CPSO Employment Application 8/1

Calcasieu Parish Sheriff's Office

Application For Employment
Position applying for? (Corrections, Patrol, Dispatch, Clerical, or other) *
*

Full Time Part Time
Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mobile Phone Number *
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Additional Number To Reach You
Please enter a valid phone number.
Social Security Number *
Driver's License Number / State / Type / Expiration *
High School Graduate? *

Yes No
GED?

Yes No
Post Secondary Education:

Employment History

List all jobs held in the past ten (10) years, regardless of length of time employed. Start with your present employer.
Start Date / End Date / Name of Employer
Start Date / End Date / Name of Employer
Start Date / End Date / Name of Employer
Start Date / End Date / Name of Employer
Start Date / End Date / Name of Employer
Start Date / End Date / Name of Employer
Start Date / End Date / Name of Employer

References

List relatives employed by the Calcasieu Parish Sheriff's Office
Full Name / Relationship / Department
Full Name / Relationship / Department
Full Name / Relationship / Department
Character References (Optional)

List three (3) persons (not employers or relatives) who know you well enough to give current or former information about you.
Name / Phone Number
Name / Phone Number
Name / Phone Number
Have you ever been terminated from any job or position?

Yes No
If yes, which employer?
Have you ever been arrested?

Yes No
If yes, which state were you arrested in?
Have you ever been convicted of a crime?

Yes No
If yes, which state were you convicted in?
Have you ever served in any branch of the United States Armed Forces or other military organization?

Yes No
What is your present draft classification?
If yes, please list Organization / Enlistment Date / Discharge Date / Type / Rank

Calcasieu Parish Sheriff's Office

Background Release Authorization
I declare that the information provided by me in this application is true, correct, and complete to the best of my knowledge. I understand that if employed, any falsification, misstatement, or omission of fact in connection with my application, whether on this document or not, may result in immediate termination of employment. *
Initial
I do hereby grant my permission to all present and former employers, health service providers, references, and law enforcement agencies to release to the Calcasieu Parish Sheriff’s Office and it’s officers all verbal and written information in their possession that pertains to me. *
Initial
I do hereby certify that a photocopy of this document shall serve as an original for the purpose of releasing information to the Calcasieu Parish Sheriff’s Office and its administrative officers. *
Initial
I do hereby understand that this document is an application only and that the completion hereof does not imply or state a condition of future employment. *
Initial
The Civil Rights Act of 1963,the Civil Rights Act of 1967, and The Americans with Disabilities Act of 1990prohibit discrimination in employment based on: Race, Color, Religion, Sex, National Origin, Age, and disabilities. I have applied for employment with the Calcasieu Parish Sheriff’s Office. I understand that completion of the application process requires that a personal background check be made by the Calcasieu Parish Sheriff’s Office. I hereby authorize the Calcasieu Parish Sheriff’s Office or its designated agents to investigate my previous record and character to collect any and all information, whether it is of record or not, that may concern my eligibility for employment. *
Type Your Name
This authorization includes, but is not limited to, criminal history, bank, credit, school, selective service, physical, hospital, health, insurance, or employment records, and releases any person, organization or corporation from any charges or claims for furnishing said information. A copy of this authorization shall be considered as effective and valid as the original. It is my desire for this authorization to be ongoing. It is my intent that the Calcasieu Parish Sheriff’s Office be allowed to run periodic checks, at their discretion, during the course of this application and if hired, the life of my employment. *

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Calcasieu Parish Sheriff's Office

Employment History

References

Character References (Optional)

Calcasieu Parish Sheriff's Office

Upload your current driver's license by either taking a photo with your phone or downloading a file on your computer.