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2. 
   
   To register for the next applicant test, please submit the following information. You must be at least 18 years of age to participate in the testing process. At the end of this form, please choose "Submit and Print" and print this form as the confirmation of registration to participate in the test. Please refrain from contacting the department to confirm your registration.
4. If you have specific questions visit the link below:
   Employment Information
6. Direct other questions to:

   Becky Potton

8. General Information
10. Last Name:*
12. First Name:*
14. Middle Name:
16. Last Four of Social Security Number:*
    This information is used as identification only and will not be collected for any other purpose.
18. Email Address:
20. Day Phone Number:
22. Sex:

    1. Male
    2. Female
23. Date of Birth*
25. Mailing Address:
27. City, State, Zip:
29. Equal Opportunity Employer
31. The City of Missoula is an Equal Opportunity and Affirmative Action Employer. The information you voluntarily provide in this form is collected in compliance with State and Federal law to determine if the Missoula Police Department and the City's selection and hiring practices are discriminating against any group. The information you provide will be separate from the application process and will not be used in making unlawful hiring decisions.
33. Personal Information
35. Please check one of the descriptions below corresponding to the ethnic group with which you most identify:

    1. White (not of Hispanic origin) - All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East
    2. Black (not of Hispanic origin) - All persons having origins in any of the black racial groups of Africa
    3. Hispanic - All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race
    4. Asian or Pacific Islander - All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or Pacific Islands; This area includes, for example, China, India, Japan, Korea, the Philippines, Somoa
    5. American Indian or Alaskan Native - All persons having origins in any of the original peoples of North American and South American (including Central American), and who maintains tribal affiliation or community recognition
37. Veteran or Disability Status
39. If you are claiming preference under Montana Veteran's Public Employment Preference Law (MCA 39-29-101 et. Seq., ARM 2-221-3601) or Montana Persons with Disabilities Employment Preference Act (MCA 39-30-103 et. Seq.), please complete the following. Upon application, written documentation confirming your preference claim will be required.
41. Veteran's Employment Preference provides the addition of five percentage points (veteran) or 10 percentage points (disabled veteran or handicapped) to the applicant's score when a numerically scored selection procedure is used.

    To claim Veteran's Employment Preference, you must be a U.S. citizen and one of the following:

    1. A veteran separated under honorable conditions
    2. A disabled veteran separated under honorable conditions
    3. The spouse of a disabled veteran if the veteran's disability prevents him/her from working
    4. The un-remarried surviving spouse of a veteran or disabled veteran
    5. The mother of a veteran, if the veteran lost his/her life under honorable conditions while serving in the armed forces, or has a service-connected, permanent, and total disability
43. You may claim Handicapped Persons' Employment Preference as one of the following(check one of the boxes):

    1. A handicapped person certified by PHHS
    2. The spouse of a totally (100%) disabled person certified by PHHS, and resides continuously in Montana for at least one year immediately before applying for employment
45. Please Note: If you claim a preference, documentation must be provided at the time of application. You do not need to bring your documentation to the Missoula Police Applicant Testing Location.
47. Thank you for your interest in applying with the City of Missoula Police Department. We wish you success in every step of your application.
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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

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