Employment Application
Last                         First                         Middle
Type of Position
LAST FOUR ADDRESSES
EDUCATION
Highest Grade Completed
High School
OTHER SPECIAL SCHOOLS, COURSES OF STUDY, OR CERTIFICATION
OTHER SKILLS
FOREIGN LANGUAGES
MILITARY SERVICE
Have you ever been an active member of the military service?
Were you subject to any demotions or other disciplinary action while in the military service?

EMPLOYMENT HISTORY

Please list all employers from the past ten years.

List three co-workers

List three co-workers

List three co-workers

List three co-workers
List three co-workers

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

ACCIDENT RECORD FOR PAST 3 YEARS, STARTING WITH MOST RECENT
TRAFFIC CONVICTIONS AND FORFEITURES FOR PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS), STARTING WITH MOST RECENT
DRIVER EXPERIENCE AND QUALIFICATIONS - LIST DETAILS OF YOUR DRIVER LICENSES, STARTING WITH THE MOST RECENT
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Has any license, permit, or privilege ever been suspended or revoked?
DRIVING EXPERIENCE
DRIVING POSITION APPLICANTS ONLY CONTINUED
END DRIVING APPLICANT ONLY SECTION


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


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

WAIVER / CONSENT TO RELEASE INFORMATION

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.

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.

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.
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.