Law Enforcement Employment Application Step 1 of 6 16% Section I – Personal InformationName(Required) First Middle Last AliasesPlace of Birth(Required)Marital Status(Required) Single Married Divorced Widowed Spouse's NameSpouse's Maiden NameDriver's License #(Required)State(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code County(Required)Home Phone #Work Phone #Cell or Alternate Phone #Email Address(Required) Best time to contact you by phone:HomeWorkAre you prevented from lawfully becoming employed by this County because of VISA or Immigration Status?(Required) Yes No Position(s) applied for(Required)Proof of Citizenship or Immigration Status will be required upon employment. Section II – Work ReferencesAre you currently on "lay-off" status and subject to recall? Yes No Date available to start: MM slash DD slash YYYY Employment History (In chronological order beginning with most recent):1. Employer's NameEmployer's Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dates Employed: From:To:Job Title:Hourly Wage:Describe your duties, responsibilities, etc for positions held:Reason for leaving:Did you leave voluntarily? Yes No Explain:Were you asked to resign? Yes No Explain:2. Employer's NameEmployer's Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dates Employed: From:To:Job Title:Hourly Wage:Describe your duties, responsibilities, etc for positions held:Reason for leaving:Did you leave voluntarily? Yes No Explain:Were you asked to resign? Yes No Explain:3. Employer's NameEmployer's Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dates Employed: From:To:Job Title:Hourly Wage:Describe your duties, responsibilities, etc for positions held:Reason for leaving:Did you leave voluntarily? Yes No Explain:Were you asked to resign? Yes No Explain: Section III – Education and Training1. School Name and LocationYears CompletedDiploma/Degree/Major2. School Name and LocationYears CompletedDiploma/Degree/Major3. School Name and LocationYears CompletedDiploma/Degree/MajorOther schools attended:Please describe the courses you took, technical training you received, or skills you have attained which you feel will help you perform the job for which you are applying (special classes, certificates, hobbies, volunteer work projects which have taught you qualifying skills):Do you hold any specialized law enforcement cerifications (instructor certifications, K-9, IDACS, etc.)? Yes No If yes please list the type of certification and date of certificationType:Date CertifiedIs certification current? Yes No Type:Date CertifiedIs certification current? Yes No Type:Date CertifiedIs certification current? Yes No Type:Date CertifiedIs certification current? Yes No Are you a graduate of a law enforcement academy? Yes No If yes, explain Section IV – Miscellaneous(The following information will be used only if it is directly related to the classification/ position for which you are applying.)AS AN ADULT OR JUVENILE: Have you ever filed an application with this office before? Yes No If yes, whenHave you ever been employed with this office before? Yes No If yes, when and what positionHave you ever been employed in the state or county service of the state of Indiana? Yes No If yes, please explainHave you ever applied for employment with any other law enforcement agency before? Yes No If yes, explainAre you currently engaged in any other hiring process? Yes No Have you any job-related training in the U.S. Military? Yes No If yes, please explainHave you ever been convicted of a felony? Yes No Have you ever been arrested for a felony? Yes No If yes, explainHave you ever been convicted of a misdemeanor? Yes No Have you ever been arrested for a misdemeanor? Yes No If yes, explainHave you ever been convicted of domestic battery? Yes No Have you ever been arrested for domestic battery? Yes No If yes, explainHas your driver’s license ever been suspended or revoked? Yes No If yes, explainHave you ever committed or assisted another person in the crime of murder, kidnapping, rape, robbery, burglary, arson, theft or conversion? Yes No If yes, explainHave you ever purchased or sold anything you knew or suspected was stolen? Yes No If yes, explainHave you ever possessed, purchased, sold or distributed any illegal drugs? Yes No If yes, explainHave you ever used an illegal drug? Yes No If yes, explain and include all drugs used and last time usedHave you ever been arrested for an alcohol related violation? (i.e. OVWI, public intoxication, illegal possession of alcohol) Yes No If yes, explainHave you ever been dismissed or asked to resign from a position of employment? Yes No If yes, explainHave you ever been subject to a restraining order? Yes No If yes, explainHave you ever been summoned to court? Yes No If yes, explainHave you ever been placed on probation or house arrest? Yes No If yes, explainHave you ever been or are currently involved in any civil actions (i.e. small claims, evictions, etc.)? Yes No If yes, explainHave you ever been investigated/charged/convicted of any sexual based crimes (i.e. sexual battery, sexual misconduct, rape, etc.) misdemeanor or felony? Yes No If yes, explainAre there any pending charges against you? Yes No If yes, explainHave you ever received a traffic violation? Yes No If yes, explainI have answered all of the above questions fully and truthfully. I understand that any misrepresentation or omission of requested information could eliminate me from consideration as an applicant with the Ripley County Sheriff’s Office. If any of the information changes, I understand that I am responsible for promptly updating that information in writing. Signature(Required)Printed Name(Required) Section V – References(Please give the name, address and telephone number of three references not related to you who would know of your skills for this position)NameAddressTelephone #NameAddressTelephone #NameAddressTelephone #I hereby authorize that the information provided by me in this application for employment is true, correct and complete to the best of my knowledge. I understand that, if employed, any misstatement or omission of fact on this application shall be considered cause for dismissal.I authorize the Ripley County Sheriff’s Office to obtain information through contacts with my former employers and references listed above.Signature(Required)Printed Name(Required)**NOTE: This application will expire after one year from date received. It is your responsibility to re-submit a new application after hiring or expiration.Resume or CVAccepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 122 MB.Have a resume or cv that you’d like to include? Please upload it here. RIPLEY COUNTY SHERIFF’S OFFICE APPLICANTS STATEMENT OF CONSENT, WAIVER AND ACKNOWLEDGEMENT In applying for employment, I want the Ripley County Sheriff’s Office to be fully informed of my previous record. Accordingly, I hereby authorize the Ripley County Sheriff’s Office to investigate my background and to obtain any and all information which may concern me, including the information set forth in my application. I hereby release all persons, including schools, companies, corporations, credit bureaus and law enforcement agencies from any liability on account of furnishing such information. I fully understand that if employed, any misrepresentation of facts on this application is sufficient reason for my immediate termination. I fully understand that any initial offer of employment is conditional upon my passing a medical examination, including a drug test, to which I consent, along with disclosure of any absolute disqualifying factors, such as the detection of certain illegal substances during a confirmed drug test. In addition to my authorization and release of information and entities set forth in paragraphs 1, 2, and 4 above, I hereby authorize the Ripley County Sheriff’s Office to discuss the results of any pre-employment investigation with those persons who conduct the interview(s) and any investigation with those persons responsible for hiring. I understand that nothing contained in this application, or in the granting of conducting of an interview, is intended to create a contract between the Ripley County Sheriff’s Office and myself. I have read and understand the above statement carefully and I agree to abide by all of its terms. Applicant Signature(Required)Printed Name(Required) 8909
