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

 

 

 

NAME AND LOCATION

 

GRADE

COMPLETED

 

COURSE/DEGREE

 

DATES

 

ELEMENTARY      

 

 

 

 

 

 

 

 

 

 

HIGH SCHOOL (GED)

 

 

 

 

 

 

 

 

 

 

COLLEGE

 

 

 

 

 

 

 

 

 

 

GRADUATE

 

 

 

 

 

 

 

 

 

 

OTHER COURSES

 

 

 

 

 

 

 

 

 

 

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:__________________________