Craig Webre, Sheriff Personnel Division/Law Enforcement Complex 1300 Lynn Street Thibodaux, Louisiana 70301

Transcription

1 DATE OF APPLCATON: Craig Webre, Sheriff Personnel Division/Law Enforcement Complex 1300 Lynn Street Thibodaux, Louisiana N GENERAL EMAL ADDRESS: For Local Calls - (985) (985) (985) (985) POSTON APPLYNG FOR: DEPUTY SHERFF COMMUNCATONS EQUPMENT OPERATOR CORRECTONS OFFCER RESERVE DEPUTY SCHOOL GUARD COOK DRVER CLERCAL / SECRETARAL OTHER (Please Specify): WTH CAN PERFORM THE ESSENTAL FUNCTONS OF THE JOB(S) FOR WHCH AM APPLYNG WTHOUT REASONABLE ACCOMMODATON(S). F REASONABLE ACCOMMODATON S NECESSARY, PLEASE SPECFY: PERSONAL NFORMATON LAST FRST MDDLE SUFFX: NCKNAMES OR OTHER NAMES HAVE USED OR AM KNOWN BY: (i.e. Maiden, Change of Name, Nicknames, Alias, etc.) HEGHT: WEGHT: DATE OF BRTH: BRTHPLACE: HAR COLOR: EYE COLOR: SEX: PHYSCAL ADDRESS (Street / City / State / Zip): MALNG ADDRESS (Street / P.O. Box / City / State / Zip): SAME AS ABOVE HOME TELEPHONE NO.: DRVER S LCENSE: STATE: NUMBER: SOCAL SECURTY NO.: AM AM NOT CAN CAN NOT A CTZEN OF THE UNTED STATES. OTHER TELEPHONE NOS.: WORK: MOBLE: OTHER: *F APPLCABLE, PLEASE SPECFY THE COUNTRY OF YOUR CTZENSHP: SUBMT VERFCATON OF MY LEGAL RGHT TO WORK N THE UNTED STATES. Name: Last First Middle

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3 AM PROFCENT N THE USE AND OPERATON OF THE FOLLOWNG COMPUTER SOFTWARE: SPEAK THE FOLLOWNG FOREGN LANGUAGES: AM PROFCENT N THE FOLLOWNG AREAS: ACCOUNTNG ARTWORK AUTOMOTVE AVATON BUSNESS MACHNES COMMUNCATONS/ELECTRONCS COMPUTER SCENCE CONSTRUCTON FREARMS DENTFCATON LEGAL MARTAL ARTS MUSC PHOTOGRAPHY OTHER(S) Please Specify: PLEASE LST ANY JOB-RELATED ORGANZATONS, CLUBS, PROFESSONAL AFFLATONS, SOCETES, OR OTHER ASSOCATONS TO WHCH YOU BELONG: MLTARY BACKGROUND AM AM NOT A VETERAN OF THE ARMY NAVY AR FORCE MARNES COAST GUARD SERVED FROM / TO / MONTH YEAR MONTH YEAR AND RECEVED AN HONORABLE DSHONORABLE OTHER DSCHARGE. F YOUR DSCHARGE WAS OTHER THAN HONORABLE, PLEASE EXPLAN: AM AM NOT A MLTARY RESERVST OF THE ARMY NAVY AR FORCE MARNES COAST GUARD WHAT EXPERENCE, SPECAL TRANNG OR EDUCATON, AND SPECAL RECOGNTON(S) DD YOU RECEVE WHLE N THE MLTARY? REFERENCES PLEASE LST THREE (3) REFERENCES OTHER THAN FAMLY MEMBERS. MALNG ADDRESS: (Street/P.O. Box/City/State/Zip) NATURE OF RELATONSHP: LENGTH OF TME KNOWN: MALNG ADDRESS: (Street/P.O. Box/City/State/Zip) NATURE OF RELATONSHP: LENGTH OF TME KNOWN: MALNG ADDRESS: (Street/P.O. Box/City/State/Zip) NATURE OF RELATONSHP: LENGTH OF TME KNOWN:

4 WORK / EMPLOYMENT HSTORY PLEASE LST POSTONS, STARTNG WTH YOUR MOST RECENT EMPLOYMENT AND ENDNG WTH YOUR FRST FULL-TME, PERMANENT EMPLOYMENT. EMPLOYER / COMPANY MALNG ADDRESS (Street / P.O. Box / City / State / Zip): PHYSCAL ADDRESS (Street / P.O. Box / City / State / Zip): KND OF BUSNESS: JOB TTLE / POSTON: SUPERVSOR: EMPLOYED FROM: TO: / / SUPERVSOR S TTLE: BEGNNNG ANNUAL SALARY: ENDNG ANNUAL SALARY: REASON FOR LEAVNG: DUTES. PLEASE LST YOUR MAJOR JOB DUTES AND APPROXMATE PERCENTAGE OF TME SPENT ON EACH DUTY. PERCENT OF TME MAJOR DUTES AWARDS / COMMENDATONS / PROMOTONS. DATE PLEASE LST ANY AWARDS, COMMENDATONS, AND/OR PROMOTONS RECEVED DURNG THS EMPLOYMENT. DESCRPTON OF AWARD / COMMENDATON / PROMOTON PLEASE LST ANY DSCPLNARY ACTON TAKEN AGANST YOU BY THS EMPLOYER, AND EXPLAN THE NATURE AND EXTENT OF THE ACTON TAKEN.

5 WORK / EMPLOYMENT HSTORY PLEASE LST POSTONS, STARTNG WTH YOUR MOST RECENT EMPLOYMENT AND ENDNG WTH YOUR FRST FULL-TME, PERMANENT EMPLOYMENT. EMPLOYER / COMPANY MALNG ADDRESS (Street / P.O. Box / City / State / Zip): PHYSCAL ADDRESS (Street / P.O. Box / City / State / Zip): KND OF BUSNESS: JOB TTLE / POSTON: SUPERVSOR: EMPLOYED FROM: TO: / / SUPERVSOR S TTLE: BEGNNNG ANNUAL SALARY: ENDNG ANNUAL SALARY: REASON FOR LEAVNG: DUTES. PLEASE LST YOUR MAJOR JOB DUTES AND APPROXMATE PERCENTAGE OF TME SPENT ON EACH DUTY. PERCENT OF TME MAJOR DUTES AWARDS / COMMENDATONS / PROMOTONS. DATE PLEASE LST ANY AWARDS, COMMENDATONS, AND/OR PROMOTONS RECEVED DURNG THS EMPLOYMENT. DESCRPTON OF AWARD / COMMENDATON / PROMOTON PLEASE LST ANY DSCPLNARY ACTON TAKEN AGANST YOU BY THS EMPLOYER, AND EXPLAN THE NATURE AND EXTENT OF THE ACTON TAKEN.

6 WORK / EMPLOYMENT HSTORY PLEASE LST POSTONS, STARTNG WTH YOUR MOST RECENT EMPLOYMENT AND ENDNG WTH YOUR FRST FULL-TME, PERMANENT EMPLOYMENT. EMPLOYER / COMPANY MALNG ADDRESS (Street / P.O. Box / City / State / Zip): PHYSCAL ADDRESS (Street / P.O. Box / City / State / Zip): KND OF BUSNESS: JOB TTLE / POSTON: SUPERVSOR: EMPLOYED FROM: TO: / / SUPERVSOR S TTLE: BEGNNNG ANNUAL SALARY: ENDNG ANNUAL SALARY: REASON FOR LEAVNG: DUTES. PLEASE LST YOUR MAJOR JOB DUTES AND APPROXMATE PERCENTAGE OF TME SPENT ON EACH DUTY. PERCENT OF TME MAJOR DUTES AWARDS / COMMENDATONS / PROMOTONS. DATE PLEASE LST ANY AWARDS, COMMENDATONS, AND/OR PROMOTONS RECEVED DURNG THS EMPLOYMENT. DESCRPTON OF AWARD / COMMENDATON / PROMOTON PLEASE LST ANY DSCPLNARY ACTON TAKEN AGANST YOU BY THS EMPLOYER, AND EXPLAN THE NATURE AND EXTENT OF THE ACTON TAKEN.

7 MSCELLANEOUS THE NFORMATON PROVDED N THS SECTON WLL NOT NECESSARLY DSQUALFY YOU FROM BENG CONSDERED FOR EMPLOYMENT WTH THE LAFOURCHE PARSH SHERFF S OFFCE. FALURE TO DSCLOSE ALL REQUESTED NFORMATON OR PROVDNG FALSE NFORMATON WLL, HOWEVER, RESULT N THE RREVERSBLE DSQUALFCATON OF YOUR APPLCATON FOR EMPLOYMENT. COMPLETE AND HONEST RESPONSES TO THE FOLLOWNG QUESTONS ARE, THEREFORE, ABSOLUTELY ESSENTAL. HAVE RECEVED A TRAFFC VOLATON(S) DURNG THE PAST THREE (3) YEARS. HAVE NOT F APPLCABLE, PLEASE LST THE VOLATONS RECEVED BELOW: VOLATON: DATE: CTY/STATE: VOLATON: DATE: CTY/STATE: VOLATON: DATE: CTY/STATE: ARRESTS. HAVE BEEN ARRESTED. HAVE NEVER F APPLCABLE, PLEASE STATE THE YEAR THE ARREST OCCURRED, THE ARRESTNG AGENCY, AND EXPLAN THE SPECFCS OF THE ARREST N THE EXPLANATON STATEMENT BELOW. (Please include any and all arrest information including charges for which you were either not prosecuted or acquitted and/or charges which have been expunged.) CONVCTONS. HAVE BEEN CONVCTED OF A CRME(S). HAVE NEVER F APPLCABLE, PLEASE STATE THE YEAR THE CONVCTON(S) OCCURRED, THE CONVCTNG JURSDCTON, THE LOCATON(S), THE DSPOSTON(S), AND EXPLAN THE SPECFCS OF THE CONVCTON(S) N THE EXPLANATON STATEMENT BELOW. (Please also include any and all information on convictions which have been expunged). DRUGS. HAVE HAVE LLEGALLY USED DRUGS N THE LAST THREE (3) YEARS; AND SOLD OR DSTRBUTED LLEGAL DRUGS. HAVE NOT HAVE NEVER F YOU HAVE ETHER LLEGALLY USED DRUGS N THE LAST THREE (3) YEARS AND/OR SOLD OR DSTRBUTED LLEGAL DRUGS, PLEASE EXPLAN N THE EXPLANATON STATEMENT BELOW. ALCOHOL. WOULD CHARACTERZE MY ALCOHOL CONSUMPTON AS FOLLOWS: DO NOT DRNK ALCOHOL OCCASONAL DRNKER SOCAL DRNKER OTHER F YOU CHECKED OTHER, PLEASE EXPLAN N THE EXPLANATON STATEMENT BELOW. STRESS. CAN ADEQUATELY FUNCTON N HGH STRESS STUATONS. CAN NOT F YOU CHECKED CAN NOT, PLEASE EXPLAN N THE EXPLANATON STATEMENT BELOW. EXPLANATON STATEMENT. T S AGANST OFFCE POLCY FOR NDVDUALS WHO HAVE ANY ECONOMC OR FAMLY RELATONSHPS TO SUPERVSE THE OTHER OR WORK N POSTONS WHCH HAVE AN AUDT OR CONTROL FUNCTON OVER THE OTHER. ECONOMC RELATONSHPS NCLUDE ROOMMATES, LANDLORD/TENANT, CREDTOR/DEBTOR, AND THE LKE. FAMLY RELATONSHPS NCLUDE MARRAGE, PARENTS, SBLNGS, N-LAWS, AUNTS, UNCLES, AND STEP-RELATVES. DO HAVE ANY RELATVES, ETHER FAMLY OR ECONOMC, ALREADY EMPLOYED WTH THE SHERFF S OFFCE. DO NOT F APPLCABLE, PLEASE GVE NAMES AND POSTONS HELD: POSTON: RELATONSHP: POSTON: RELATONSHP: NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF TWO (2) PERSONS TO BE NOTFED N THE CASE OF ACCDENT OR EMERGENCY. ADDRESS: RELATONSHP: ADDRESS: RELATONSHP: HOME: WORK:

8 CERTFCATON, ACKNOWLEDGMENT OF CONDTONS FOR EMPLOYMENT AND AUTHORTY TO RELEASE NFORMATON at will employment Printed: First, Middle, and Last Name Name Position Date