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  • Employment Application

  • PERSONAL INFORMATION

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date Available
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  • Date of Birth*
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  • Are you a citizen of the United States?
  • If no, are you authorized to work in the U.S.?
  • Have you ever worked for Riverside Regional Jail?
  • Do you have any relatives employed by Riverside Regional Jail?

  • EDUCATION

  • From
     - -
  • To
     - -
  • Did you graduate?
  • From
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  • To
     - -
  • Did you graduate?
  • From
     - -
  • To
     - -
  • Did you graduate?

  • Starting with the most recent, describe all paid, military and applicable voluntary experience. Please include any prior jail or law enforcement experience.

    You must include at least the last consecutive 5 years of employment including periods of unemployment, if any.

    (Use Supplementary Experience Form for additional space)

  • PREVIOUS EMPLOYMENT

  • Format: (000) 000-0000.
  • From
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  • To
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  • May we contact your previous supervisor for a reference?*
  • Format: (000) 000-0000.
  • From
     - -
  • To
     - -
  • May we contact your previous supervisor for a reference?
  • Format: (000) 000-0000.
  • From
     - -
  • To
     - -
  • May we contact your previous supervisor for a reference?
  • Do you have additional employers to add?
  • Have you ever served in the military?

  • MILITARY SERVICE

  • From
     - -
  • Date
     - -

  • SUPPLEMENTAL EXPERIENCE FORM

  • Format: (000) 000-0000.
  • From
     - -
  • To
     - -
  • May we contact your previous supervisor for a reference?
  • Format: (000) 000-0000.
  • From
     - -
  • To
     - -
  • May we contact your previous supervisor for a reference?
  • Format: (000) 000-0000.
  • From
     - -
  • To
     - -
  • May we contact your previous supervisor for a reference?
  • Format: (000) 000-0000.
  • From
     - -
  • To
     - -
  • May we contact your previous supervisor for a reference?
  • Format: (000) 000-0000.
  • From
     - -
  • To
     - -
  • May we contact your previous supervisor for a reference?

  • REFERENCES

  • PLEASE LIST THREE (3) PROFESSIONAL REFERENCES.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • DISCLAIMER AND SIGNATURE

  • My signature below gives authority to request any school or institution of learning, creditor, past or present employer or law enforcement agency to release information contained in their records to the proper official presenting this authorization for use in conducting research specifically relating to my suitability as an employee of Riverside Regional Jail.

    I hereby certify that all entries on this application including any attachments are true and complete, and I agree and fully understand that any falsification of information herein, regardless of time and discovery, may cause forfeiture on my part to any employment with the Riverside Regional Jail. I understand that information on this application is subject to verification and I consent to references, former employers, and educational institutions listed being contacted, and criminal history, credit, and DMV check being conducted regarding this application.

  • Date*
     / /
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  • BACKGROUND QUESTIONNAIRE

  • PERSONAL INFORMATION

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date of Birth
     / /

  • OPERATOR’S LICENSE

  • Driver’s License Date Received
     / /
  • Driver’s License Expiration Date
     / /
  • Has your driver’s license ever been suspended or revoked?
  • If yes, date
     / /
  • Have you ever been convicted of driving while your license was suspended or revoked?
  • If yes, date
     / /
  • Have you ever been charged or convicted of any type of alcohol or drug related offense?
  • If yes, date
     / /
  • Have you ever held a driver’s license in another state?
  • In the past 10 years, have you ever been involved in an automobile accident in which you were the driver?
  • Have you been convicted of a moving traffic violation in the past 24 months?

  • FINANCIAL STATUS

  • Have you ever claimed bankruptcy, had your wages garnished, or had a civil judgement against you?
  • Have you ever had an account referred to a collection agency?
  • Have you ever been delinquent on income or other tax payments?
  • Have you ever had any personal property repossessed?

  • DRUG USE

  • Have you ever, as a juvenile or adult, experimented, possessed or used any type of illegal substances or drugs?

  • CRIMINAL HISTORY

  • Have you ever been convicted of a felony?
  • Have you ever been convicted of a misdemeanor?
  • Have you ever been arrested or detained by the police?
  • Have you ever been arrested or convicted of domestic assault?
  • Have you ever committed an illegal act(s) even as a juvenile?
  • Have you been convicted of a moving traffic violation in the past 24 months?
  • Have you ever been dismissed or requested to resign from a former position?
  • Is there any court action (criminal, civil, or traffic) pending against you currently?
  • Have you ever been incarcerated in the Riverside Regional Jail?
  • Have you ever been incarcerated in any jail?
  • Do you now, or have you in the past possessed, used, or sold any illegal drugs?
  • Have you ever engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution? (as defined in 42 U.S.C. 1997)
  • Have you ever been convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent of refuse?
  • Have you ever been civilly or administratively adjudicated to have engaged in the activity described in the previous two (2) questions, or accused of or reprimanded for sexually harassing behavior?

  • ADDITIONAL BACKGROUND INFORMATION

  • Have you ever applied for employment with any other law enforcement agency?
  • Have you ever applied for employment with Riverside Regional Jail?
  • Do you know anyone that works for the Riverside Regional Jail now, or has worked for the jail in the past?
  • Do you know anyone who is currently or has been incarcerated in Riverside Regional Jail in the past?
  • If yes, have you received any phone calls, had in-person or internet visits, or exchanged messages with them while incarcerated?

  • PREVIOUS ADDRESSES

  • Please list any previous addresses for the past ten years:

  • FAMILY HISTORY

  • Please list the names, address, and phone number of your parents or legal guardians, any siblings, spouse, children and parents or legal guardians of your spouse. Please identify the relationship of each person listed.

  • Has any member of your family ever been arrested for or convicted of a felony?
  • Are you or any members of your family currently or formerly a member of any subversive/terrorist organization?

  • AUTHORITY FOR RELEASE OF INFORMATION

  • I hereby authorize any duly accredited representative of the Riverside Regional Jail bearing this release or a copy thereof, to obtain any information from schools, residential management agents, employers, criminal justice agencies, credit references, or individuals relating to my activities. The information may include, but is not limited to, academic, disciplinary, and conviction records. I hereby direct you to release such information upon request of the bearer. I understand that the information released is for official use of the Riverside Regional Jail and may be disclosed to such third parties as necessary in the fulfillment of official responsibilities.

    I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind of nature which; may at any time result to me on account of compliance, or any attempts to comply with this authorization.

  • Authority for Release of Information Date
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  • Equal Employment Opportunity (EEO) Reporting Information

    This information will be used to comply with State and Federal Equal Employment Opportunity Laws and related reporting requirements. This information will NOT be kept with your application for employment and will NOT be used for making employment decisions. Federal law prohibits unlawful discrimination on the basis of race, sex, age, national origin, religion, or disability.
  • Date of Birth*
     / /
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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