WASHINGTON COUNTY SHERIFF’S OFFICE  Application for Employment

1535 Colfax Street Blair, NE. 68008

Phone 426-6866 * Fax 426-6820

Mike Robinson, Sheriff

 

We consider applicants for all positions without regard to race, color, religion, national origin, age, marital or veteran status, the presence of non-job-related medical condition or handicap, or any other legally protected status.

(Please Print)

Social

Security #:

 

                         /        /                      

 

Date of Application:

 

Position Applied For:

(   ) Deputy   (   ) Part-time Deputy    (   ) Reserve Deputy

(   ) Clerical   (   ) Correction Officer  (   ) Communication Officer

Last Name:

 

First Name:

 

M.I.

 

Address:

 

 

City:

 

State:

 

Zip:

  

Phone:

Home

Work

 

If you are under 18 years of age, can you provide required proof of your eligibility to work?

                                                                                                                                (   ) Yes    (   ) No

Have you ever filed an application with us before?                                                (   ) Yes    (   ) No

                                                                                                            If yes, give date:_______________

Have you ever been employed by us before?                                                         (   ) Yes    (   ) No

                                                                                                            If yes, give date:_______________
Are you currently employed?                                                                                  (   ) Yes    (   ) No
May we contact your present employer?                                                                 (   ) Yes    (   ) No

Are you prevented from lawfully becoming employed in this country because of Visa or

Immigration status?                                                                                                 (   ) Yes    (   ) No

Proof of citizenship or immigration status will be required upon employment.
On what date would you be available for work?                                                    _______________
Are you available to work            (   ) Full Time    (   ) Part Time    (   ) Shift Work    (   ) Temporary
Are you currently on "Lay-off" status and subject to recall?                                    (   ) Yes    (   ) No
Can you travel if a job requires it?                                                                          (   ) Yes    (   ) No

Have you ever been the subject of a criminal investigation or charged with a crime?                                                                                                                      (   ) Yes   (   ) No

Being the subject of a criminal investigation will not necessarily disqualify an applicant from employment.
   
If yes, please explain  
   
 
 

Are you physically or otherwise unable to perform the duties of the job you are applying for?

                                                                                                                                (   ) Yes    (   ) No

  EMPLOYMENT HISTORY

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations, which indicate race, color, religion, gender, national origin, handicap or other protected status.

Employer:  
Address:   Telephone #:  
Dates Employed: From: To: Pay Rate: Starting: Final:

Job Title:

 Supervisor:
Work Performed:
Reason For Leaving:

Employer:  
Address:   Telephone #:  
Dates Employed: From: To: Pay Rate: Starting: Final:

Job Title:

 Supervisor:
Work Performed:
Reason For Leaving:

Employer:  
Address:   Telephone #:  
Dates Employed: From: To: Pay Rate: Starting: Final:

Job Title:

 Supervisor:
 Work Performed:
Reason For Leaving:

Special Skills and Qualifications (Summarize special job-related skills and qualifications)

 
 
 

EDUCATION HISTORY

School Name and Location

Years Completed

Diploma

/

Degree
Elementary:

4

5

6

7

8
High School:

9

10

11

12

Course of Study              
College/University:  

1

2

3

4

 
Course of Study              
Other:  

1

2

3

4

    
Course of Study              

 
Describe any specialized training, apprenticeship, skills, extra-curricular activities, honors received and any additional information you feel may be helpful to us in considering your application.
 
 
 

 

Indicate any foreign languages you can speak, read and / or write
 

Fluent

Good

Fair
Speak      
Read      
Write      

REFERENCES

Name

Address

Phone #
     
     
     

Have you ever had any job-related training in the United States Military?             (   ) Yes    (   ) No

If yes, please decribe:_____________________________________________________________________________

 

I certify that answers given herein 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.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any application wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

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 the employer.

 

_____________________________________________ ______________________

Signature of Applicant Date

 

FOR PERSONNEL DEPARTMENT USE ONLY

Arrange Interview? (   ) Yes    (    ) No
Remarks:  
 
 
 
 
 
 
 
 
 
Interviewer:  

Date:

  
Employed:

(   )Yes   (   )No

Date of Employment: Division:
Job Title:  

Salary-Hourly Rate:

  
By:  

Date: