Simple Job Application Form

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

Daniel H. Edwards, Sheriff
INSTRUCTIONS:

This application form is intended for use in evaluating your BASIC qualifications for employment. Completing this form does not constitute an offer of employment, does not guarantee an offer of employment will be made nor does it constitute an employment contract. Answer all questions completely and accurately. Any intentional false or misleading statements made on this form or during any employment interviews and/or testing are grounds for terminating the application process or, if discovered alter employment, terminating employment. All qualified applicants will receive consideration without regard to sex, marital status, race, age, creed, national origin, or the presence of disabilities. Individuals selected for further processing will be required to provide more detailed, additional background and personal data. Additional testing of job-related skills, physical and psychological fitness for duty may be required. Testing for the presence of drugs/alcohol in your body will be required prior to and during employment.
Full Name*

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Email Address*
Are you 18 years or older?
Do you have a valid driver's license?
Have you ever worked under or attended school under a different name?
What name?
Do you have any relatives employed by Tangipahoa Parish Sheriff's Office?
List name(s) of any relatives employed by the Tangipahoa Parish Sheriff's Office required
*If an employment offer is made, you must provide proof of United States citizenship or eligibility to work in the United States.

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

Daniel H. Edwards, Sheriff
Type of Employment desired
Position
Salary expected
Can you work rotating shifts?
Start date

MonthDayYear
Have you previously applied for employment, or worked, with this agency?
If you have previously applied for employment with us, what position did you apply for and/or and why did you leave?

Education

	Name and Location of School	Course of Study	Did you Graduate?	Degree or Diploma
High School
College
Technical School
Other

Please list any other special training or skills (languages, machine operations, etc.) you have completed:
Are you P.O.S.T. Certified?
Where? When? Agency?
P.O.S.T. certification level(s) completed?

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

Daniel H. Edwards, Sheriff
Are you an Armed Forces Veteran?
What branch of the military?
Type of Discharge?
Have you ever been convicted of a felony (Civilian or Military)?
Charge
Date
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Explain

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

Daniel H. Edwards, Sheriff
Work History
Please list your work history for the past 10 years and list all of your law enforcement experience.
Have you ever been dismissed, or asked to resign from employment?
Explain:
Are you currently employed?
Company Name
Hire Date (Mo/Yr)
Duties
Salary
Company Address
Company Phone
Supervisor Name
Supervisor Phone Number
Reason For Wanting To Leave Current Employer
Add Additional Employment
Company Name
Hire Date (Mo/Yr)
Duties
Salary
Company Address
Company Phone
Supervisor Name
Supervisor Phone Number
Reason For Wanting To Leave Current Employer
Add Additional Employment
Company Name
Hire Date (Mo/Yr)
Duties
Salary
Company Phone
Company Address
Supervisor Name
Supervisor Phone Number
Reason For Wanting To Leave Current Employer

References - Give below: Names of persons not related to you, whom you've known at least one year.

	Name	Phone	Occupation	Years Acquainted
Person 1
Person 2
Person 3

I authorize the references listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal and otherwise, and release all parties from any liability for any damage that may result from furnishing same to you.
Name

First NameLast Name
Date

MonthDayYear
Date
Signature

Clear

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

Daniel H. Edwards, Sheriff
TANGIPAHOA PARISH SHERIFF'S OFFICE CREDIT AND BACKGROUND INVESTIGATION ACKNOWLEDGEMENT
I understand and acknowledge that in connection with my application for employment, a thorough background investigation will be conducted by the Tangipahoa Parish Sheriff's Office. In connection with this investigation, I understand and consent to the Sheriff's Office obtaining a credit report concerning me. I understand that, consistent with the requirements of the position for which I am applying, as determined by Tangipahoa Parish Sheriff's Office, the investigation into my background may entail inquires involving public and private sources, including a consumer report. I understand that this investigation and these reports may include, but not limited to, information such as my financial history and obligations, my character, education, criminal and civil history, driving history, property ownership, work habits, job performance, and experience, along with reasons for termination of past employment. My neighbors, friends, family, employers, co-workers, teachers, and others may be interviewed. I understand that according to the Fair Credit Reporting Act, if employment is denied because of information obtained by my prospective employer from a consumer reporting agency, I am entitled to know this fact and I will be notified and be given the name of the agency. In consideration of my application for employment, I consent to the above-described investigation.
Signature

Clear
Date

MonthDayYear
Date

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

Daniel H. Edwards, Sheriff
VOLUNTARY DISCLOSURE OF PERSONAL IDENTIFYING INFORMATION
In the event you are selected for further processing in connection with this employment application, it will be necessary for you to provide personal identifying information and extensive personal history data. The Sheriff's Office does not require you to disclose personal identifying information or personal history data at this time; however, you may voluntarily elect to provide some additional information at this time. This will permit the Tangipahoa Parish Sheriff's Office to expedite its inquiry into criminal and civil records, which can be time-consuming and delay the processing of your application. Disclosure of the below-listed information is not compelled at this time and your application for employment will not be rejected solely for not providing this information at this time.

This information is required by law enforcement and other government entities for positive identification in connection with criminal and civil record checks. These records checks are used for the purpose of determining your eligibility for employment insecurity and safety-sensitive positions with the Tangipahoa Parish Sheriff's Office. This information will be maintained in strict confidence, in a secure manner, and will not be used for any other purpose.
Full Name

First NameMiddle NameLast NameSuffix
Please list all other names you have used:

First NameMiddle NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Place of Birth
Driver's License Number
State of Issue
Expiration Date:
Previous Residence. List City/State where you have resided. List your most current residence first and work backward.
Address

Street Address

Street Address Line 2

CityState

Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date
Add additional address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date
Add additional address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From

MonthDayYear
Date
To

MonthDayYear
Date

Race (This data is collected for identification purposes only and is not disclosed or used for any other purpose):

	Asian	Hispanic	Black	White	Other
RACE

I acknowledge that I have provided the above personal identifying information on a voluntary basis at this time.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

Work History Please list your work history for the past 10 years and list all of your law enforcement experience.

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

TANGIPAHOA PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

Work History
Please list your work history for the past 10 years and list all of your law enforcement experience.