NEWTON COUNTY SHERIFF=S OFFICE
APPLICATION FOR EMPLOYMENT
Instructions to Applicant
Completing
the Application: Legibly print or type and complete all spaces. If the question does not apply to you, mark
N/A (non-applicable);
Education:
If you
cannot answer this portion to your satisfaction in the space provided, attach
additional pages. A copy of your high school diploma should be submitted with
the completed application.
Authority
to Release Information: Sign and Date.
Certification
of Information: Sign and Date
NOTICE: APPLICANTS ARE CONSIDERED FOR ALL POSITIONS WITHOUT
REGARD TO RACE, COLOR, RELIGION; SEX, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN
STATUS, HANDICAP AND WITHOUT REGARD TO POLITICAL AFFILIATION.
Date:________________________________
Position(s) Applied For: “ Full Time “ Part Time
“ Investigations “ Civil Process “ Clerical
“ Court Security/Bailiff “ Reserves “ Other (Describe):_______________
“ Road Deputy “ Correction Officer
Referral
Source: __________________________________________________________________
NAME:
________________________________________________________________________
LAST FIRST M.I. JR./SR. SOCIAL SECURITY
NUMBER
ADDRESS:
_____________________________________________________________________
STREET/ROUTE
CITY
STATE ZIP
TELEPHONE:
___________________________________________________________________
HOME BUSINESS
ALTERNATE/EMERGENCY
ARE YOU 21 YEARS OF AGE OR OLDER? “ Yes “ No
HAVE YOU EVER FILED AN APPLICATION
WITH THIS DEPARTMENT? “ Yes “ No
IF YES,
GIVE DATES: ___________________________________________________________
DO YOU HAVE ANY RELATIVES WORKING
FOR NEWTON COUNTY? “ Yes “ No
CAN YOU LEGALLY WORK IN THE UNITED
STATES? “ Yes “ No
DID YOU SERVE WITH THE U.S. ARMED
FORCES? (If Yes, attach DD214) “ Yes “ No
REFERENCES
LIST
FOUR PERSONS WHO HAVE KNOWN YOU FOR AT LEAST THREE YEARS, OTHER THAN FORMER
EMPLOYERS OR RELATIVES, WHO MAY BE CONTACTED FOR PERSONAL REFERENCES. LOCAL REFERENCES ARE PREFERRED:
Name:
________________________________________________ Phone: ___________________
Address:
________________________________________________________________________
Business
or Occupation:____________________________________________________________
Name:
________________________________________________ Phone: ___________________
Address:
________________________________________________________________________
Business
or Occupation:____________________________________________________________
Name:
________________________________________________ Phone: ___________________
Address:
________________________________________________________________________
Business
or Occupation:____________________________________________________________
Name:
________________________________________________ Phone: ___________________
Address:
________________________________________________________________________
Business
or Occupation:____________________________________________________________
EDUCATION
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NAME AND LOCATION
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GRADE
COMPLETED
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COURSE/DEGREE
|
DATES
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ELEMENTARY
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HIGH
SCHOOL (GED)
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COLLEGE
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GRADUATE
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OTHER
COURSES
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SCHOLASTIC
HONORS, SCHOLARSHIPS, ETC. _______________________________________
_______________________________________________________________________________
_______________________________________________________________________________
LIST
ALL LOCATIONS WHERE YOU ACTUALLY LIVED REGARDLESS OF THE PERIOD OF TIME YOU
RESIDED THERE, FROM TODAY BACK FIFTEEN (15) YEARS. IF YOU WERE IN THE ARMED SERVICES, LIST DATES AND BRANCH ONLY. ATTACH AN EXTRA SHEET IF NEEDED:
FROM TO ADDRESS CITY STATE
_________ _________ ______________________________________________________________________
_________ _________ ______________________________________________________________________
_________ _________ ______________________________________________________________________
_________ _________ ______________________________________________________________________
_________ _________ ______________________________________________________________________
_________ _________ _______________________________________________________________________
EMPLOYMENT HISTORY
START
WITH YOUR PRESENT OR LAST JOB. ACCOUNT
FOR THE PAST FIFTEEN (15) YEARS, INCLUDING UNEMPLOYED PERIODS. INCLUDE MILITARY SERVICE ASSIGNMENTS AND
VOLUNTEER POSITIONS. EXCLUDE ORGANIZATION
NAMES WHICH INDICATE RACE, COLOR, RELIGION, SEX OR NATIONAL ORIGIN. CONTINUE ON A SEPARATE SHEET IF NECESSARY:
FROM:
______________________ THROUGH:
_________________ MAY WE CONTACT?_____
EMPLOYER:
____________________________________________________________________
MAILING
ADDRESS: ______________________________________________________________
PHONE:
_________________________________ SUPERVISOR: __________________________
TYPE OF
BUSINESS: _____________________________________________________________
STARTING
POSITION: ____________________________________ SALARY: ________________
FINAL
POSITION: ________________________________________ SALARY: ________________ JOB
DUTIES:____________________________________________________________________
_______________________________________________________________________________
REASON FOR
LEAVING: __________________________________________________________
FROM: ______________________ THROUGH: _________________ MAY WE CONTACT?______ EMPLOYER:
_____________________________________________________________________
MAILING ADDRESS:
_______________________________________________________________
PHONE: _______________________________ SUPERVISOR:
_____________________________
TYPE OF BUSINESS: ______________________________________________________________
STARTING POSITION: ______________________________________
SALARY: _______________
FINAL POSITION: __________________________________________
SALARY: _______________
JOB
DUTIES:____________________________________________________________________
_______________________________________________________________________________
REASON FOR
LEAVING: __________________________________________________________
FROM:
______________________ THROUGH:
_________________ MAY WE CONTACT?_____
EMPLOYER:
____________________________________________________________________
MAILING
ADDRESS: ______________________________________________________________
PHONE:
_________________________________ SUPERVISOR: __________________________
TYPE OF
BUSINESS: _____________________________________________________________
STARTING
POSITION: _____________________________________ SALARY: _______________
FINAL
POSITION: _________________________________________ SALARY: _______________
JOB DUTIES:____________________________________________________________________
_______________________________________________________________________________
REASON FOR
LEAVING: __________________________________________________________
ATTACH ANY
LETTERS OR REFERENCES OR RECOMMENDATIONS FROM PAST EMPLOYERS:
CERTIFICATION OF INFORMATION
I CERTIFY
THAT THE ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE. BY MY SIGNATURE BELOW, I
VOLUNTARILY GRANT TO THE NEWTON COUNTY SHERIFF=S DEPARTMENT, ITS OFFICERS AND AGENTS, THE AUTHORITY TO
INVESTIGATE MY BACKGROUND AND ALL STATEMENTS MADE IN THIS APPLICATION. I UNDERSTAND THAT ANY FALSIFICATION,
MISREPRESENTATION OR OMISSION OF ANY PERTINENT INFORMATION MAY CAUSE THIS
APPLICATION TO BE REJECTED, OR IN THE EVENT OF MY EMPLOYMENT MAY RESULT IN
DISCHARGE. I UNDERSTAND THAT SUCH
INQUIRY AS HEREIN AGREED TO SHALL BEAR THE UTMOST DEGREE OF CONFIDENTIALITY AND
WILL BE GUARDED AND PROTECTED ROM DISCLOSURE.
I UNDERSTAND AND AGREE THAT IF I AM EMPLOYED IN A POSITION
WHICH REQUIRES ME TO OPERATE A COUNTY OWNED VEHICLE, MY DRIVING RECORD SHALL BE
REVIEWED ON AN ANNUAL BASIS. I
UNDERSTAND THAT IF I AM HIRED, MY APPOINTMENT SHALL NOT BE OFFICIAL UNTIL I
HAVE SUCCESSFULLY PASSED A PRE-EMPLOYMENT PHYSICAL. I UNDERSTAND THAT AT SUCH TIME AS MY EMPLOYMENT WITH NEWTON
COUNTY IS TERMINATED BY RETIREMENT OR OTHERWISE, I MUST RETURN ALL OF MY
EMPLOYEE=S PROPERTY IN MY CUSTODY BEFORE I AM
ENTITLED TO FINAL PAYMENTS OF ANY AMOUNTS DUE ME ON SEPARATION. I UNDERSTAND THAT IF I AM EMPLOYED, I AM
REQUIRED TO ABIDE BY ALL POLICIES, RULES AND REGULATIONS OF THE NEWTON COUNTY
SHERIFF=S DEPARTMENT.
Date: _____________________________ __________________________________________
Signature of Applicant
AUTHORITY TO RELEASE INFORMATION
I
RESPECTFULLY REQUEST AND AUTHORIZE YOU TO FURNISH THE NEWTON COUNTY SHERIFF=S DEPARTMENT ANY AND ALL INFORMATION
THAT YOU MAY HAVE CONCERNING ME, MY WORK RECORD, AND MY REPUTATION. THIS INFORMATION IS TO BE USED TO ASSIST THE
NEWTON COUNTY SHERIFF=S DEPARTMENT IN DETERMINING MY QUALIFICATIONS AND FITNESS
FOR THE POSITION I AM SEEKING WITH THE NEWTON COUNTY SHERIFF=S DEPARTMENT.
I HEREBY
RELEASE YOU, YOUR ORGANIZATION OR OTHERS FROM ANY LIABILITY, OR DAMAGE, WHICH
MAY RESULT FROM FURNISHING THE INFORMATION REQUESTED.
Date:________________________________ ____________________________________
Applicant=s Full Name Signature
_____________________________________
Signature of Witness
DPS LICENSED OR COMMISSIONABLE
APPLICANTS ONLY
IS DPS CERTIFICATION CURRENT: “ Yes “ No
THE PERSONNEL POLICIES OF THE SHERIFF=S DEPARTMENT STATE THAT BECAUSE OUR
EMPLOYEES ARE IN A POSITION OF PUBLIC TRUST, IT IS IMPERATIVE THAT THEY
MAINTAIN HIGH STANDARDS IN THEIR PUBLIC AND PRIVATE LIFE, AND MEET THEIR
FINANCIAL OBLIGATIONS. FOR THIS REASON,
WE RESPECTFULLY ASK THAT YOU AUTHORIZE THE NEWTON COUNTY SHERIFF=S DEPARTMENT TO OBTAIN A COPY OF
YOUR CREDIT HISTORY. THIS REPORT WILL
BE USED FOR EMPLOYMENT PURPOSES ONLY.
I Hereby Authorize the Newton County Sheriff=s Office to obtain Credit
Information as it pertains to my employment:
Date:
____________________________ __________________________________________
Signature of Applicant
Witness:__________________________