Read the Instructions Carefully
If the question does not apply to you, indicate with N/A. If space available is insufficient, please upload attachements as applicable. Do Not Misstate or Omit material facts, since the statements made herein are subject to verification to determine your qualifications for employment. NOTE: A Resume is encouraged but may not be used as a substitute for completing this application.

Personal Information:

Name

First Name*

Middle Name*

Last Name*

E-mail Address

E-mail Address*

Address

Street Address*

City*

State*

Zip*

County*

Telephone Number

Home Phone Cell Phone Work Phone

Employment Desired

Apply For* Part Time Full Time

Position

Apply For* Corrections Dispatch Enforcement Administrative Volunteer Reserves IT Department Cook/Custodial

OPOTA Certification

OPOTA Certification* Yes No

Academy*

Citizen Status

U.S. Citizen* Yes No

If derived, parent(s) Certificate Number:*

Naturalization Certificate No.*

Date, Place & Court:*

Drivers License Information

Valid Drivers Licence* Yes No

License No*

Expiration Date*

Restrictions*

State*

Arrest and Detention

Have you ever been arrested or detained (including traffic citations/tickets) by a Law Enforcement Agency?* Yes No

If yes, explain*

Educational Background

(Upload proof of High School Diploma or G.E.D.) List all schools you attended including High School, beginning with the most recent:

High School

School Name*

Years Completed*

Degree/Diploma/Certificate*

GPA*

College/Trade School

School

Years Completed

Degree/Diploma/Certificate

GPA

Major

Minor

College/Trade School

School

Years Completed

Degree/Diploma/Certificate

GPA

Major

Minor

Military Status and Records (Upload DD 214, if applicable)

Branch 1

Branch

Active Entered

Active Discharged

Rank Entry

Rank Discharge

Type of Duty

Branch 2

Branch

Active Entered

Active Discharged

Rank Entry

Rank Discharge

Type of Duty

Branch 3

Branch

Active Entered

Active Discharged

Rank Entry

Rank Discharge

Type of Duty

Work Experience

In the area below, list your past work experience beginning with the most recent employment. Attach extra sheets if necessary. Explain any breaks in service of employment. Volunteer work may also be included as employment.

Employer 1

Employer's Name

Employer's Phone

Address

Length of Employment

Position

Salary

Duties Performed

Reason for Leaving

Supervisor's Name

Ok to Contact Yes No

Employer 2

Employer's Name

Employer's Phone

Address

Length of Employment

Position

Salary

Duties Performed

Reason for Leaving

Supervisor's Name

Ok to Contact Yes No

Employer 3

Employer's Name

Employer's Phone

Address

Length of Employment

Position

Salary

Duties Performed

Reason for Leaving

Supervisor's Name

Ok to Contact Yes No

Employer 4

Employer's Name

Employer's Phone

Address

Length of Employment

Position

Salary

Duties Performed

Reason for Leaving

Supervisor's Name

Ok to Contact Yes No

Employer 5

Employer's Name

Employer's Phone

Address

Length of Employment

Position

Salary

Duties Performed

Reason for Leaving

Supervisor's Name

Ok to Contact Yes No

Employer 6

Employer's Name

Employer's Phone

Address

Length of Employment

Position

Salary

Duties Performed

Reason for Leaving

Supervisor's Name

Ok to Contact Yes No

References

List three business/work, school or personal references who are not related to you and are not previous supervisors.

References 1

Name*

Address*

Phone Number*

Years Acquainted*

How Acquainted

References 2

Name*

Address*

Phone Number*

Years Acquainted*

How Acquainted

References 3

Name*

Address*

Phone Number*

Years Acquainted*

How Acquainted

How did you hear about this position

How did you hear about this position* Hometown Opportunity Sheriff Staff Facebook Other

File Uploads

Resume - pdf,doc,txt,docx

High School Diploma - pdf,doc,txt,docx

Other Upload - pdf,doc,txt,docx

By Clicking this box, I verify all the above information is true to the best of my knowledge and belief.*

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Thank you for submitting your online application for employment.

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