Employment Application – Warren County Sheriff Department

Employment Application

Name

Last First Middle

Date

Position Applied For

Desired Salary

Type of Position

Full Time

Part Time

If part time, hours

Date available for employment

Length of notice required

Who referred you?

Are you currently employed?

If not, how long since leaving last employment?

Address

City, State, Zip

Phone

Best time to call

Date of Birth

Place of Birth

Eye Color

Hair Color

Height

Weight

Social Security Number

Driver's License Number

State of Issue

LAST FOUR ADDRESSES

1) Previous Address

From

Rent

Own

If rented, name of landlord

Phone

2) Previous Address

From

Rent

Own

If rented, Name of landlord

Phone

3) Previous Address

From

Rent

Own

If rented, Name of landlord

Phone

4) Previous Address

From

Rent

Own

If rented, Name of landlord

Phone

Marital Status

If applicable, maiden name(s)

Any previous "also known as" (AKA)

Wife's maiden name

Husband's name

Spouse's occupation

Spouse's employer

Employer's address

Are you now or have you ever been a member of any foreign or domestic organization, association, movement, group, or combination of persons which have adopted, or shown a policy of advocating or approving the commission of acts or force of violence to deny other persons their rights under the Constitution of the United States, or which seeks to alter the form of government of the United States by unconstitutional means?

If yes, please explain

Have you ever stolen anything from an employer?

If yes, please explain

Have you ever been arrested or charged with a criminal offense, misdemeanor or felony, to include traffic charges?

If yes, please explain

Are you now, or have you ever been, a plaintiff or defendant in any civil action?

If yes, please explain

Are you now, or have you been the subject of a restraining order?

If yes, please explain

Do you currently use any illegal or non-prescribed drugs including marijuana, methamphetamines, amphetamines, depressants, steroids, tranquilizers, cocaine, etc.? Do you abuse any prescription or non- prescription drugs?

If yes, please explain

Have you ever taken a polygraph or a computer voice stress analysis examination?

If yes, please explain

Are there any incidents in your life, whether or not you were directly involved, which if discovered by a subsequent investigation, would disqualify you as an applicant?

If yes, please explain

Have you ever pled guilty or 'no contest' to a crime or been convicted of a crime?

If yes, please give date and details of each

Have you ever been terminated or asked to resign from any job?

Are you prevented from lawfully becoming employed in the United States due to your visa or immigration status?

If yes, please describe the circumstances

Can you provide documented proof of your eligibility for your employment in the United States?

EDUCATION

High School

Date of graduation from high school (or completion of GED)

Name of High School

Address of High School

College, University, or Trade School

Address

Major

Attended From

Type of Degree or Certificate

OTHER SPECIAL SCHOOLS, COURSES OF STUDY, OR CERTIFICATION

Name

Course of Study

Certification

Date Granted

OTHER SKILLS

Please List

FOREIGN LANGUAGES

Please List

MILITARY SERVICE

Have you ever been an active member of the military service?

Yes

If yes, what branch of service

From

Highest Rank Attained

Describe your duties

If you were released early from the military service, explain why?

What was your last duty station?

Date of discharge

Were you subject to any demotions or other disciplinary action while in the military service?

Yes

If yes, please explain

Have you worked for this or any other County or public employer before?

If yes, where?

From

Rate of Pay

Reason for leaving

What experience, training, or education have you had which will help you in the position(s) for which you are applying?

List special equipment or other technical expertise you may have

Why do you want to become an employee of Warren County?

State any additional information you feel may be helpful to us in considering your application

Summarize special job-related skills and/or qualifications from previous employment or other experience

EMPLOYMENT HISTORY

Please list all employers from the past ten years.

Can you legally obtain / maintain a drivers license issued by the state of Missouri? (Please answer only if applying for driving position)

Current Employer

Address

Employed From

Highest Position Held

Job Duties

Supervisor's Name

Phone

List three co-workers

Name

Phone

Name

Phone

Name

Phone

Reason for leaving (be specific)

Past Employer

Address

From

Highest Position Held

Job Duties

Supervisor’s Name

Phone

List three co-workers

Name

Phone

Name

Phone

Name

Phone

Reason for leaving (be specific)

Past Employer

Address

From

Highest Position Held

Job Duties

Supervisor's Name

Phone

List three co-workers

Name

Phone

Name

Phone

Name

Phone

Reason for leaving (be specific)

Past Employer

Address

From

Highest Position Held

Job Duties

Supervisor's Name

Phone

List three co-workers

Name

Phone

Name

Phone

Name

Phone

Reason for leaving (be specific)

Past Employer

Address

From

Highest Position Held

Job Duties

Supervisor's Name

Phone

List three co-workers

Name

Phone

Name

Phone

Name

Phone

Reason for leaving (be specific)

Complete this section only if you are applying to a driving position

ACCIDENT RECORD FOR PAST 3 YEARS, STARTING WITH MOST RECENT

Date

Nature of accident (head-on, rear-end, etc.)

Fatalities

Injuries

Date

Nature of accident (head-on, rear-end, etc.)

Fatalities

Injuries

Date

Nature of accident (head-on, rear-end, etc.)

Fatalities

Injuries

TRAFFIC CONVICTIONS AND FORFEITURES FOR PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS), STARTING WITH MOST RECENT

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

END DRIVING APPLICANT ONLY SECTION

PERSONAL REFERENCES
Please list the name, address, and telephone number of four personal references.

Name

Address

City, State, Zip

Phone

Relationship

How Long?

Name

Address

City, State, Zip

Phone

Relationship

How Long?

Name

Address

City, State, Zip

Phone

Relationship

How Long?

Name

Address

City, State, Zip

Phone

Relationship

How Long?

Are you presently an applicant, or on an eligibility list with any other employer?

Yes

Company name

Address

Position sought

Company name

Address

Position sought

Company name

Address

Position sought

Company name

Address

Position sought

If acceptable for employment, are you willing to relinquish any other employment or employment offers in favor of employment with the Warren County Sheriff's Department?

Yes

If no, please explain

WAIVER / CONSENT TO RELEASE INFORMATION

Applicant's Name

Date of Birth

Social Security Number

I am presently an applicant for employment with the Warren County Sheriff’s Department in Missouri. I fully understand that the Warren County Sheriff's Department conducts a background investigation on all applicants, who are being considered for a position with the Warren County Sheriff's Department. This investigation includes, but is not limited to, an investigation of my past employment performance, school records, financial stability, military, police, driving record, and character traits.
I hereby authorize any person who is contacted by the Warren County Sheriff's Department personnel to release any information to the Warren County Sheriff's Department pertaining to the background investigation including, but not limited to, records or information relating to my past employment purpose, financial stability, schooling, military, police, driving records, and character traits for use by the Warren County Sheriff's Department in the consideration of my application for employment and for no other purpose.

I also understand that this application (and any and all papers and other exhibits submitted by me or any purpose, government agency, former employer, private business, or any other individual or group of individuals in support and attached hereto) becomes upon submission to the Warren County Sheriff's Department (in petition for employment), the property of the County of Warren, State of Missouri, and cannot and will not be returned to me under any circumstance whatsoever.
I authorize the Warren County Sheriff's Department to release any documents or information collected during the application process to any person or entity lawfully empowered to obtain such information or documents.

I further agree to release and hold harmless any person releasing such information to the Warren County Sheriff's Department from any and all liabilities or claims which I may have against that person arising out of the release of such information.

I further agree to release and hold harmless Warren County, its elected officials, officers, agents, and employees from any and all liability or claims which I may have arising out of the disclosure of such information to the Warren County Sheriff's Department for use by the Warren County Sheriff's Department in consideration of my application for employment and for such other purposes as may be related to any subsequent employment with the Warren County Sheriff's Department.

This authorization for the release of information shall be valid for one (01) year from the date hereof. Any release of claim or liability set forth herein shall survive the termination of the agreement.

I further certify that all statements made by me in the completion of this application are, to the best of my knowledge and recollection, accurate and true and I understand that any false answer (deceitfully made) or any fraud whatsoever, constitutes a basis for rejection of the application with no further consideration, or if I am hired and fraud and / or deceit is subsequently discovered, such fraud and deceit will become the grounds for my immediate dismissal from the Warren County Sheriff's Department.

I further acknowledge that I understand all employment with the Warren County Sheriff's Department is at the will and pleasure of the Sheriff, per Missouri State Statute 57.251.

This release, or photocopy of same, when presented by any authorized representative of the Warren County Sheriff's Department, will constitute my consent and authority to examine and obtain copies of records and to receive statements and information.

Applicant's Signature

Date

This certifies that all entries on this application and information in it are true, accurate and complete.

I authorize you to make such investigations and inquiries of my employment history (when appropriate) and other related matters as may be necessary in arriving at an employment decision. I herby release employers, schools, or persons from all liability in responding to inquiries in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Warren County, as permitted by law.

Applicant's Signature

Date

I understand that Warren County maintains a Substance Abuse Policy and that I must comply with the Policy as a condition of employment with the County. I agree that I will at all times comply with Warren County's Substance Abuse Policy, which I understand may include pre-employment and employment testing for drug or alcohol usage, as set forth more fully in Warren County's Substance Abuse Policy.

Applicant's Signature

Date

I understand that all employees of Warren County are employees at will and that as such, my employment, if hired, can be terminated at any time, with or without cause.

Applicant's Signature

Date

reCAPTCHA

If you are human, leave this field blank.

Office: 636-456-4332 | Dispatch: 636-456-7088 | Emergencies CALL 911
104 West Main St., Suite A, Warrenton, Missouri 63383

MAIN MENU

SITE MAP

DEPARTMENT DIRECTORY

SAFETY TIPS

Office: 636-456-4332 | Dispatch: 636-456-7088 | Emergencies CALL 911104 West Main St., Suite A, Warrenton, Missouri 63383

MAIN MENU

SITE MAP

DEPARTMENT DIRECTORY

SAFETY TIPS

Office: 636-456-4332 | Dispatch: 636-456-7088 | Emergencies CALL 911
104 West Main St., Suite A, Warrenton, Missouri 63383