Applicant Scheduling

Please use the following form to request an appointment for your applicant(s).  This form should only be used if you have 5 or less applicants to schedule.  

If you have more than 5 applicants, please contact Alexis at 317.964.2339. 

Within 2 business days the person making the request and the Department Chief will receive an email confirming the scheduled dates for your applicant(s) along with an expected date of delivery of the results. Thank you.

Name of Department *

Name of Person Making Request *

Title of Person Making Request *

Email of Person Making Request *

Direct Phone Number of Person Making Request *

Please Provide your Department's Mailing Address *

Name of Chief of Department *

Direct Phone Number of Chief of Department *

Email of Chief of Department *

Do You Want the Applicant(s) to Pay for Any Portion of the Evaluation? *

Yes

No

Please Indicate Your Preference on What the Applicant(s) Should Pay. *

50% of Medical and Psychological Evaluation

50% of Medical Evaluation Only

50% of Psychological Evaluation Only

Your applicant's results will be sent to you via secure e-mail. Please contact Chad with questions at 317.964.2364.

Who Should Receive the Results? (check all that apply) *

"Person Making Request" above

The Chief Named Above

Someone Else other than the applicant

Name to Whom Results should be Sent *

Title of Results Contact *

Email of Results Contact *

Direct Phone Number of Results Contact *

All Invoices Will Be Sent By Email To:

Name to Send Invoice To: *

Title *

Clerk / Treasurer

Accounts Payable

Email *

Phone *

Do You Require a Purchase Order? *

Yes

No

Please attached PO if Possible

Drop a file here or click to upload Choose File

Maximum file size: 2MB

Mailing Address *

Number of Applicants to be Scheduled (up to 5) Please Note: PSM will not contact applicants directly.

Please provide several dates that each applicant will be available. If more than 5 applicants, please call Alexis in Special Services at 317.964.2339.

Enter Number of Applicants You are Scheduling * 12345

Choose from drop-down list

Position that Applicant(s) are Applying For * FirefighterCivilian EMTCivilian ParamedicTelecommunicatorOther

Choose from drop down list

Please List "Other" Position

Results are estimated to be prepared within 12 business days of the appointment.

If applicable, has a Conditional Offer of Employment Been Made to the Applicant(s)? *

Yes

No

Not applicable

Please Provide Date that a Conditional Offer will be Made. *

Please Indicate Type of Evaluation.

What Type of Applicant Evaluation Do You Need? *

Indiana PERF (1977 Police Officers’ and Firefighters’ Pension Fund)

Ohio Police & Fire Pension Fund

Another Pension Fund

Non-Pension Fund

Please provide the name of the Pension Fund

All services are performed in one location in one day.

Which of the Following Do You Want Performed? *

Medical and Psychological Evaluation

Psychological Evaluation Only

Medical Evaluation Only

Please Select (or type in) Any Additional Testing that You Would Like Performed. (All Applicant Testing for Departments not on a Pension will be Based Upon Indiana's 1977 Fund Testing Requirements.)

Treadmill Stress Test

Hepatitis B Titer

Muscular Fitness Evaluation

OtherOther

What is your anticipated hire date? *

Applicant(s) can only pay by credit or debit card (if applicable).

Please Provide the Following Information on Each Applicant.

Applicant #1 Full Legal Name *

Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")

Applicant #1 Date of Birth *

Enter as MM/DD/YYYY

Applicant #1 Gender *

Male

Female

Is Applicant #1 Is this person currently enrolled in the 1977 Police and Firefighter pension fund? *

Yes

No

Applicant #1 Please Type in any Dates the Applicant WILL be Available for Scheduling *

Applicant #2 Full Legal Name

Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")

Applicant #2 Date of Birth *

Enter as MM/DD/YYYY

Applicant #2 Gender

Male

Female

Is Applicant #2 Is this person currently enrolled in the 1977 Police and Firefighter pension fund?

Yes

No

Applicant #2 Please Type in any Dates the Applicant WILL be Available for Scheduling

Applicant #3 Full Legal Name

Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")

Applicant #3 Date of Birth *

Enter as MM/DD/YYYY

Applicant #3 Gender

Male

Female

Is Applicant #3 Is this person currently enrolled in the 1977 Police and Firefighter pension fund?

Yes

No

Applicant #3 Please Type in any Dates the Applicant WILL be Available for Scheduling

Applicant #4 Full Legal Name

Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")

Applicant #4 Date of Birth *

Enter as MM/DD/YYYY

Applicant #4 Gender

Male

Female

Is Applicant #4 Is this person currently enrolled in the 1977 Police and Firefighter pension fund?

Yes

No

Applicant #4 Please Type in any Dates the Applicant WILL be Available for Scheduling

Applicant #5 Full Legal Name

Enter First Name, Middle Initial, Last Name (if Unknown, type "Unknown")

Applicant #5 Date of Birth *

Enter MM/DD/YYYY

Applicant #5 Gender

Male

Female

Is Applicant #5 Is this person currently enrolled in the 1977 Police and Firefighter pension fund?

Yes

No

Applicant #5 Please Type in any Dates the Applicant WILL be Available for Scheduling

PLEASE CLICK "SUBMIT" AT BOTTOM OF SCREEN

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