filling out the application.

It is our policy to comply fully with all federal, state and local equal employment opportunity laws. This
organization provides equal employment and advancement opportunities for all persons regardless of
race, creed, sex, national origin, age, religion, disability, marital status, sexual orientation or any other
classification protected by law.
Please type or print clearly
Fill all sections completely. If answers need more space than provided, there is additional space at the
end of the application. Incomplete applications will be rejected. A notation of "see resume" or "see
attached" may not be used as an answer to a question. A resume will not be accepted in lieu of a
completed application.

Note: The personal data requested is used only to create an applicant database and is to used as a screening tool.

Position Applying For: Officer Date: 9/25/2024

Are you a U.S. Citizen? X Yes No ( Natural Born? X or Naturalized? )

Are you at least 21 years of age? X Yes No

Did you graduate from high school or do you have a GED? X Yes No

A yes answer to the prior three questions is a requirement for a sworn law officer position!
For non-sworn officer positions minimum age is 18.

Personal Information

Name Peal David Thomas

Last First Middle or Maiden

Address 2839 m Lois Ln

Number Street Apt. #

Loganville Georgia 30052

City State Zip Code

Social Security Number 260-51-0401

Drivers License Number 051490851 State of Issue Georgia

Home Phone

Cell Phone 470-641-7503

E-mail Address

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Emergency Rickie Boze
Contacts: Name Address Phone Relationship

Brandy Jones
Name Address Phone Relationship

How did you hear of this opening? Friend

When would you be available to begin work? Immediately

Are you currently on "lay-off" status and subject to recall? Yes X No

Can you travel if a job requires it? X Yes No

Have you previously applied for a position with the Monroe Police Department? Yes X No

If yes, what year, what position?

Have you ever worked for the City of Monroe? Yes X No

If yes, when, position and reason for leaving?

Give name, relationship and department of any relatives who are employed with the City of Monroe.

Are you willing to work nights, days, weekends, and holidays? X Yes No

Over the past three years, how would you describe your credit standing? Fair to poor

Other names used: Dates:

(e.g. maiden name, (e.g.
married name(s), 1989-1994)
adoption,
legal change,
alias, etc)

Nicknames used:

Personal info:
date of birth 10/23/1985 city of birth Tucker

county of birth Dekalb state of birth Georgia

height 5’9” eye color Hazel

weight 160 lb hair color Brown

race White sex Male

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Describe any scars, marks & tattoos, including location on body:

Cross tattoo and JR initials on upper right arm, Paige tattoo on upper left arm

List Prior Addresses

From: 2013 Street: 2192 Nancy Way

To: 2016 City: State: Zip Code:

From: Street:

To: City: State: Zip Code:

From: Street:

To: City: State: Zip Code:

From: Street:

To: City: State: Zip Code:

Personal References
Read below before continuing

Please provide at least three (3) personal references that are not former employers, relatives, or employed by the City
of Monroe or the Monroe Police Department.

Name Jerry Allen Name Samantha Knight

Address 1450 S Broad St. Lot 110 Address 2242 Everett Ct

City, State, Zip Monroe, Georgia 30655 City, State, Zip Loganville, Ga 30952

Daytime Phone 678-777-6419 Daytime Phone 678-414-8187

Relationship Friend Relationship Friend

Name Misty Etheridge Name

Address 2320 Bold Springs Rd Address

City, State, Zip Monroe, Ga 30656 City, State, Zip

Daytime Phone 678-933-8631 Daytime Phone

Relationship Friend Relationship

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 Education

Name of High School attended City State Graduation Date

Highest grade completed:

If not a high school graduate, do you have a GED? X Yes No

If GED - Athens Technical College Monroe Georgia 2005

Agency that awarded GED City State Date of GED

Name of Technical School attended City State Graduation Date

Athens Technical College Monroe, Ga 30656

Name of College or University attended City State Semr. Hrs. Qtr. Hrs. Major Degree
Earned Earned Earned

Name of College or University attended City State Semr. Hrs. Qtr. Hrs. Major Degree
Earned Earned Earned

Name of College or University attended City State Semr. Hrs. Qtr. Hrs. Major Degree
Earned Earned Earned

Describe special vocational or business courses you have taken which relate to the job for which you are applying.

Computer class

List special skills, qualifications, and certifications (including language skills, typing skills, and business
equipment or machine operating skills) which relate to the job for which you are applying.

CDL, computer skills, weapons training and safety, field medic training

List professional, trade, business or civic activities or offices held.

Please use the space below for additional information pertinent to your education, training and experience:

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 Employment History
Read below before continuing

Describe your work history BEGINNING WITH YOUR CURRENT OR MOST RECENT JOB. Include military, volunteer
experience and periods of unemployment. Failure to give complete information regarding each job held will result in
your disqualification. Complete addresses with zip code and phone numbers for all employers are necessary. A
resume may be attached only as additional information and will not be accepted in lieu of completing this section.

Name of Organization or Firm

XTCBRN
Telephone Number
404-375-9762
11/2024-present To Mo/Yr
Dates Employed
From Mo/Yr
Address Total Time Employed
Street XTCBRN
768 State Hwy 11 City Monroe State GA Zip Code 30655 10 months
Official Job Title Name of Supervisor Pay
Trim and foam specialist Michael Gooding Start: $15/hr End: $15/hr
Describe Specific Job Duties:
Trim carbon fiber parts and foaming

Specific Reason for Leaving:

Possible better opportunity

Name of Organization or Firm Telephone Number Dates Employed

Guardian Fueling Technologies
Address
From Mo/Yr
Jan 2023-Oct 2023To Mo/Yr
Total Time Employed
Street 405 Bell Court City Woodstock, GA State Zip Code 10 months
Official Job Title Name of Supervisor Pay
David Start: $18 End:
Describe Specific Job Duties:
Clean fuel, change filters, discuss with business owners, write reports, drive truck

Specific Reason for Leaving:

Downsized employees

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Name of Organization or Firm
Dominos Telephone Number Dates Employed
From Mo/Yr 2019-2023 To Mo/Yr
Address Total Time Employed
Street City Loganville State Ga Zip Code
Official Job Title Name of Supervisor Pay
Start: End:
Describe Specific Job Duties:

Specific Reason for Leaving:

Better job opportunity

Name of Organization or Firm Telephone Number Dates Employed

From Mo/Yr To Mo/Yr
Address Total Time Employed
Street City State Zip Code
Official Job Title Name of Supervisor Pay
Start: End:
Describe Specific Job Duties:

Specific Reason for Leaving:

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Have you ever been reprimanded or disciplined for any reason by your present or past employer?
Yes X No If yes, list employer's name and reason:

Have you ever been suspended, terminated or forced to resign from any place of employment?
Yes X No If yes, list employer's name and reason:

Have you ever left a job without giving a two weeks notice?
Yes X No If yes, explain:

In the past five years, have you submitted an application for employment with any other public safety agency or
department? Yes X No If yes, provide the following information:

Agency Date Applied Disposition of Application

Have you ever taken a voice stress analysis/polygraph examination for any reason?
Yes X No If yes, provide the following information:

Date Agency/Company City/State Reason Tested Result

Have you ever been rejected for cause from a public safety job?
Yes X No If yes, explain:

At the present time, do you have any pending applications with any other public safety agency?
Yes X No If yes, list the agency, the position applied for and the current status:

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 Military Experience

Have you ever unsuccessfully attempted to enlist in the United States Armed Forces?
(Including Reserves, National Guard and/or Coast Guard)
Yes X No If yes, explain:

If you do not have prior military experience, check here and go to next section.

Military branch: Army Type of discharge: Honorable

Military branch: Type of discharge:

List all periods of active military service - anything over 30 days:

Date from Date to
Name of Duty Station and Closest City Rank Held
Month/Year Month/Year

Oct 2006 Aug 2008 Fort Hood Texas, Killeen, Tx PFC E3

While serving in the military, were you ever the subject of any court marshals, Article 15, company punishment,
or disciplinary action? Yes X No

If yes, explain

List any job-related training you had in the military: Firearm training, field medic, detainee training, breach training,

Urban warfare training, drone training

Have you ever served in any branch of a Foreign Military?

Yes X No If yes, explain:

Have you ever been involved in a subversive act against the United States Government, or any other government,
such as mutiny, treason, sabotage, espionage, etc.?
Yes X No If yes, explain:

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 Criminal and Traffic History
Read below before continuing
The Monroe Police Department maintains strict hiring guidelines that all applicants must satisfactorily meet or surpass
in order to be considered for positions within the Monroe Police Department. Any applicant convicted of any criminal
offence involving the manufacture, distribution, trafficking or sale of a controlled substance, dangerous drugs or
marijuana, or convicted of any felony involving a violent crime such as assault with a deadly weapon, aggravated
assault or murder are ineligible for employment with the Monroe Police Department. Such applicants shall be
automatically rejected. The failure to provide all the information requested in this section will result in the rejection of
your application and bar you from further consideration for employment. Include in your answers below each and every
arrest, citation and accident, along with the disposition of each arrest and / or citation. Dispositions include, but are not
specifically limited to - dismissal, placement on dead docket, nolle prosequi, finding or verdict of guilt, pleas of nolo
contendere, treatment under the First Offender Act, and bond forfeiture.
Your responses will be verified during the background investigation process and pre-employment Voice Stress
examination. Complete and honest responses are required. Answering "yes" will not necessarily result in your
disqualification from the hiring process. Any negative information provided will be evaluated to determine your
eligibility. Be honest with all your answers. If your information is different from any additional information gathered in
the formal background investigation, you will be removed from the employment process. Any false or misleading
information identified during the background investigation process will also result in immediate disqualification and
removal from the process.
Have you ever been arrested, detained by police, or summoned to court? Yes X No
If yes, provide the following information.

Charge Location Date Disposition

Charge Location Date Disposition

Charge Location Date Disposition

Charge Location Date Disposition

In the past ten (10) years, have you received a traffic citation? Yes NO
If yes, provide the following information.

Unsure
Violation Location Date Disposition

Violation Location Date Disposition

Violation Location Date Disposition

In the past ten (10) years, have you been involved as a driver in a motor vehicle accident? Yes X No
If yes, provide the following information:

Type of accident Date of accident Citation issued Driver at fault

Type of accident Date of accident Citation issued Driver at fault

Type of accident Date of accident Citation issued Driver at fault

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Do you presently hold a valid driver's license? X Yes No

If no, explain

State GA Licenses # 051490851 Licenses Class A Expiration date 10/23/2027

Has your driver's license ever been suspended or revoked for any reason? Yes X No
If yes, Provide the following information:

Date Reason Date Reinstated

Have you ever used an illegal drug, to include but not limited to, marijuana, cocaine, heroin, angel dust / PCP,
LSD / acid or other hallucinogenic, crack, opium, Quaaludes, speed, crank, mushrooms / peyote, ecstasy /
MDMA, ice, hashish, steroids, crystal methadone, morphine, valium, ect? Yes X No
If yes, explain in detail:

Marijuana 2001 2001 1

Drug Date first used Date last used Number of times

Drug Date first used Date last used Number of times

Drug Date first used Date last used Number of times

Drug Date first used Date last used Number of times

Have you ever been involved in the SALE, DISTRIBUTION OR MANUFACTURE of any illegal drugs?
Yes X No

If yes, explain:

Have you ever consumed any drugs prescribed for another person? Yes X No

If yes, explain including name/type of drug, number of times taken, dates:

Have you ever consumed any alcoholic beverages or used any type of illegal drugs while working?
Yes X No

If yes, explain:

Have you ever been convicted or pled nolo to DUI.? Yes X No

If yes, provide charge, date, location, and actual disposition of the case:

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Have you ever been convicted or pled nolo to a misdemeanor offense? Yes X No

If yes, provide charge, date, location, and actual disposition of the case:

Have you ever been convicted or pled nolo to a felony offense? Yes X No

If yes, provide charge, date, location, and actual disposition of the case:

At this time do you have any pending criminal charges against you, including but not limited to traffic citations or
domestic violence? Yes X No If yes, explain:

At this time are you under subpoena or involved in any criminal or civil litigation either as a plaintiff or defendant?
Yes X No

If yes, explain:

Are you currently serving probation for any offense? Yes X No

If yes, explain:

If you had to place a dollar amount on the property that you have taken throughout your lifetime, what would that
amount be? This amount should also include any theft from an employer,
including but not limited to pens, paper and other office supplies. $

Describe items taken:

Have you ever committed any undetected crimes (crimes that you have not been arrested for)?
Yes X No

If yes, explain:

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Have you been completely honest with us when completing your application for employment?
X Yes No

If no, explain:

Over a period of time the duties and responsibilities of a position will tend to change. This may arise from
technological changes in department policies and procedures. Are you willing to accept changes in the
duties and responsibilities for the position, for which you have applied? X Yes No

Please use this opportunity to tell us anything else about yourself that you have not addressed to this point.

Special Accommodation
If you require reasonable accommodations for interviewing, testing, or any portion of the application or employment
process, please notify the Monroe Police Department's Pre-Employment Manager at the time an appointment is
scheduled. If any accommodation is requested, the applicant must provide verification from an appropriate
professional.

If you are physically or otherwise unable to perform the essential duties of the job for which you are applying
without accommodations, please describe the accommodation that would be needed:

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Additional Space for Answers

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 Applicant's Certification and Agreement

I, [print name] ______________________________,

David Thomas Peal do hereby certify that the facts set
forth in my application for employment are true and complete.
I authorize investigation of all statements contained in this application for employment.

I understand that a drug screen, physical, and psychological exams are required for the
job for which I have applied and agree to submit to these exams as required. I
understand that any offer of employment would be conditional upon the results of these
tests and satisfactory background reports.

I further understand that if employed, any false statements on this application may
result in dismissal. I further understand that this application is not intended to be a
contract of employment, nor does this application obligate the employer in any way if
the employer decides to employ me. I understand and agree that my employment is at-
will and can be terminated by either party with or without notice / with or without cause
at any time.

I further understand that applications, proof of identity and employment eligibility,

resumes, letters of reference, ect., submitted with my application or received during the
background investigation become property of The City of Monroe and cannot be
returned.

I further understand that the information I provided on my application may be subject to

public disclosure under the Georgia Open Records Act.

I further understand that falsification of this application or the omission of complete

information at any time during the employment process will result in permanent removal
from consideration of any employment opportunities with the Monroe Police
Department.

Applicant's Signature Date Signed

Sworn to and subscribed before me this Day of 20

Notary Public:
(Signature and Seal with Expiration Date Required)

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 Authorization to Release Information

I, [print name]_______________________________________,
David Thomas Peal do hereby authorize the review of
and the full disclosure of all records concerning myself to the duly authorized agent of
the Monroe Police Department.
The intent of this authorization is to give my consent for a full and complete disclosure
of the records of educational institutions; financial statements and records wherever
filed; medical and psychiatric treatment and/or consultation including hospitals, clinics,
private practitioners, and the U.S. Veteran's Administration; employment and pre-
employment records, including background reports, polygraph examinations, voice
stress examinations or reports, efficiency ratings, motor vehicle record, criminal history
information which may be in the files of any state or local criminal justice agency,
complaints or grievances filed by or against me and the records and recollections of
attorneys at law, or of other counsel, whether representing me or another person in any
case, either criminal or civil, in which I presently have or have had an interest, and any
other information contained in files relevant to employment.
I understand that any information obtained by a personal history background
investigation, which is developed directly or indirectly, in whole or part, upon this
release authorization will be considered in compiling any report for consideration for
employment with the Monroe Police Department. I certify that any person(s) who may
furnish such information concerning me shall not be held accountable for giving this
information; and I do hereby release said person(s) from any and all liability, which may
be incurred as a result of furnishing such information. Further, a photocopy of this
release will be valid as an original thereof, even though the said photocopy does not
contain any original writing of my signature.

Applicant's Signature Date Signed

Sworn to and subscribed before me this Day of 20

Notary Public:
(Signature and Seal with Expiration Date Required)

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 EMPLOYMENT BACKGROUND & MVR RELEASE
ACKNOWLEDGEMENT
I, [print name]______________________________________,
David Thomas Peal as an applicant for the City of
Monroe grant authorization for the City to obtain information regarding my driving record and
conduct a background investigation at this time of consideration of hire and during subsequent
City employment. I acknowledge that signing this release is not a guarantee of employment
with the City.
I understand that driving for the City using either a City vehicle or my personal vehicle is a
privilege granted only to employees whose driving record satisfactorily meets City standards.

I understand that if driving is a requirement of the job, then an acceptable driving record is also a
requirement of the job, both at the time of consideration for hire and as an ongoing condition of
employment.
As an applicant or an employee, the City may conduct motor vehicle record (MVR) checks
periodically and I give permission to the City to obtain such information regarding my driving
record anytime the City deems necessary.
I understand my driving record must continue to meet City standards. Should my driving record
not meet City standards, my driving privileges for the City may be revoked and could be grounds
for applicant disqualification or dismissal of employment.

I understand the information identified in my driver's record check is a part of the hiring process,
and if hired, will be discussed as the City deems it necessary.

I acknowledge reading this release and grant authorization to the City to conduct a background
investigation and MVR check, obtain information regarding my driving record, and discuss this
information as the City deems necessary.

Applicant Name: David Thomas Peal

(as it appears on license)

DL# 051490851 State: GA Date of Birth: 10/23/1985

SSN: 260-51-0401 Date Signed:

(this form)

Applicant Signature:

Sworn to and subscribed before me this Day of 20

Notary Public:
(Signature and Seal with Expiration Date Required)

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 EMPLOYMENT CRIMINAL HISTORY RELEASE
ACKNOWLEDGEMENT

I, [print name]______________________________________
David Thomas Peal , as an applicant for the City of
Monroe grant authorization for the City to obtain information regarding my criminal history
record at this time of consideration of hire. This includes any criminal history record
information pertaining to me which may be in the files of any federal, state, or local criminal
justice agency. I acknowledge that signing this release is not a guarantee of employment with the
City.

I understand the information identified in my criminal record check is part of the hiring process
and will be discussed as the City deems necessary.

I acknowledge reading this release and grant authorization to the City to conduct a criminal
history record check, obtain information regarding my criminal record, and discuss this
information as the City deems necessary.

Applicant Full Name: David Thomas Peal

SSN: 260-51-0401 Race: White

Date of Birth: 10/23/1985 Sex: Male

Applicant Signature:

Date Signed:

Sworn to and Subscribed Before Me This Day of 20

Notary Public:

Notary Expiration:

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 Applicant/Employee’s Authorizations and Receipt of Notice

Employer’s Disclosure About

Nature and Scope of Investigations and Use of Information Obtained From Third Parties

THE CITY OF MONROE hereby discloses to its employees and/or applicants that it may obtain from third
parties, including consumer reporting agencies, former employers, outside investigators, and other locations,
divisions, subsidiaries, or affiliates of THE CITY OF MONROE information concerning you, including, but not
limited to, information about your credit, character, general reputation, personal characteristics, or mode of
living which may include information obtained through personal interviews with your past employers,
neighbors, friends, or associates and which may include medical information. THE CITY OF MONROE will
use this information solely for the purpose of deciding whether or not to employ, promote, transfer, or take
some other employment action concerning you. THE CITY OF MONROE may, with your authorization, share
the information it collects with other locations, divisions, subsidiaries, or affiliates of THE CITY OF
MONROE but will not share this information with any other person.

Authorization for THE CITY OF MONROE to

Obtain an Investigative Consumer Report, Obtain Medical Information
and to Obtain a Consumer Report

David Thomas Peal

I, [print name]____________________________, have received as a separate document, read, and understand
the foregoing Employer’s Disclosure About Nature and Scope of Investigations And Use of Information
Obtained From Third Parties. I authorize THE CITY OF MONROE to obtain from third parties, including the
consumer reporting agency of its choice, an investigative consumer report, a consumer report, and medical
information regarding me. I understand that an investigative consumer report may include personal interviews
with my past employers, neighbors, friends, or associates concerning my credit, character, general reputation,
personal characteristics, or mode of living, together with public record information regarding arrests,
indictments, convictions or civil suits in which I was involved as a party.

Applicant's Signature: Date:

Sworn to and Subscribed Before Me This Day of 20

Notary Public: Expiration date:

Authorization for THE CITY OF MONROE to

Share Information with its other Locations, Divisions, Subsidiaries, or Affiliates

David Thomas Peal hereby [circle one] authorize / do not authorize THE CITY
I, [print name]________________________
OF MONROE to receive and to share information it obtains from third parties, including consumer
reporting agencies, investigators, and prior employers, with its other locations, divisions, subsidiaries, or
affiliates.

Applicant's Signature: Date:

Sworn to and Subscribed Before Me This Day of 20

Notary Public: Expiration date:

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 THE CITY OF MONROE's Disclosure About
Nature and Scope of Investigations
And Use of Information Obtained From Third Parties

THE CITY OF MONROE hereby discloses to its employees and/or applicants that it may
obtain from third parties, including consumer reporting agencies, former employers, outside
investigators, and other locations, divisions, subsidiaries, or affiliates of THE CITY OF
MONROE information concerning you, including, but not limited to, information about your
credit, character, general reputation, personal characteristics, or mode of living which may
include information obtained through personal interviews with your past employers,
neighbors, friends, or associates and which may include medical information. THE CITY OF
MONROE will use this information solely for the purpose of deciding whether or not to
employ, promote, transfer, or take some other employment action concerning you. THE
CITY OF MONROE may, with your authorization, share the information it collects with
other locations, divisions, subsidiaries, or affiliates of THE CITY OF MONROE, but will
not share this information with any other person.

PLEASE KEEP THIS FOR YOUR RECORDS

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 Application Checklist
(If applicable, a copy of the following documents are required to be turned in with application.)

Birth Certificate

Social Security Card (copy both front and back)

Drivers License (copy both front and back)

High School Diploma or GED certification

College Diploma and Transcripts

Trade School Diploma / Certification

Training Certifications

Military DD214 (showing discharge type)

Notarized Authorization to Release Information

Notarized Employment Background

& MVR Release Acknowledgement

Notarized Criminal History Release

Notarized Authorizations and Receipt of Notice

of DisclosureAbout Investigations and Use
of Information

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