Application for Employment

Application for Employment
Thank you for your interest in serving our community as an employee of the WashingtonParish Sheriff’s.

The mission of the Washington Parish Sheriff’s Office is to prevent crime, enforce thelaw, and support quality public safety by delivering respectful, professional anddependable law enforcement services.
- Preventing crime includes everything from strengthening neighborhoods andfamilies to using crime data to identify patterns and suspects.
- Enforcing the law includes not just the measures of arrest and warnings but alsoeducating the public about their responsibilities.
- Supporting quality public safety means being a full partner with other parts ofthe criminal justice system and assisting witnesses and crime victims throughoutthe process.
- Delivering respectful law enforcement services means treating people the wayyou want to be treated.
- Professionalism is our hallmark and it means knowledgeable, competent, andethical policing.
- Dependable means that we keep our promises and serve with courage anddedication
We welcome your application. Please complete the application in its entirety. Inaddition to the application please provide the following documents:
- Driver’s License
- High School Diploma
- Birth Certificate
- Social Security Card
- Marriage License
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 and 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 interview are grounds for terminating the application process or, if discovered after 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 may be required. Testing for the presence of drugs/alcohol in your body will be required prior to and during employment.
Name*

First NameMiddle NameLast NameJr. / Sr. / III
Address*

Street Address

Street Address Line 2

CityState

Zip Code
How long at present address?*
Home Phone
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Sex*

MaleFemale
Are you 18 years of age or older?*

YesNo
Date of Birth*

MonthDayYear
Date
Age
Social Security Number*
Driver's License No.
Driver's License State
Expiration Date
Spouse's Name
Children's Name
Father's Name
Mother's Maiden Name
Have you ever applied for employment at this or any Sheriff's Office before?*

YesNo
If yes, give date*

MonthDayYear
Date
Position Desired - Prefill*

YesNo
Position Desired?*
Pay Expected
Are you legally eligible for employment in the United States?*

YesNo
List other special training or skills (Languages, Machine Operations, etc)
Education

College
College - Name
College - Location
College - Course of Study
College - No. of Years Completed
Years
College - Did You Graduate?

YesNo
College - Degree or Diploma

High School
High School - Name
High School - Location
High School - No. of Years Completed
Years
High School - Did You Graduate?

YesNo

Elementary
Elementary - Name
Elementary - Location
Elementary - No. of Years Completed
Years
Elementary - Did You Graduate?

YesNo

Other Education
Other - Name
Other - Location
Other - Course of Study
Other - No. of Years Completed
Years
Other - Did You Graduate?

YesNo
Other - Degree or Diploma

Employment History

Employment History #1
Company Name
Company Telephone
Please enter a valid phone number.
Company Address

Street Address

Street Address Line 2

CityState

Zip Code
Start Employed Date (State Month and Year)

MonthDayYear
Date
End Employed Date (State Month and Year)

MonthDayYear
Date
Name of Supervisor
Starting Weekly Play
Ending Weekly Play
Job Title
Describe Your Work
Reason for Leaving

Employment History #2
Company Name
Company Telephone
Please enter a valid phone number.
Company Address

Street Address

Street Address Line 2

CityState

Zip Code
Start Employed Date (State Month and Year)

MonthDayYear
Date
End Employed Date (State Month and Year)

MonthDayYear
Date
Name of Supervisor
Starting Weekly Play
Ending Weekly Play
Job Title
Describe Your Work
Reason for Leaving

Employment History #3
Company Name
Company Telephone
Please enter a valid phone number.
Company Address

Street Address

Street Address Line 2

CityState

Zip Code
Start Employed Date (State Month and Year)

MonthDayYear
Date
End Employed Date (State Month and Year)

MonthDayYear
Date
Name of Supervisor
Starting Weekly Play
Ending Weekly Play
Job Title
Describe Your Work
Reason for Leaving

Employment History #4
Company Name
Company Telephone
Please enter a valid phone number.
Company Address

Street Address

Street Address Line 2

CityState

Zip Code
Start Employed Date (State Month and Year)

MonthDayYear
Date
End Employed Date (State Month and Year)

MonthDayYear
Date
Name of Supervisor
Starting Weekly Play
Ending Weekly Play
Job Title
Describe Your Work
Reason for Leaving

Employment History #5
Company Name
Company Telephone
Please enter a valid phone number.
Company Address

Street Address

Street Address Line 2

CityState

Zip Code
Start Employed Date (State Month and Year)

MonthDayYear
Date
End Employed Date (State Month and Year)

MonthDayYear
Date
Name of Supervisor
Starting Weekly Play
Ending Weekly Play
Job Title
Describe Your Work
Reason for Leaving

Do Not Contact List
DO NOT CONTACT List

We may contact the employers listed above unless you indicate those you do not want us to contact.
Employer Number(s)
Reason(s)

Military

Complete this section if you have served in the U.S. Armed Forces

Military Form Fields
Branch of Service
Describe Your Duties and any special training
Start Period of Active Duty (Month and Year)

MonthDayYear
Date
End Period of Active Duty (Month and Year)

MonthDayYear
Date
Rank at Discharge
Type of Final Discharge
COPY OF DD214
Have you ever been bonded?

YesNo
If Yes, with what company or employer?
Have you ever been convicted of a crime (juvenile, felony, misdemeanor) excluding minor traffic offenses, which has not been annulled, expunged or sealed by a court?

YesNo
If Yes, describe in full including City, State, Year, and Charge.
Do you have any criminal charges (felony, misdemeanor, traffic) currently pending against you?

YesNo
If Yes, describe in full including City, State, Year, and Charge.
State names of relatives and friends working for the Washington Parish Sheriff's Office.

References

Include only individuals familiar with your work ability. Do Not Include Relatives.
Name #1
Years Known/Relationship #1
Address/Phone #1
Name #2
Years Known/Relationship #2
Address/Phone #2
Name #3
Years Known/Relationship #3
Address/Phone #3
Certification and Release
I certify that the answers given by me to each and every one of the foregoing questions are complete and true tothe best of my knowledge and belief. I understand that any false information, omissions or misrepresentations offacts in this application may result in rejection of my application or, if I am eventually selected for employment,subject me to immediate discharge. I authorize the Washington Parish Sheriff’s Office, including consumerreporting bureaus, to conduct a background investigation and verify any of this information. I authorize allformer employers, neighbors, co-workers, associates, family members, friends, schools, companies and lawenforcement authorities to release any information concerning my background. I hereby release any such person,schools, companies and law enforcement authorities from any liability for any damage whatsoever for complyingwith requests for information in connection with this employment application. I also understand that the use ofillegal drugs is prohibited during employment with the Washington Parish Sheriff’s Office. In connection withthis application, I am willing to submit to drug testing to detect the use of illegal drugs, alcohol and submit to apolygraph test. If I am selected for employment, I am willing to submit to drug testing to detect the use of illegaldrugs and alcohol at anytime during my employment.
Credit and Background Investigation Acknowledgement
I understand and acknowledge that in connection with my application for employment, a thorough background investigation will be conductedby the Washington Parish Sheriff’s Office. In connection with this investigation, I understand and consent to, the Sheriff’s Office, obtaining acredit report concerning me.

I understand that, consistent with requirements of the position for which I am applying, as determined by Washington Parish Sheriff’s Office,the investigation into my background may entail inquiries involving public and private sources, including a consumer report. I understandthat this investigation and these reports may include, but not limited to, information such as my financial history and obligations, mycharacter, education, criminal and civil history, driving history, property ownership, work habits, job performance and experience, along withreasons 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 prospectiveemployer 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*

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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 providepersonal identifying information and extensive personal history data. The Sheriff’s Office does not require you to disclose personal identifyinginformation or personal history data at this time: however, you may voluntarily elect to provide some additional information at this time. Thiswill permit the Washington Parish Sheriff’s Office to expedite its inquiry into criminal and civil records, which can be time consuming anddelay processing of your application. Disclosure of the below listed information is not compelled at this time and your application foremployment 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 civilrecord checks. These records checks are used for the purpose of determining your eligibility for employment in security and safety sensitivepositions with the Washington Parish Sheriff’s Office. This information will be maintained in strict confidence, in a secure manner, and willnot be used for any other purpose.
Please list all other name(s) you have used*

First NameMiddle NameLast NameMaiden
Place of Birth*
Previous Residence. List City/State where you have resided. List your most current residence first and work backwards.
When did you move to your current address?*

MonthDayYear
Date
City (List Any Previous Residence)
State (List Any Previous Residence)
From (Previous Residence State Month and Year)

MonthDayYear
Date
To (Previous Residence State Month and Year)

MonthDayYear
Date
Race (this data is collected for ID purposes only and is not disclosed or used for any other purpose)*

AsianBlackHispanicWhiteOther
You may provide information or an explanation concerning any matter that you feel the investigator should know prior to conducting a background investigation on you.
I acknowledge that I have provided the above personal identifying information on a voluntary basis at this time.*

I understand
Voluntary Disclosure Signature*

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Today's Date*

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Date
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Application for Employment

Instructions:

Education

Employment History

DO NOT CONTACT List

Military

References

Certification and Release

Credit and Background Investigation Acknowledgement

Voluntary Disclosure of Personal Identifying Information

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