APPLICATION FOR EMPLOYMENT - Stephens County Sheriffs Office€¦ · THE STEPHENS COUNTY...

THE STEPHENS COUNTY SHERIFF’S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER

APPLICATION FOR EMPLOYMENT

NOTICE TO ALL APPLICANTS

Thank you for your interest in employment with the Stephens County Sheriff’s

Office, a state certified, full-service law enforcement agency. Stephens County is a

great place to work and live and is an equal opportunity employer.

An employment application follows, along with additional information that you

may find useful during your application process. Resumes are not accepted in lieu

of completing any section of the application. If you wish to apply for more than

one position, now or in the future, YOU are responsible for making copies of your

application. WE WILL NOT MAKE COPIES FOR YOU.

It is the policy of the Stephens County Sheriff’s Office that all applicants meet the

minimum qualifications of the position applied for. PLEASE REVIEW THE

MINIMUM QUALIFICATIONS CONTAINED WITHIN THE

APPLICABLE JOB DESCRIPTION PRIOR TO CONTINUING WITH

COMPLETION OF THE APPLICATION FOR EMPLOYMENT PACKET.

ANY APPLICATION THAT DOES NOT

MEET THE MINIMUM REQUIREMENTS

WILL NOT BE CONSIDERED.

NOTE: All questions contained in the Application for Employment packet must

be answered fully and completely. If a question does not apply to you, indicate so

by placing an “N/A” in the blank. Failure to complete this application fully and

accurately may subject you to disqualification.

Equal Employment Opportunity Employer

Serving our Citizens


BEFORE PROCEEDING ENSURE YOU HAVE

INCLUDED THE FOLLOWING DOCUMENTS:

• Copy of Social Security Card

• Copy of Birth Certificate

• Copy of your Valid Driver’s License

• Copy of High School Diploma/GED Certificate

• Marriage License and/or Divorce Decree

• Copy of DD-214 (Member-4 and/or Copy#2) If Applicable

• Basic Law Enforcement Training (BLET)Certificate for lateral applicants

(including out-of-state applicants) or applicants that have graduated BLET within the last 12 months.

• Attach a written, signed and notarized statement detailing ANY crime(s) that

you have ever been convicted of, including any convictions you may have

had under the First Offender Act.

• Attach a copy of the court disposition for ANY misdemeanor or felony

crime(s) you have been charged with, convicted of or plead NOLO to.

• Ensure that you have COMPLETELY FILLED out the Application and the Background Questionnaire

INCOMPLETE APPLICATIONS WILL NOT

BE CONSIDERED MAIL OR RETURN YOUR

COMPLETED PACKET TO

FOR QUESTIONS CALL OR

EMAIL:

Stephens County Sheriff’s Office

Office of Professional Standards & Training

70 N. Alexander Street, Suite 205 Toccoa, GA 30577

Lt. Stephen Stewart

706-898-5853

[email protected]

mailto:[email protected]


STEPHENS COUNTY SHERIFF’S OFFICE 70 N. Alexander Street, Suite 205

Toccoa, GA 30577 Office (706) 886-2525 ~ Jail (706) 886-2514

EMPLOYEE SELECTION PROCESS ITINERARY

1. Applicants must submit a completed application packet to the Background and Recruiting. Application packets will be accepted on a continuous basis; therefore, applicants are not limited to submitting application packets during announced application periods. All application packets will remain active for six (6) months. After six (6) months, applicants must submit a subsequent application packet to be considered for the selection process. Each subsequent application packet will be retained with the initial application packet. The selection process begins with the submission of a completed application packet. An application packet consists of a completed application for employment, copy of your birth certificate, copy of your college diploma (if applicable), completed background questionnaire, copy of entrance examination with passing scores as detailed on the next page (not required for communications or civilian applicants), copy of your valid driver’s license, copy of your high school diploma or G.E.D. certificate, copy of your law enforcement academy certificate (if applicable), copy of your social security card, and a copy of your DD214 (military discharge form - if applicable). If you fail to pass any portion of the process will disqualify you from the selection process for one (1) year from the date of disqualification. Upon receipt of the above items, the application packet will be thoroughly reviewed, and the selection process will begin.

2. Applicant must pass an initial background screening. This includes a criminal history and driver’s history check.

3. Interview with an appointed board and division commander. All applicants that have completed and successfully passed the prior steps in the selection process will complete an interview with an appointed board and division head or designee. Applicants should arrive prepared and on time. The division head or designee will forward the top applicants to the chief deputy or designee for review.

4. Complete and pass a truth verification exam. The Office of Professional Standards will schedule the applicant(s) for a truth verification examination consisting of a Computer Voice Stress Analysis (C.V.S.A.) and/or a polygraph examination. All information contained within the application packet is subject to truth verification

5. Pass the final background check. This includes verification of personal and professional references, verification of any qualifying credentials, a check of credit history and appropriate follow-up measures to questionable information previously developed or obtained from the truth verification exam.

6. Conditional offer from the Sheriff. Applicants who are recommended by the chief deputy or designee for a conditional job offer will be referred to the sheriff for his authorization to make a formal conditional offer of employment.

7. Complete a psychological fitness examination. All applicants will be required to complete this step.

8. Pass a drug screening test and medical examination. This will be conducted by a licensed medical doctor of the agency’s choosing.





WAIVER AND AUTHORIZATION FOR RELEASE OF INFORMATION

(READ CAREFULLY AND SIGN WHERE INDICATED)

I hereby authorize a review of and full disclosure of all records concerning me to any duly authorized agent of the Stephens County

Sheriff's Office, whether said records are of a public, private, or confidential nature.

The intent of this authorization is to give my consent for full and complete disclosure of all records including, but not limited to, records

of educational institutions, driving history records, GCIC and/or NCIC criminal history records, financial or credit institutions including

records of loans, records of commercial or retail credit agencies including credit reports or ratings, and other financial statements and

records wherever filed, employment and pre-employment records, including background reports, efficiency ratings, complaints or

grievances filed by or against me, and the record and recollections of attorneys or other counsel whether representing me or another

party in any case either criminal or civil in which I presently have had an interest.

I understand that any information obtained in a personal history background investigation arising in whole or in part, directly or

indirectly, from this waiver and authorization will be considered in determining my suitability for employment with the Stephens County

Sheriff's Office.

I certify that any person furnishing information concerning me shall not be held accountable for such information, and I hereby release

said person from any and all liability, be it civil or criminal in nature, which may be incurred as a result of furnishing such information.

I understand that the 1974 Privacy Act affords me the right to expect certain types of information not to be disseminated by persons who

have access to such information. For the purpose of a personal history background investigation to determine my suitability for

employment with the Stephens County Sheriff's Office, I hereby waive said rights. I understand that, by my signature below, I am

authorizing the Stephens County Sheriff’s Office to release any and all information regarding or relating to my employment with the

Stephens County Sheriff’s Office to future or prospective employers seeking information regarding my employment and/or performance

while employed by the Stephens County Sheriff’s Office.

A copy of this release form shall be valid as an original thereof even though said photocopy does not bear an original of my signature.

Sworn to me and subscribed before me this _____ day of ________________ 20___.

_____________________________________ _____________________________________

Notary Public Full Legal Signature of Applicant (Including Maiden Name if Applicable)

_________________________________ Address _________________________________ City State Zip ________________________________ Telephone Number _________________________________ Date of Birth SSN




APPLICATION FOR EMPLOYMENT FACTORS FOR DISQUALIFICATION (READ AND SIGN WHERE INDICATED)

An applicant shall be disqualified and not considered for employment if any of the following situations exist:

1. Conviction in any court for any felony offense

2. Conviction in any court for any drug related offense

3. Any pending criminal actions in any court

4. Presently under investigation for any criminal offense by this or any other law enforcement or similar agency

5. Dishonorable discharge from any military service branch

6. Seven or more points accumulated against driving record at time of application

7. Unable, for any reason, to obtain a Georgia driver's license

8. Adverse credit record at time of application

9. Absence of high school graduation or GED certificate

10. Any medical or physical impairment that would prevent applicant from satisfactorily performing the essential

functions of the position applied for or complying with standards set by the Georgia peace officers standard and

training council

11. Any known association with any group, organization or otherwise whose primary objective is to foster hatred,

oppression, or persecution of any individual, group of individuals, or any private or public company or

organization

12. Not having attained 18 years of age for Jail Officer or 20 years of age for Deputy Sheriff at the time of

application

13. Not a citizen of the United States of America

14. Any activity (including social media) where criminal behaviors, drug use, sexually explicit language, images,

or acts and statements or other forms of speech that ridicule, malign, disparage, or otherwise express bias against

any race, any religion, or any protected class of individuals are observed.

The above stated guidelines are not considered all-inclusive. Each candidate will be considered on a case-by-

case basis, and disqualification may be deemed necessary for a number of reasons not listed herein.

I certify that I have read the entire contents of this page and fully understand the same. I also certify that, to the

best of my knowledge, none of the above situations apply to me. I understand that in the event that I have received

an official pardon or other similar action for an alleged crime for which I was convicted, I am not required to

reveal that said pardon or action exists. However, if during the course of a background investigation to determine

my suitability for employment, facts are revealed concerning said crime, I may be required to produce proof of

said pardon or action if I wish to be considered for employment.

_________________________________________ __________________________________ Signature Witness Signature _________________________________________ SSN _________________________________________ Date




APPLICATION FOR EMPLOYMENT AUTHORIZATION TO OBTAIN CREDIT REPORT

The Fair Credit Reporting Act, as amended (15 U.S. C. § 1681, et seq.) allows the Stephens County Sheriff’s

Office to get one or more credit reports on you for employment purposes. Should a decision to take any adverse

action against you be made, based ether in whole or in part on the credit report, you should know that the

consumer or credit reporting agency that provided the report has played no role in the decision to take action.

The Stephens County Sheriff’s Office is requesting an investigation to determine your fitness for employment.

The information in this authorization will be given to the consumer or credit reporting agency so that the agency

will release information about you and your credit history. This information may be redisclosed to other law

enforcement agencies (for the above purpose) and to fulfill official responsibilities, to the extent that the

disclosure is permitted by law.

As part of qualifying for a position with the Stephens County Sheriff’s Office, I am undergoing a personal

background investigation in order to receive a public trust certification and as such I hereby authorize the

Stephens County Sheriff’s Office and its authorized agents to obtain my credit reports from any consumer or

credit reporting agency for employment purposes. Sworn to me and subscribed before me this _____ day of ________________ 20___.

_____________________________________ _____________________________________

Notary Public Full Legal Signature of Applicant (Including Maiden Name if Applicable)

_________________________________ Address _________________________________ City State Zip ________________________________ Telephone Number _________________________________ Date of Birth SSN


STEPHENS COUNTY SHERIFF’S OFFICE CONTRACT FOR REIMBURSEMENT

O.C.G.A. § 35-8-22. Reimbursement of training expenses by subsequent employer of peace officer reads as follows:

a. Unless otherwise provided by an employment contract to the contrary, if the State of Georgia or any county or municipality thereof employs a peace

officer and said peace officer is hired by another agency within 15 months after completing mandated or formalized training requirements, then the

total expense of training, including salary paid during training, shall be reimbursed by the hiring agency to the State of Georgia or any county or

municipality thereof which initially paid for such training. If said officer is hired by another agency during a period of 15 to 24 months after mandated

or formalized training requirements are completed, then one-half of the total expense of training, including salary paid during training, shall be

reimbursed by the hiring agency to the State of Georgia or any county or municipality thereof which initially paid for such training. The council shall

set standards for reimbursement by hiring agencies based upon actual expenses incurred in mandated or formalized training by individual

departments.

b. The State of Georgia or any county or municipality thereof which initially paid for the training of a peace officer shall submit an itemized, sworn

statement to the new employer of the peace officer and shall demand payment thereof and may enforce collection of such obligation through civil

remedies and procedures.

c. Effective July 1, 2003, in order for the State of Georgia or any county or municipality thereof to demand reimbursement, the demanding governmental

unit must be able to document that the peace officer in question signed an acknowledgement of the terms of this Code section or an employment

contract specifying the provisions of this Code section prior to such peace officer’s employment with the demanding governmental unit. Otherwise,

this Code section shall not apply to such demand for reimbursement.

WHEREAS, the above-referenced state statute provides for certain monetary obligations in reference to Peace Officer Standards and Training

(P.O.S.T.) Basic Peace Officer Mandate training;

WHEREAS, the Stephens County Sheriff’s Office does not wish to incur any liability for reimbursement of any expenses relating to the provisions of

the above-referenced state statute;

THEREFORE, for and in consideration of my employment with the Stephens County Sheriff’s Office and other mutual consideration, I,

__________________________________, the undersigned, an applicant for employment with the Stephens County Sheriff's Office, hereby certify and

affirm that I have read the provisions of O.C.G.A. § 35-8-22. I further certify and affirm that I hereby covenant and acknowledge the following:

(NOTE: INITIAL THE SECTION THAT APPLIES AND PLACE AN “X” NEXT TO THOSE SECTIONS THAT DO NOT APPLY)

__________ That I have not completed the Peace Officer Standards and Training (P.O.S.T.) Basic Peace Officer Mandate training nor have any

expenses towards such training been paid for on my behalf by any law enforcement agency. I understand that should the Stephens County Sheriff's

Office incur expenses (to include salary expenses paid during the time of such training) in providing me with such training and should I obtain

employment with any other state, local, or municipal law enforcement agency within TWENTY-FOUR (24) months of completing such training, that

I will personally assume full financial responsibility for all reimbursements due to the Stephens County Sheriff's Office pursuant to O.C.G.A. § 35-8-

22 not reimbursed, within ten (10) days of my leaving employment with the Stephens County Sheriff's Office, by my subsequent law enforcement

employer. This obligation may be enforced by garnishment of my wages or any other remedial action available.

__________ That I have completed the Peace Officer Standards and Training (P.O.S.T.) Basic Peace Officer Mandate training when I was employed

by ___________________________________ (NAME OF LAW ENFORCEMENT AGENCY THAT PAID FOR SAID TRAINING) and have

completed at least TWENTY-FOUR (24) months of service, subsequent to my completing the training, with that law enforcement agency.

__________ That I completed the Peace Officer Standards and Training (P.O.S.T.) Basic Peace Officer Mandate training while I was employed by

_________________________________ (NAME OF LAW ENFORCEMENT AGENCY THAT PAID FOR SIAD TRAINING) but have not

completed at least TWENTY-FOUR (24) months of service, subsequent to my completing the training, with that law enforcement agency. Should I be

offered a position with the Stephens County Sheriff's Office, I fully understand that said offer is conditional and that I will not be permitted to begin

my employment with the Stephens County Sheriff's Office until I have personally compensated the law enforcement agency that paid for such training

and/or obtained a written release, signed by the Sheriff, Chief, or Chief Executive of said agency, waiving any and all financial obligations due under

O.C.G.A. § 35-8-22. I further understand that this conditional offer of employment may be revoked if I have not provided the required written release

to the Stephens County Sheriff's Office within FIVE (5) days of the conditional offer of employment being made.

___________________________________ _________________________________ Applicant

Date

___________________________________ _________________________________

Witness Date


(COMPLETE IN INK ONLY)




PERSONAL INFORMATION

POSITION APPLIED FOR:

LAST NAME: FIRST NAME: M.I.:

ADDRESS:

CITY: STATE: ZIP:

SOCIAL SECURITY NUMBER: DATE OF BIRTH:

HOME PHONE: ALTERNATE PHONE:

EMAIL ADDRESS:

DRIVER’S LICENSE?

YES NO STATE: DRIVER’S LICENSE #: LEGALLY ELIGIBLE TO WORK IN THE

US? YES NO

EDUCATION

CIRCLE HIGHEST GRADE COMPLETED: 8 9 10 11 12 OR GED: YES NO

CHECK HIGHEST COLLEGE LEVEL COMPLETED: 1 2 3 4 GRADUATE STUDIES? YES NO

COLLEGE OR

UNIVERSITY

LOCATION SEM.

HOURS

EARNED

QTR.

HOURS

EARNED

DEGREE TYPE AND

MAJOR (EG, BA, BS)

DEGREE

EARNED?

YES NO

YES NO

YES NO

CERTIFICATES AND LICENSES

TYPE: DATE ISSUED: DATE EXPIRES:

CERTIFICATE/LICENSE NUMBER: ISSUING AGENCY:








WORK HISTORY

Describe your complete work history BEGINNING WITH YOUR CURRENT OR MOST RECENT JOB.

Include military, volunteer experience, and periods of unemployment. Failure to give complete information regarding each job held will result in your disqualification. Complete addresses with zip code and phone numbers for all employers are

necessary. A resume may be attached only as additional information and will not be accepted in lieu of completing this

application.

EMPLOYER: FROM (MO/YR):

TO (MO/YR):

TOTAL (YRS/MOS):

ADDRESS: JOB TITLE:

PHONE NUMBER: SUPERVISOR: MAY WE CONTACT THIS

EMPLOYER? YES NO

HOURS PER WEEK: SALARY: FULL TIME PART TIME

DUTIES:

REASON FOR LEAVING:


TO (MO/YR):

TOTAL (YRS/MOS):

ADDRESS: JOB TITLE:

PHONE NUMBER: SUPERVISOR: MAY WE CONTACT THIS EMPLOYER? YES NO


DUTIES:

REASON FOR LEAVING:


TO (MO/YR):

TOTAL (YRS/MOS):

ADDRESS: JOB TITLE:


EMPLOYER? YES NO


DUTIES:

REASON FOR LEAVING:


TO (MO/YR):

TOTAL (YRS/MOS):

ADDRESS: JOB TITLE:


EMPLOYER? YES NO


DUTIES:

REASON FOR LEAVING:


WORK HISTORY (cont.)


TO (MO/YR):

TOTAL (YRS/MOS):

ADDRESS: JOB TITLE:


EMPLOYER? YES NO


DUTIES:

REASON FOR LEAVING:

EMPLOYER: FROM (MO/YR): TO (MO/YR):

TOTAL (YRS/MOS):

ADDRESS: JOB TITLE:

PHONE NUMBER: SUPERVISOR: MAY WE CONTACT THIS EMPLOYER? YES NO


DUTIES:

REASON FOR LEAVING:


TO (MO/YR):

TOTAL (YRS/MOS):

ADDRESS: JOB TITLE:


EMPLOYER? YES NO


DUTIES:

REASON FOR LEAVING:


TO (MO/YR):

TOTAL (YRS/MOS):

ADDRESS: JOB TITLE:


EMPLOYER? YES NO


DUTIES:

REASON FOR LEAVING:


SKILLS

OFFICE/COMPUTER SKILLS:

OTHER SKILLS:

LANGUAGES:

ADDITIONAL INFORMATION

If you require special accommodations for testing, interviewing, or any portion of the application or employment process,

please contact the Stephens County Sheriff’s Office Training Unit at (706) 898-5853. Any request for special accommodation should be made, if at all possible, at the time your appointment is scheduled. If any accommodation is

requested, the applicant must provide verification from an appropriate professional.

SIGNATURE

CERTIFICATION: I certify that every statement I have made in this application is true and complete to the best of my knowledge. I understand that any false answers may be grounds for not employing me or for dismissing me after I begin work. I understand that I will have to produce documentation verifying identity and employment eligibility in the United States. I understand that I may be required to verify any and all information given in this application. I understand that this

completed application is the property of the Stephens County Sheriff's Office, and will not be returned. The Sheriff's Office is hereby authorized to make any investigation of personal, educational, and work history. I understand that I must notify the Training Unit of the Stephens County Sheriff’s Office of any changes in my name, address, or phone number. I understand that the information I have provided on this application may be subject to public disclosure under the Georgia

Open Records Act.

Signature of Applicant (sign in ink): Date Signed:


AGENCY-WIDE SUPPLEMENTAL QUESTIONS

1. Are you currently employed by the Stephens County government? YES NO

If so, in what department do you work at this time?

2. Have you previously been employed by the Stephens County government? YES NO

If so, when and where?

3. Give name, relationship, and department of any relatives who are employed by the Stephens County

government.

4. Would you accept temporary work YES NO

5. Would you accept shift work? YES NO

6. Would you accept part-time work? YES NO

7. Would you accept weekend/holiday work YES NO

8. Are you 18 years old or older? YES NO

9. Are you a citizen of the United States YES NO

10. Do you have a valid commercial driver’s license (CDL)? YES NO

If so, what is your CDL classification?

11. Have you received any traffic citations in the past three years? YES NO

If yes, please indicate types of offenses and dates.

12. Have you (since the age of 18) ever been convicted of or plead guilty or contest

to a misdemeanor?

YES NO

If yes, please describe the circumstances.

13. Have you (since the age of 18) ever been convicted of or plead guilty or contest

to a felony?

YES NO

If yes, please describe the circumstances.

14. Have you ever been suspended, dismissed, or asked to resign from any job? YES NO

If yes, please explain in detail.


STEPHENS COUNTY SHERIFF’S OFFICE

BACKGROUND QUESTIONNAIRE 70 N. Alexander Street, Suite 205


NAME:__________________________________________________________________

(LAST) (FIRST) (MIDDLE)

PROTECTIVE SERVICES APPLICANT: INSTRUCTIONS

(READ COMPLETELY AND THOROUGHLY)

The information you provide in this questionnaire will be used as a part of your background investigation to assist

the Stephens County Sheriff’s Office, and the community, in which it serves, in determining your suitability as a

employee. Completion of this questionnaire is necessary if you wish to continue in the selection process.

Stephens County has a right to expect, and in fact demand, truthfulness from the men and women who are to

serve as sheriff’s office employees. Honesty is expected and required from the very onset of this processing.

Your background investigator WILL NOT distinguish between lies, big or small. Any perceived or deliberate

inaccuracies, incomplete statements, untruthfulness or omissions will not be tolerated and may be grounds

for disqualification.

Please print (legibly) all responses. If you need more space to answer a question, turn the sheet over, identify

the question numeral and write your response on the back of the page. Leave no question blank or unanswered.

Write “None” if this is an appropriate answer. If a question does not apply to you, print “N/A” (not applicable).

No question is intended as a medical inquiry. The American with Disabilities Act prohibits employers from

making medically related inquiries prior to a conditional offer of employment. Therefore, if you are completing

this questionnaire before you have received a conditional offer of employment, DO NOT; divulge information

concerning physical or medical conditions, either past of current.

Remember, your responses may be confirmed by an in-depth polygraph examination and background

investigation.

If you have read and understand the instructions, sign and date as indicated.

________________________________________________________

Signature of Applicant Date


Note: Stephens County Government and the Stephens County Sheriff’s Office are equal employment

opportunity employers. The personal data requested below is used only to create an applicant database

and is not used as a screening tool.

PERSONAL DATA

Name

Last First Maiden Middle Address

Number Street Apt No.

City State Zip Code

Telephone Number Home : ( ) Cell: ( )

SSN#: Race Sex

Place of Birth Date of Birth

City County State

Height Weight Hair Color Eye Color

MARITAL STATUS AND SPOUSAL INFORMATION Spouse Name

Last First Maiden Middle

Place of Birth Date of Birth

City County State

Telephone Number Home : ( ) Cell: ( )

Employer Employer’s Address (Number, Street, City, State) Telephone

NEXT OF KIN INFORMATION

List all Dependents; Include all children who may not live in your household Name Address Telephone Number


List the names of every member of your immediate family who are currently living; Including Father, Mother, Sisters, Brothers, Father-in-Law, and Mother -in-Law. Name Relationship Address Telephone Number

BACKGROUND QUESTIONS

1. If applying for a sworn law enforcement position you must be at least 20 years of age. Are you at least 20 years of age? (Sworn position is Deputy Sheriff) Yes No

2. Are you a citizen of the United States of America? This is a requirement for the Sworn positions. (Deputy Sheriff) Yes No

3. Did you graduate from High School or do you have a G.E.D.? (This is a requirement) Yes No

4. Have you ever applied for a position with Stephens County? Yes No If yes, please provide position applied for and the year you made the application.

5. List chronologically all address for the past 10 years, including residences while at school and in the military. For college or campus residences, give dormitory name, city, and state. If residences in military service cannot be shown as street address, indicate complete military unit designation and location by city and state. If post office box, give location of post office. If apartment complex, give name, phone number and point of contact/manager. Attach a separate sheet of paper for additional residences if necessary. Dates To/From Address (City, State, Zip)


6. List All traffic citations received within the past ten years. Date Charge Location Disposition

7. In the past ten years, have you been involved, as a driver, in a motor vehicle accident? Yes No If yes, please provide the following information:

Date Type Citation Issued Driver at Fault

8. Do you presently hold a valid driver's license? Yes No If Yes, State Where License Is Held: _______ Class: ______ Expiration Date: _______ Driver’s License Number: _________________ If No, Explain:

9. Has your driver's license ever been suspended and/or revoked for any reason? Yes No If yes, please provide Date of Suspension: _______________________ Reason Suspended: _______________________ Date Reinstated: ________________

10. Have you ever been convicted of or pled nolo to D.U.I.? Yes No If yes, please explain. Provide date, location, and disposition of the case.

11. Have you ever been convicted or pled nolo to a Misdemeanor offense? Yes No If yes, please provide date, charge, location and actual disposition of the case.

12. Have you ever been convicted or pled nolo to a felony offense? Yes No If yes, please provide date, charge, location and actual disposition of the case.


13. List five people whom you know well and who live in the United States. They should be a good friend, peer, colleague or college roommate, whose combined association with you covers as much as possible of the last 10 years. DO NOT list your spouse, former spouse, or other relatives. DO NOT list anyone who is listed elsewhere in this application.

Complete Name Home Address

Years Known & Relationship City, State, Zip

DOB or Approximate Age Phone#

Occupation Cell




Occupation Cell




Occupation Cell




Occupation Cell




Occupation Cell


14. Have you ever enlisted or attempted to enlist in the military? Yes No If yes, which branch?

Number of years served. ________ Type of discharge. ________________________

15. While serving in the military, were you ever the subject of any court martial, Article 15, company punishment or disciplinary action? Yes No If yes, please explain:

16. Have you ever been suspended, terminated or forced to resign from any place of employment? Yes No If yes, please provide employer's name and reason for termination/forced resignation.

17. Have you ever been disciplined for any reason by your present or any past employer? Yes No If yes, please explain.

18. Do you have any commitments that would not allow you to work on various shifts, weekends, holidays or other periods? Yes No If yes, please explain.

19. If you had to place a dollar amount on the property that you have taken throughout your lifetime, what would that amount be? This amount should also include any theft from an employer, including but not limited to pens, paper, other office supplies. $______________ If yes, please describe the items taken.

20. Over the past three years, how would you describe your credit standing?

21. In the past five years have you used marijuana? Yes No If yes, please explain. Date First Used Date Last Used Number of Times Used

22. In the past ten years, have you used any illegal, illicit or street drugs? Yes No If yes, please explain.

Drug Used Date First Used Date Last Used Number of Times Used


23. Have you ever been involved in the SALE, DISTRIBUTION, OR MANUFACTURE of any illegal drugs? Yes No If yes, please explain.

24. In the past ten years, have you consumed any drugs prescribed for another person? Yes No If yes, please explain- providing name or type of drug(s), dates, number times taken.

25. Have you ever consumed any alcoholic beverages or used any type of illegal drugs while working? Yes No If yes, please explain.

26. At this time do you have any pending criminal charges against you, including but not limited to, traffic citations or domestic violence? Yes No If yes, please explain.

27. At this time are you under subpoena or involved in any criminal or civil litigation, either as a plaintiff or defendant? Yes No If yes, please explain.

28. Are you currently serving probation for any offense? Yes No If yes, please explain.

29. Have you ever applied or worked with any law enforcement agencies? Yes No If yes, please provide the following:

Agency Date Applied Position Applied For Status

30. Are you currently under investigation by the Georgia Peace Officer Standards and Training Council (P.O.S.T.) and/or any law enforcement agency? Yes No If yes, please explain.

31. Have you ever been investigated by P.O.S.T. or the G.B.I.? Yes No If yes, please include the date, disposition, a letter from P.O.S.T. saying that you have been cleared and are in good standing with the council, and explain the circumstances:


32. Over a period of time the duties and responsibilities of a position will tend to change. This may arise from

technological changes, or changes in Sheriff’s Office procedural guidelines. Are you willing to accept changes in the duties and responsibilities for the position which you have applied?

Yes No

33. Have you been completely honest with us when completing your application for employment and this questionnaire? Yes No If no, please explain.

Answering “yes” to any of the aforementioned questions will not necessarily result in your disqualification from the hiring process. Any intentional omissions or dishonesty in any documents submitted as part of your application or any other part of the hiring process will be cause for immediate disqualification from further consideration.

SOCIAL MEDIA INFORMATION REQUEST As part of the application and background investigation process, the Stephens County Sheriff’s Office requires access to each applicant’s social media websites for content and associations. Please provide your contact information, Social media sites, and/or BLOG information. If you do not wish to provide your information here, you must contact the Office of Professional Standards at (706) 898-5853 to make arrangements for his review of your social media content and associations. _________________________________________________________________________________ Applicant Email Address _________________________________________________________________________________ Facebook _________________________________________________________________________________ LinkedIn _________________________________________________________________________________ Snapchat _________________________________________________________________________________ Twitter _________________________________________________________________________________ Pinterest _________________________________________________________________________________ BLOG _________________________________________________________________________________ Other


APPLICANT ESSAY: Please explain why you want to be in Law Enforcement and why you are seeking employment with the Stephens County Sheriff’s Office.

(NOTE: Your response must be in your own handwriting and is limited to the space provided below.)

________________________________________________________________________________

________________________________________________________________________________

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**CERTIFICATION*** I hereby certify that the statements made and dates provided within this application for employment with the Stephens County Sheriff’s Office are true, accurate, and complete to the best of my knowledge and belief. I authorize investigation of all statements and information contained within this application for employment, and I understand that any misrepresentation or omission of facts, however slight, will be sufficient cause for denial of employment, or if employed, for subsequent dismissal. Print Name: ________________________ Signature: __________________________ Date: ____________________________________

APPLICATION FOR EMPLOYMENT - Stephens County Sheriffs Office€¦ · THE STEPHENS COUNTY...

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Transcript of APPLICATION FOR EMPLOYMENT - Stephens County Sheriffs Office€¦ · THE STEPHENS COUNTY...