BRULE COUNTY SHERIFF’S DEPARTMENT

   APPLICATION FOR EMPLOYMENT

 

 

APPLICANT INFORMATION

 

POSITION APPLIED FOR: ___________________________ DATE OF APPLICATION____________

 

NAME: LAST: ___________________ FIRST: _______________________ MIDDLE: _____________

 

ADDRESS: BOX # OR STREET __________________________________ CITY: _________________

 

DOB: _______________ STATE: ____________ ZIP: ________________ SSN: __________________

 

PLACE OF BIRTH: _________________ PHONE HOME: _________________CELL: _____________

 

E-MAIL: _________________________________________ MARITAL STATUS: ________________

 

NUMBER OF CHILDREN: ______________________________

 

SCARS, MARKS TATTOOS, AMPUTATIONS: ____________________________________________

 

ARE YOU A MILITARY VETERAN: YES_____ NO_____  BRANCH: _________________________

TYPE OF DISCHARGE________________________________________________________________

 

ARE YOU A U.S. CITIZEN: YES_____ NO_____

NATURALIZED CERTIFICATE # (IF APPLICABLE) ______________________________

 

HAVE YOU FILED AN APPLICATION HERE BEFORE: YES_____ NO_____

IF YES, DATE FILED: ________________________

 

ARE YOU EMPLOYED NOW: YES_____ NO_____ CAN WE CONTACT YOUR EMPLOYER_____

 

ON WHAT DATE WOULD YOU BE AVAILABLE TO START WORK: ________________________

 

HAVE YOU BEEN CONVICTED OF A MISDEMEANOR: YES_____ NO_____

OF A FELONY: YES_____ NO_____ IF YES TO ANY EXPLAIN: (INCLUDE TRAFFIC TICKETS)

__________________________________________________________________________________________________________________________________________________________________________

 

HAVE YOU BEEN INVOLVED IN CIVIL LITIGATION DURING THE LAST THREE YEARS:

YES_____ NO_____ IF YES, EXPLAIN: (INCLUDE IF SERVED CIVIL PAPERS OR INVOLVED IN SMALL CLAIMS LAWSUIT):___________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

 

DO YOU HAVE A VALID DRIVERS LICENSE: YES_____ NO_____ IF YES, LIST TYPE, DATE OF EXPIRATION AND RESTRICTIONS:______________________________________________________

________________________________ IF NO, EXPLAIN:_____________________________________

_____________________________________________________________________________________

 

APPLICANT INFORMATION CONTINUED

 

HAVE YOU EVER BEEN DENIED ISSURANCE OF A LICENSE OR HAD IT SUSPENDED OR REVOKED: YES_____ NO_____ IF YES, EXPLAIN:________________________________________

_____________________________________________________________________________________

 

DO YOU HAVE ANY PHYSICAL, MENTAL, OR MEDICAL IMPAIRMENT OR DISABILITY THAT WOULD LIMIT YOUR JOB PERFORMANCE FOR THE POSITION YOU AR APPLYING FOR:

YES_____ NO_____ IF YES, EXPLAIN: __________________________________________________

 

 

 

EDUCATION

 

HIGH SCHOOL: ____________________________ ADDRESS:_______________________________

 

FROM: ____________________ TO: _______________________

 

DID YOU GRADUATE: YES_____ NO_____ DEGREE:_____________________________________

 

 

 

COLLEGE: ________________________________ ADDRESS: _______________________________

 

FROM: ____________________ TO: _______________________

 

DID YOU GRADUATE: YES_____ NO_____ DEGREE: ____________________________________

 

 

 

OTHER: ___________________________________ ADDRESS: ______________________________

 

FROM: ___________________ TO: _________________________ DEGREE:____________________

 

 

DESCRIBE ANY SPECIALIZED TRAINING, SKILLS, AND EXTRA CURRICULAR ACTIVITIES:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

 

 

TYPING EXPERIENCE: YES_____ NO_____

 

 

COMPUTER EXPERIENCE: YES_____ NO_____

 

 

 

PERVIOUS EMPLOYMENT

LAST FIVE YEARS OR LAST THREE EMPLOYERS

 

 

DATES OF EMPLOYMENT FROM: _________________TO _________________

 

EMPLOYER: __________________________________ JOB TITLE: ____________________________

 

ADDRESS: _______________________________________________ PHONE: ___________________

 

TYPE OF BUISNESS: _______________________ SUPERVISORS NAME: _____________________

 

STARTING SALARY: $______________________ ENDING SALARY: $_______________________

 

REASON FOR LEAVING: ______________________________________________________________

 

COMPLETE DESCRIPTION OF DUTIES: _________________________________________________

_____________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________

 

 

DATES OF EMPLOYMENT FROM: _________________TO _________________

 

EMPLOYER: __________________________________ JOB TITLE: ____________________________

 

ADDRESS: _______________________________________________ PHONE: ____________________

 

TYPE OF BUISNESS: _______________________ SUPERVISORS NAME: ______________________

 

STARTING SALARY: $______________________ ENDING SALARY: $________________________

 

REASON FOR LEAVING: _______________________________________________________________

 

COMPLETE DESCRIPTION OF DUTIES: __________________________________________________

_____________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________

 

 

 

REFERENCES

 

FULL NAME:__________________________RELATIONSHIP:______________________

ADDRESS:____________________________ PHONE: ___________________

 

FULL NAME:__________________________RELATIONSHIP:______________________

ADDRESS:____________________________ PHONE: ___________________

 

FULL NAME:__________________________RELATIONSHIP:______________________

ADDRESS:____________________________ PHONE: ___________________

 

 

DISCLAIMER AND SIGNATURE

 

I CERTIFY THAT MY ANSWERS ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. IN THE EVENT OF EMPLOYMENT. IF THIS APPLICATION LEADS TO EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION IN MY APPLICATION OR INTERVIEW MAY RESULT IN MY RELEASE.

 

 

 

 

_________________________________________________________

SIGNATURE OF APPLICANT                                                           DATE

 

 

BRULE COUNTY SHERIFF’S DEPARTMENT

APPLICANT SCREENING SURVEY

 

THIS DOCUMENT IS PREPARED BY THE UNDERSIGNED TO INFORM THE BRULE COUNTY SHERIFF’S DEPARTMENT OF MY BACKGROUND AND EMPLOYMENT HISTORY.

I, _______________________________________DO HEREBY VOLUNTARYIL, WITHOUT DURESS, COERCION, THREATS OR PROMISE OF REWARD OF IMMUNITY, AGREE TO AN EXTENSIVE BACKGROUND INVESTIGATION CONDUCTED BY MEMBERS OF THE BRULE COUNTY SHERIFF’S DEPARTMENT. I UNDERSTAND THAT THIS PROCEDURE WILL INVOLVE PERSONAL INTERVIEWS WITH THOSE WHOM I HAVE LISTED ON THIS APPLICATION AS REFERENCES FOR EMPLOYMENT, AS WELL AS OTHER FORMER BUSINESS AND PERSONAL ASSOCIATES.

I HEREBY RELEASE AND HOLD FOREVER HARMLESS THE MEMBERS OF THE BRULE COUNTY SHERIFF’S DEPARTMENT, ALL THOSE LISTED ON MY APPLICATION AS REFERENCES AND ALL OTHERS WITH WHOM THE INVESTIGATION MIGHT SPEAK REGUARDING MY BACKGROUND, FROM ALL LIABILITY RESULTING FROM SUCH RESEARCH INTO MY BACKGROUND.

 

 

__________________________________________________________________             

APPLICANT’S SIGNATURE                            D/O/B                                       DATE

 

__________________________________________________________________                                              

WITNESS SIGNATURE, TITLE                                                                         DATE