EFPSO Employment Application

CHARACTER REFERENCES
List character references that are not former employees or relatives. Make sure to provide a valid telephone number.
Name

First NameLast Name
Phone Number with Area Code
Format: (000) 000-0000.
Name

First NameLast Name
Phone Number with Area Code
Format: (000) 000-0000.
Name

First NameLast Name
Phone Number with Area Code
Format: (000) 000-0000.
Name

First NameLast Name
Phone Number with Area Code
Format: (000) 000-0000.
Name

First NameLast Name
Phone Number with Area Code
Format: (000) 000-0000.
Name

First NameLast Name
Phone Number with Area Code
Format: (000) 000-0000.

EDUCATION AND TRAINING

List your education including high school, GED, colleges, business school, and/or technical school.

Rows	School Name	Area of Study	Did You Graduate?

List any POST certifications and other Specialized Training you have completed.

Rows	School / Training Name	Certification Received	Date

List other special skills or abilities as related to this area of work. You may also list any equipment that you are able or certified to operate boat, 4-wheeler, tractor, etc, as well as any computer programs that you are proficient at using. List any certificates or commendations you have received.

EMPLOYMENT HISTORY
List all former employment, beginning with your most recent job.
Name of Employer
Job Title / Description
From

MonthDayYear
Date
To

MonthDayYear
Date
Salary
Hours Worked Per Week
Supervisor's Name
Phone Number
Format: (000) 000-0000.
Reason for Leaving
Name of Employer
Job Title / Description
From

MonthDayYear
Date
To

MonthDayYear
Date
Salary
Hours Worked Per Week
Supervisor's Name
Phone Number
Format: (000) 000-0000.
Reason for Leaving
Name of Employer
Job Title / Description
From

MonthDayYear
Date
To

MonthDayYear
Date
Salary
Hours Worked Per Week
Supervisor's Name
Phone Number
Format: (000) 000-0000.
Reason for Leaving
Name of Employer
Job Title / Description
From

MonthDayYear
Date
To

MonthDayYear
Date
Salary
Hours Worked Per Week
Supervisor's Name
Phone Number
Format: (000) 000-0000.
Reason for Leaving
Name of Employer
Job Title / Description
From

MonthDayYear
Date
To

MonthDayYear
Date
Salary
Hours Worked Per Week
Supervisor's Name
Phone Number
Format: (000) 000-0000.
Reason for Leaving
Name of Employer
Job Title / Description
From

MonthDayYear
Date
To

MonthDayYear
Date
Salary
Hours Worked Per Week
Supervisor's Name
Phone Number
Format: (000) 000-0000.
Reason for Leaving
Name of Employer
Job Title / Description
From

MonthDayYear
Date
To

MonthDayYear
Date
Salary
Hours Worked Per Week
Supervisor's Name
Phone Number
Format: (000) 000-0000.
Reason for Leaving

DISCLAIMERS / ACKNOWLEDGEMENT
I certify that all information given here is true and accurate and I am aware that any misrepresentations or falsifications made in connection with my obtaining employment with the East Feliciana Parish Sheriff’s Office will be sufficient grounds for rejection or dismissal.*
Initial
I understand that my employment with the East Feliciana Parish Sheriff’s Office will be voluntary and will be subject to termination by myself or the East Feliciana Parish Sheriff’s Office at will, with or without cause, and with or without notice, at any time.*
Initial
The East Feliciana Parish Sheriff’s Office has a strict drug, alcohol, and contraband policy and prohibits the use, distribution and/or sale of illegal drugs on all premises and work locations. Any employee reporting to work in a condition caused by off duty use of drugs, alcohol, or controlled substances, which detrimentally affects his or her ability to perform work, shall be deemed in violation of the East Feliciana Parish Sheriff’s Office policy. I understand that if I am employed, I will be required to take a drug test before starting work as well as at random times throughout the duration of my employment. I hereby give my voluntary consent for a urine and/or blood sample to be collected from me and submitted for alcohol and/or drug testing.*
Initial
The East Feliciana Parish Sheriff’s Office may be required to provide test results to other companies with whom the East Feliciana Parish Sheriff’s Office has contracts to undertake certain work. I hereby further consent to the release of testing results to any such company or companies, or their agents or designees, where release of this form has been requested by said companies or their agents with respect to work undertaken by the East Feliciana Parish Sheriff’s Office.*
Initial
I understand and give consent to the East Feliciana Parish Sheriff’s Office to search my person, personal effects, locker, lunch box, purse, parcels, and other property belonging to the East Feliciana Parish Sheriff’s Office. I understand that my consent to this procedure is a condition of my employment and that refusal to consent will result in my discharge from employment. I further agree to hold the East Feliciana Parish Sheriff’s Office, its agents, directors, officers, and employees harmless from any and all liability in connection with search and investigation.*
Initial
I understand that if I am employed with the East Feliciana Parish Sheriff’s Office, I will have to provide the following information for my personnel file and for a pre-employment background check: a copy of my Driver’s License, a copy of my Social Security Card, a copy of my high school diploma or GED, a copy of my birth certificate, and any other documents required to complete the employment process. I also understand that I will have to take a photo for an ID badge.*
Initial
I understand that if I am offered employment, I may be required to submit to a physical fitness exam, a financial background check, and/or a Fit for Duty health exam depending on my position.*
Initial
If you answered YES to all of the above disclaimers, please sign below.
Signature*
Name*
Date

MonthDayYear
I HEREBY GIVE THE EAST FELICIANA PARISH SHERIFF’S OFFICE AUTHORIZATION TO PERFORM A COMPLETE AND THOROUGH BACKGROUND CHECK, INCLUDING BUT NOT LIMITED TO: A CURRENT CRIMINAL HISTORY CHECK AND A CURRENT DRIVING HISTORY CHECK.
Signature*
Name*
Date

MonthDayYear
All applications are kept on file for one year. Although you may call to inquire as to the status of your application or the availability of positions, it is not necessary to do so. If and when you are considered for employment, you will be contacted. Thank you again for your interest in joining the East Feliciana Parish Sheriff’s Office!
Should be Empty:

Rows	MON	TUES	WED	THUR	FRI	SAT	SUN
8am - 4:30pm (N/A Saturday and Sunday)
6am – 6pm
6pm – 6am

SHERIFF EAST FELICIANA PARISH

Application For Employment

BASIC INFORMATION

POSITIONS & AVAILABILITY

CHARACTER REFERENCES

EDUCATION AND TRAINING

EMPLOYMENT HISTORY

DISCLAIMERS / ACKNOWLEDGEMENT