Midpeninsula Regional Open Space District: Supervising Ranger (20703777) 1. I understand that the Supervising Ranger qualifying process requires completion of a background investigation including but not limited to: personal, work & credit history; education, fingerprinting & conviction record. Upon receiving a conditional offer of employment, a psychological evaluation & pre-employment medical examination with drug testing is required. Any falsification of information I provide or any failure to meet required standards will result in disqualification from the selection process. Yes No 2. I have reviewed the POST website (Background/Hiring section) at www.post.ca.gov/forms.aspx. and understand that I will need to complete Form 2-251 Peace Officer Personal History Statement (27 pages) in the event I am notified by Midpen that I am advancing to the background process, along with supporting documentation related to, but not limited to: personal, work & credit history, education and fingerprint & conviction record. If selected to advance in the process, I agree to be responsible to obtain all of the required documentation to complete the Personal History Statement by the deadline specified by Midpen and to be available to attend an in-person meeting with the background investigator on a future date scheduled by Midpen. Yes No 3. I further understand some of the potential reasons for disqualification from the selection process include: • Conviction of a felony, sex crime, or larceny • Involvement in a crime, the nature of which would impair my credibility or cause embarrassment to the Open Space District • Use of illegal drugs either recently or extensively • Failure to disclose prior drug use (excluding the use of cannabis off the job and away from the workplace) • Failure to possess a valid Class C driver’s license with a satisfactory driving record • Poor employment record • Falsification of any required application or report • Failure to have met educational standards • Inability to meet physical or psychological standards • Failure to fully cooperate with the background investigation Yes No 4. I certify that I possess the following qualifications required by Midpen to be appointed as a Peace Officer: • High School Diploma, G.E.D. or equivalent • Legal Authorization to work in the United States under federal law Possession of a valid Driver’s License (or the ability to obtain a California Driver’s License) and a satisfactory driving record • Age 18 by date of appointment • Physical capacity to meet standards established by the Open Space District • Visual acuity to judge distances of 20 feet or more & ability to distinguish color Yes No 5. Do you meet the requirements for experience and education as listed in the job description for Supervising Ranger? Yes No
