Application for Employment

WAYNE COUNTY SHERIFF’S OFFICE

 

Wayne County Sheriff’s Office is an equal opportunity educational institution and EEO/Affirmative Action Employer committed to excellence through diversity. Employment are made on the basis of qualifications and without regards to race, sex, religion, national or ethnic origin, disability, age, veteran status or sexual orientation.

PLEASE TYPE OR PRINT: Complete the entire application. You may attach a resume, but you must still complete the questions; or your application will be deemed incomplete and may not be considered. Please fill out each box (don’t just indicate “See Resume.”) Applications with missing or invalid job numbers will not be considered for any position. Please email this application and attached resume to This email address is being protected from spambots. You need JavaScript enabled to view it. or bring it in to the Sheriff's Office.

 

Position Applying For:

 

 

Name: (Last, First, Middle)

Date Applied:

Street Address:

City, State, Zip:

Other names in which you have attended school or been employed:

Social Security Number:

Home Phone:

Work Phone:

Other Phone:

Have you ever been arrested or convicted of any crimes?

____ Yes  ____ No

 

If yes explain:

Are you 21 years of age or older?

____ Yes  ____ No

If NO, what is your current age?

Are you currently employed?

____ Yes  ____ No

If YES, what is your current job?

Have you ever been employed by the Wayne Co. Sheriff’s Office?

____ Yes  ____ No

If YES, dates of employment and reason for leaving:

Are you related to any current company employee?

____ Yes  ____ No

If YES, their name and relationship to you:

If required for position, do you have a valid driver’s license?

____ Yes  ____ No

If YES, State of Issuance, license number and expiration date:

How did you learn about this employment opportunity? Check all that apply: ____ Ad in newspaper, ___ Job Bulletin (Posting), ____ Walk-in, ____ Website, ____ Dept. of Labor, ____ Ad in magazine,  ___ Employee Referral, ____ Other:

                 

 

EDUCATION

 

 

Name of School

 

City / State

 

Did you graduate?

If NO, # of years left to graduation

 

If YES, date of graduation

 

Degree received

 

Major

High School:

 

____ Yes  ____ No

 

 

 

 

GED:

 

____ Yes  ____ No

 

 

 

 

Other School:

 

____ Yes  ____ No

 

 

 

 

College:

 

____ Yes  ____ No

 

 

 

 

College:

 

____ Yes  ____ No

 

 

 

 

College:

 

____ Yes  ____ No

 

 

 

 

 

Describe any specialized training, apprenticeship, skills and extra-curricular activities. Describe any honors you have received. State any additional information you feel may be helpful to us in considering your application. _______________________________________________________________________

 

SKILLS: Please list all skills, clerical skills, trade skills, ect., relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency. (Basic, Intermediate, Expert) _____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

 

WORK EXPERIENCE: Please detail your entire work history. Begin with your current or most recent employer. If you help multiple positions with the same organization, detail each position separately. (Attach additional sheets in necessary.) Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. PLEASE DO NOT complete this information with the notation “See Resume.”

 

PLEASE NOTE: Wayne County Sheriff’s Office reserves the right to contact all current and former employers for reference information.

 

Date Employed: (current or most recent position)

From:                   To:

 

____ Full-time    ____ Part-time

 

If part-time, # hrs./wk. ____

Title:

Starting Salary:

 

Final Salary:

Organization Name and Address and Phone#:

Supervisor’s Name, Title and Phone #

Other Reference Name, Title and Phone #

Contact my current references:

____ At any time

____ Only if I’m a finalist candidate

Primary Duties:

Reason for leaving:

Date Employed: (most recent position)

From:                   To:

 

____ Full-time    ____ Part-time

 

If part-time, # hrs./wk. ____

Title:

Starting Salary:

 

Final Salary:

Organization Name and Address and Phone#:

Supervisor’s Name, Title and Phone #

Other Reference Name, Title and Phone #

Contact my current references:

____ At any time

____ Only if I’m a finalist candidate

Primary Duties:

Reason for leaving:

Date Employed: (most recent position)

From:                   To:

 

____ Full-time    ____ Part-time

 

If part-time, # hrs./wk. ____

Title:

Starting Salary:

 

Final Salary:

Organization Name and Address and Phone#:

Supervisor’s Name, Title and Phone #

Other Reference Name, Title and Phone #

Contact my current references:

____ At any time

____ Only if I’m a finalist candidate

Primary Duties:

Reason for leaving:

           

 

REFERENCES

Give name, address and telephone number of three references who are not related to you and are not previous employers.

 

  1. Name: _______________ Address: ___________________________ Phone: ________________

  2. Name: _______________ Address: ___________________________ Phone: ________________

  3. Name: _______________ Address: ___________________________ Phone: ________________

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.

I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete this form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later time. I authorize the Wayne County Sheriff’s Office to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquires in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that the staff of the Wayne County Sheriff’s Office serve at-will, and the employment relationship may be terminated at any time by either party, for any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, to file a security questioner and a state loyalty oath, and to comply company and departmental regulations. I understand that if employed on a temporary basis, I will be paid for hours worked only, and would be ineligible for benefits including paid time off. If employed on a regular, benefits-eligible  basis, I understand that I would be able to make mandatory contributions to the Wayne County Sheriff’s Office Retirement System or to an optional retirement program, if applicable. I understand that any benefits I receive may be subject to change or discontinue at any time without prior notice. I understand that the first SIX MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.

  

Applicant Signature: ______________________________________ Date: _________________________

 

FOR PERSONNEL DEPARTMENT USE ONLY

 

Arrange Interview:                                        _____ Yes _____ No

REMARKS: ____________________________________________________________________________ _____________________________________________________________________________________     _____________________________________________________________________________________   _____________________________________________________________________________________  

Employed: _____________________                 Date of Employment: _____________________________

Job Title: _______________________                 Hourly Rate / Salary: _____________________________

Name and Title: _____________________________________________________ Date: _____________