Lyndhurst Police Auxiliary - Lyndhurst, NJ  07071










Lyndhurst Police Auxiliary Application

You may submit this application online, or you can Print This Page and mail it to our address provided below

(Print using Landscape Mode)

Mail To: Town Hall
c/o Lyndhurst Police Auxiliary
Lyndhurst, NJ 07071


Date: (mm/dd/yyyy)
Email Address:
Your Name (First, Middle, Last):
Address:
City:
State:
Zip Code:
Telephone #:
1.  Are You A Citizen Of The United States? Yes
No
2.  Have You Ever Legally Changed Your Name? Yes
No
  • If Yes, Give Previous Name And Date Of Change
3.  Date Of Birth: (mm/dd/yyyy)
  • Birthplace:
  • Current Age:
4.  Marital Status: Single
Married
  • Social Security Number:
  • If Single, Do You Live With Your Parents?
Yes
No
5.  Have You Ever Been Charged or Convicted Of A Crime? Yes
No
  • If Yes, Give Details:
6.  Do You Posses A NJ Firearms Purchaser Identification Card? Yes
No
  • If Yes, Give Card Number:
  • Date Issued:
  • Issuing Police Department:
  • Have You Ever Been Refused A Permit?
(mm/dd/yyyy)

Yes
No
7.  Have You Ever Been Charged With A Motor Vehicle Violation? Yes
No
  • If So, Give Details:
8.  NJ Driver's License Number:
  • Do You Own A Car?
  • Vehicle Year:
  • Vehicle Make:
  • Vehicle Model:
  • Vehicle License Plate Number:
 Yes No
9.  How Long Have You Resided In Your Current Town Of Residency? Years
  • List Addresses For The Past Ten (10) Years, Starting With Your Present Address First:







10. Do You Object To Wearing A Uniform? Yes
No
11. Do You Object To Working Nights, Weekends Or Holidays? Yes
No
12. Do You Object To Working With The Opposite Sex? Yes
No
13. Have You Ever Served In A Military Or Naval Organization Of The United States? Yes
No
  • Branch Of Service:
  • Service Number:
  • Rank Held:
  • Type Of Discharge:


14. Do You Have Any Police Experience? Yes
No
15. Do You Hold A Police Training Certificate? Yes
No
  • Where Taken:
  • Date Completed:
(mm/dd/yyyy)
16. Current Occupation:
  • Name And Address Of Current Employer:
17. Do You Work Full Or Part Time:
  • Specify Hours:
18. Do You Have Any Physical Handicaps Which Will Prevent You From Performing Any Specific Types Of Duties? Yes
No
  • Describe And Explain Limitations:
19. Have You Ever Had Any Serious Illness Or Mental Disorder In The Past? Yes
No
  • If Yes, Describe:
20. List The Names And Locations Of Your Educational History Below:
  • Elementary School:
  • High School:
  • College:
  • Graduate School:
  • Other:
21. List Three (3) Personal References Not Related To You Below:
  • (Name, Address, Phone, Years Known)
  • (Name, Address, Phone, Years Known)
  • (Name, Address, Phone, Years Known)
 Additional information/comments:
* To The Best Of My Knowledge, All Of The Preceding Statements Are True.  I Realize That The Falsification Of Any Answer Is Grounds For The Rejection Of This Application:
Applicants Signature Or Initial:
   

Click "Apply Now!" to submit your Application.

You will be contacted shortly regarding your application status via e-mail and/or postal mail.