Employment Application | Floyd County Sheriff

1General Information

All fields are required. You must provide your three last employers and three professional references. If a question does not apply to you, type N/A.

Applying for the Position of: *

Police Officer Corrections Officer Communications Officer Jail Cook

Please select the position you are applying for.

Date Submitted *

Referral

Were you referred by a current employee? *

Yes No

Name of the employee who referred you *

Name *

Email *

Phone *

Address *

Social Security Number *

Date of Birth *

State ID or Drivers License # *

State of which the ID is issued? *

2Background Information

Are you able to perform the full job functions of the applied positions without reasonable accommodations? (Sitting, Standing, Physical Activity, etc.) *

Yes No

Are you a United States Citizen? *

Yes No

Have you worked for this department previously or are you related to anyone that currently works at the Floyd County Sheriff's Department? *

Yes No

Do you have a valid Drivers License? *

Yes No

Have you ever been arrested, charged or convicted of any criminal act? (Misdemeanor or Felony?) *

Yes No

Please explain your arrest history: *

Be sure to list dates, times, location of arrest, and charges in detail.

Are you currently a certified police officer? *

Yes No

3Education & Training

If you did not attend college, type N/A in the College fields.

High School *

Years Attended: *

Address *

Did you Graduate? *

Yes No

Degree Type *

College *

Years Attended: *

Address *

Did you Graduate? *

Yes No

Degree Type *

Additional Education & Training: *

Type N/A if none.

4Employment

Please list your last three places of employment starting with the most recent.

Employer # 1

Employer / Company *

Phone *

Start Date *

End Date

Leave blank if still working at this job

Employer Address *

Job Title *

Salary (Annual or Hourly) *

Job Responsibilities *

May we contact this employer for reference? *

Yes No

Employer # 2

Employer / Company *

Phone *

Start Date *

End Date

Leave blank if still working at this job

Employer Address *

Job Title *

Salary (Annual or Hourly) *

Job Responsibilities *

May we contact this employer for reference? *

Yes No

Employer # 3

Employer / Company *

Phone *

Start Date *

End Date

Leave blank if still working at this job

Employer Address *

Job Title *

Salary (Annual or Hourly) *

Job Responsibilities *

May we contact this employer for reference? *

Yes No

5Military

Branch of Service *

Rank or Rank at Discharge *

Type of Discharge *

Are you still an active member or reservist? *

Yes No

Describe your assigned Military Occupational Speciality (M.O.S.)? *

Service Start Date? *

Ending Date of Service?

Leave blank if you are currently serving.

6References

Please list three professional references.

Professional Reference # 1

Name *

Relationship *

Phone *

Address *

Professional Reference # 2

Name *

Relationship *

Phone *

Address *

Professional Reference # 3

Name *

Relationship *

Phone *

Address *

7Release & Signature

I hereby certify that the information that I have provided is accurate and complete to the best of my knowledge. I also authorize the use of my identifying information such as name, date of birth, and social security number to be used to complete a full background investigation. Furthermore I give authorization to 3rd parties to release privileged information concerning my credit report, education record, medical record, employment record, military record, and any other such information pertaining to my background to the Floyd County Sheriff's Department. This information will not be made available to the public. The social security number provided is being released on a voluntary basis with the understanding that such is not required by Federal Law or regulation.

Yes, I have read and understand the release above and also agree to that by submitting this form agree to this statement *

Yes No

Digital Signature *

Type FULL NAME

Date of Release *