DeKalb County Sheriff’s Office Employment Application Name * First Name Last Name Date of Birth * MM DD YYYY Social Security Number * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Alternate Phone (###) ### #### Email * Referred By: * Former Names EMPLOYMENT INFORMATION What position are you applying for? * Date available to begin: * MM DD YYYY Expected Wage * $ Type of employment desired: * Full-time Part-time Are you available to work overtime? * Yes No Are you eligible to work in the U.S.? * Yes No EDUCATION High School Name * City / State * Highest year completed: * 1 2 3 4 Degree earned Major / Minor College / Trade School Name City / State Highest year completed: * 1 2 3 4 Degree earned Major / Minor List current licenses/certifications that are relevant to the position for which you are applying (copies maybe requested) List any training that is relevant to the position for which you are applying List any skills and/or qualifications that are relevant to the position for which you are applying GENERAL INFORMATION Have you ever been employed by the DeKalb County Sheriff's Office? * Yes No If yes, give dates of employment From MM DD YYYY To MM DD YYYY Do you have any friends or family who are currently employed by us? * Yes No If yes, what are their names? Are you less than 18 years old? (Proof of age may be required after a job offer) * Yes No Have you ever been convicted of a felony or misdemeanor? (A conviction does not constitute an automatic bar to employment) * Yes No If yes, state crime(s), court(s), and sentence(s) Have you ever been terminated or asked to resign from employment * Yes No If yes, please explain WORK EXPERIENCE Please list your current or most recent employer first Company #1 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Position Starting Date MM DD YYYY Ending Date MM DD YYYY Supervisor's Name First Name Last Name Phone (###) ### #### Description Reason for leaving Permission to contact Yes No Starting Pay $ Ending Pay $ Company #2 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Position Starting Date MM DD YYYY Ending Date MM DD YYYY Supervisor's Name First Name Last Name Phone (###) ### #### Description Reason for leaving Permission to contact Yes No Starting Pay $ Ending Pay $ Company #3 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Position Starting Date MM DD YYYY Ending Date MM DD YYYY Supervisor's Name First Name Last Name Phone (###) ### #### Description Reason for leaving Permission to contact Yes No Starting Pay $ Ending Pay $ WORK REFERENCES Please provide three work-related references, preferably past supervisors/managers Reference #1 * First Name Last Name Title * Phone * (###) ### #### Organization * Years Known * Nature of Acquaintance * Reference #2 * First Name Last Name Title * Phone * (###) ### #### Organization * Years Known * Nature of Acquaintance * Reference #3 * First Name Last Name Title * Phone * (###) ### #### Organization * Years Known * Nature of Acquaintance * TERMS AND CONDITIONS OF APPLICATION AND EMPLOYMENT I hereby certify that the information provided on this application is true and complete. I understand and agree that any falsification or significant omissions on this application may result in not being hired or, if found out after employment, may be grounds for dismissal. I understand and agree that under the terms of employment with the DeKalb County Sheriff’s Office, the employment relationship is terminable “at will” without notice or cause, unless set out in writing, dated, and executed by both parties. I understand that neither this document nor any offer of employment from the DeKalb County Sheriff’s Office constitutes an employment contract. I understand that any offer of employment may be contingent upon my ability to comply with USCIS regulations establishing my identity and right to work in the United States. I understand that the DeKalb County Sheriff’s Office is an Equal Employment Opportunity employer. The DeKalb County Sheriff’s Office recruits and hires persons in all job titles without regard to race, sex, age, color, religion, national origin, disability, or sexual orientation. I hereby authorize the DeKalb County Sheriff’s Office to investigate fully all information contained in this employment application and to investigate and compile any other information that may bear upon my suitability for employment. I further authorize my past and present employers to furnish the DeKalb County Sheriff’s Office with my records of employment and the reasons for my separation and any and all information those employers may possess concerning me. I further release the DeKalb County Sheriff’s Office and/or its agents to make an independent investigation of criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application. I release the DeKalb County Sheriff’s Office from liability or damages for compiling such information. Additionally, I release any organization that provides information pursuant to this authorization from any and all liabilities, claims, or lawsuits in regard to the information obtained from any and all of the above-referenced sources used. Further, I understand that this application will be considered active for a period of ninety days. I have read and understand the foregoing statements and accept the same as conditions of employment. By typing my name below, I am agreeing to the above terms and conditions * First Name Last Name Thank you!
