Lincoln County Sheriff's Department - Correctional Officer

The Sheriffs Office is an Equal Employment Opportunity Employer. We consider applicants for all positions without regard to race, color, national origin, sex, age, disability, marital status, religion or any other legally protected status.

NOTICE: The following additional documents must be attached to this application
1. A copy of birth certificate
2. A copy of high school diploma or approved G.E.D.
3. A copy of military discharge(s)

All questions must be answered. Applications which are not complete will not be considered.

I understand that the submission of this application for sponsorship to a law enforcement academy does not constitute an appllcation for employment or appointment with the sponsor-law enforcement agency. Moreover, I understand this law enforcement agency is under no obligation to sponsor me as a candidale for any law enforcement training program.

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Please upload your resume in PDF or Word format.

Background Information

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Place of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Are you a United States Citizen? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Marital Staus {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you have or have you ever applied for a passport? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Education/Training

School {binding ItemNumber}

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Type of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Location of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Speak any foreign languages? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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List all employment including summer & part time. Account for all unemployment periods.

Employment History

Employer {binding ItemNumber}
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Supervisor Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been dismissed or asked to resign from any employment or position you have held? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you had any disciplinary action taken against you from any employment or position you have held? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you resigned, or left a job by mutual agreement following allegations of misconduct or unsatisfactory job performance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever applied to or performed paid or unpaid services for a law enforcement agency not listed as an employer? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you own a business, or are you a partner or corporate officer in any business or organization not previously listed as a current or former employer? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Residences

Actual Places of Residence for the past 10 years. list in chronological order. Include all residences while at school and in military. For college campus residences, give dormitory name, city, and state. If residences in military service cannot be shown as street address, indicate complete military unit designation and location by city and state. If post office box, give location of post office.

Residence {binding ItemNumber}

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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Arrest History/Court Data

Have you been arrested, charged or received a notice or summons to appear, convicted, pled nolo contendere or pled guilty to any criminal violation, regardless if the record was sealed or expunged? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever received a ticket or been charged with a traffic violation (exclude parking tickets)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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To your knowledge, has any member of your immediate family ever been arrested for other than traffic violations? Include juvenile records and records of arrest(s) which have been sealed, if any. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you or your spouse ever been a plaintiff or defendant in a court action? (lnclude any liens, lawsuits, bankruptcy, domestic violence injunctions, etc.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been detained by any law enforcement officer for investigative purposes or to your knowledge have you ever been the subject of or a suspect in any criminal investigation? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been flngerprinted for any reason (arrest, job application, military, etc.)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Driving History

Are you a licensed Tennessee automobile operator or chauffeur? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you hold or have you ever held an operator or chauffeur license in another state? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been denied issuance of a license or have you ever had a license suspended or revoked? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever had automobile insurance refused, withdrawn, or revoked? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Military History

Are you registered for Selective Service? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever served on active duty in the Armed Forces ofthe United States? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Are you now or have you ever been a member of a reserve unit or the National Guard? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Was any type of disciplinary action taken against you in the service? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever served In the Armed Forces of a foreign country? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Organization Membership

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Are you now or have you ever been a member of any foreign or domestic organization, association, movement, group or combination of persons which has adopted, or shows a policy of advocating or approving the commission of acts of force or violence to deny other persons their rights under the constitution of the United States, or which seeks to alter the form of government of the United States by unconstitutional means? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever made a financial or other material contribution to any organization of the type described in the question above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you answered yes to the two previous questions please answer the next two questions.

At the time of your membership, participation, or contribution, did you know of any unlawful aims of the organization? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Did you intend to promote any unlawful aims of the organization? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Personal References: Give three references (not relatives, former or present employers, fellow employees, or school teachers) who are responsible adults of reputable standing in their communitites, such as proprety owners, business or professional men or women who have know you well for the past five  (5) years. lf retired, give former occupation.

References

Reference {binding ItemNumber}

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Employee History

THE INFORMATION CONTAINED HEREIN MAY BE CONFIDENTIAL AND NOT AVAILABLE FOR PUBLIC INSPECTION.

 

Applicant's Current Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Spouse's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Spouse's Address (If Different) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Former Spouse's Name and Address (If Any) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Former Spouse's Name and Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Are you now able to participate in defensive tactics, firealms or physical training, operation of a motor vehicle, or otherwise perform the duties set forth in the job description or task analysis related-to tie positon for which you applied? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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This position may require a physical agility test, if such a test or examinataon is required, would you be able to take this test or examination? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please provide name and address of next of kin or other person to be contacted in case of an emergency: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please provide the name and address of your personal or family physician to be contacted in case of an emergency: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Drug History

The information contained herein MAY BE a confidential medical record under the Americans with Disabilities Act if the applicant is a rehabilitated drug or alcohol abuser or under section 119.071(4()b) whether the medical information, if disclosed, would identify the applicant.

Do you currently use any narcotic or controlled substance, such as cannabinoids, PCP, hallucinogen; methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturate, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature, or have you used such a narcotic or controlled substance within the last year? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever illegally experimented with or used any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogen; methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you now or have you ever illegally obtained, possessed, supplied, or sold any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogen; methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you now or have you within the last year. abused or illegally obtained, possessed or sold any prescription drug? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you claim to be a rehabilitated alcohol, narcotics or drug user of any of the controlled substances as set forth above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I understand that the "Applicants Certification" applies in all respects to the responses provided in this "Confidential Employee History" and "Drug History."

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Lincoln County Sheriff's Department - Correctional Officer

NOTICE: The following additional documents must be attached to this application
1. A copy of birth certificate
2. A copy of high school diploma or approved G.E.D.
3. A copy of military discharge(s)

All questions must be answered. Applications which are not complete will not be considered.

I understand that the submission of this application for sponsorship to a law enforcement academy does not constitute an appllcation for employment or appointment with the sponsor-law enforcement agency. Moreover, I understand this law enforcement agency is under no obligation to sponsor me as a candidale for any law enforcement training program.

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Other: List all other names you have used including circumstances and time periods you used them. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Resume {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Background Information

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Place of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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County of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Country of Birth (if not United States) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Are you a United States Citizen? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Height {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Weight {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If naturalized, please provide date, place and number. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Marital Staus {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you have or have you ever applied for a passport? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Passport Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Education/Training

School {binding ItemNumber}

Name of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Type of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Location of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Degree Received {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Major {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Number of Years Completed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Describe any awards, honors, citations, positions held in school organizations, and any other special recognition you received while attending school: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Speak any foreign languages? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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List the languages you speak, read or write. Indicate if you are fluent, good or fair. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Indicate any law enforcement education/training {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Describe any special abilities, interests, and hobbies includang the degree of proficiency: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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lndicate any special skills you possess and equipment you can use which may be related to law enforcement work. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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List all employment including summer & part time. Account for all unemployment periods.

Employment History

Employer {binding ItemNumber}
Name of Employer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date Worked From {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date Worked To {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Title or Position {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Supervisor Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Reason for leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been dismissed or asked to resign from any employment or position you have held? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you had any disciplinary action taken against you from any employment or position you have held? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you resigned, or left a job by mutual agreement following allegations of misconduct or unsatisfactory job performance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you answered YES to any of the three questions above, please provide details. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever applied to or performed paid or unpaid services for a law enforcement agency not listed as an employer? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If yes, please provide name of agency and date of application or service. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you own a business, or are you a partner or corporate officer in any business or organization not previously listed as a current or former employer? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If yes, please provide name & address of business, corporation or organization & describe your relationship/position. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Residences

Residence {binding ItemNumber}

Date From {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date To {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Arrest History/Court Data

Have you been arrested, charged or received a notice or summons to appear, convicted, pled nolo contendere or pled guilty to any criminal violation, regardless if the record was sealed or expunged? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever received a ticket or been charged with a traffic violation (exclude parking tickets)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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To your knowledge, has any member of your immediate family ever been arrested for other than traffic violations? Include juvenile records and records of arrest(s) which have been sealed, if any. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Provide details for each response for the three questions above: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you or your spouse ever been a plaintiff or defendant in a court action? (lnclude any liens, lawsuits, bankruptcy, domestic violence injunctions, etc.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you answered yes, give date, place orcourt, case number, names of involved parties, nature of action, and final disposition. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been detained by any law enforcement officer for investigative purposes or to your knowledge have you ever been the subject of or a suspect in any criminal investigation? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been flngerprinted for any reason (arrest, job application, military, etc.)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you answered YES to the two previous questions, please provide details. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Driving History

Are you a licensed Tennessee automobile operator or chauffeur? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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License No. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Expiration Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Restrictions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you hold or have you ever held an operator or chauffeur license in another state? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If yes, please provide state(s), name used, and approximate dates license(s) was/were held {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been denied issuance of a license or have you ever had a license suspended or revoked? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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lf yes, please provide complete details lncluding why license was revoked. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever had automobile insurance refused, withdrawn, or revoked? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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lf yes, please provide complete details. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Military History

Are you registered for Selective Service? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If yes, your Selective Service Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Classification {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Classifacation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever served on active duty in the Armed Forces ofthe United States? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Branch of Service {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Highest Rank {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Serial Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Duty Dates - Please list the date from and the date to: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date and type of discharge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Are you now or have you ever been a member of a reserve unit or the National Guard? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
lf yes state the branch of service, name and location of your unit and whether you attend drills, meetings, or camps: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Was any type of disciplinary action taken against you in the service? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If YES, please provide date, place, nature of offense and action taken: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever served In the Armed Forces of a foreign country? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If yes, please spcify countries and dates {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Organization Membership

List all clubs, societies of which you are a former or present member. Include name, city, state, and position held & describe activity. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Are you now or have you ever been a member of any foreign or domestic organization, association, movement, group or combination of persons which has adopted, or shows a policy of advocating or approving the commission of acts of force or violence to deny other persons their rights under the constitution of the United States, or which seeks to alter the form of government of the United States by unconstitutional means? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever made a financial or other material contribution to any organization of the type described in the question above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

If you answered yes to the two previous questions please answer the next two questions.

At the time of your membership, participation, or contribution, did you know of any unlawful aims of the organization? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Did you intend to promote any unlawful aims of the organization? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If you answered YES to any question in this section, please explain including name of organization and location. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Personal References: Give three references (not relatives, former or present employers, fellow employees, or school teachers) who are responsible adults of reputable standing in their communitites, such as proprety owners, business or professional men or women who have know you well for the past five  (5) years. lf retired, give former occupation.

References

Reference {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Company {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Employee History

THE INFORMATION CONTAINED HEREIN MAY BE CONFIDENTIAL AND NOT AVAILABLE FOR PUBLIC INSPECTION.

 

Applicant's Current Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Applicants Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Spouse's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Spouse's Address (If Different) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Former Spouse's Name and Address (If Any) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Former Spouse's Name and Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are you now able to participate in defensive tactics, firealms or physical training, operation of a motor vehicle, or otherwise perform the duties set forth in the job description or task analysis related-to tie positon for which you applied? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
This position may require a physical agility test, if such a test or examinataon is required, would you be able to take this test or examination? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide name and address of next of kin or other person to be contacted in case of an emergency: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide the name and address of your personal or family physician to be contacted in case of an emergency: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Drug History

The information contained herein MAY BE a confidential medical record under the Americans with Disabilities Act if the applicant is a rehabilitated drug or alcohol abuser or under section 119.071(4()b) whether the medical information, if disclosed, would identify the applicant.

Do you currently use any narcotic or controlled substance, such as cannabinoids, PCP, hallucinogen; methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturate, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature, or have you used such a narcotic or controlled substance within the last year? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you ever illegally experimented with or used any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogen; methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If yes, please complete the following: (Drug taken, how long, last time experimented with or used) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you now or have you ever illegally obtained, possessed, supplied, or sold any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogen; methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
lf yes, please complete the following: (Drug, circumstances, number of times illegally obtained/possesed/supplied/sold, and first and last time illegally obtained/possesed/supplied/sold) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you now or have you within the last year. abused or illegally obtained, possessed or sold any prescription drug? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
lf yes, provide details, including drug, date, and circumstances {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you claim to be a rehabilitated alcohol, narcotics or drug user of any of the controlled substances as set forth above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
lf yes, provide details. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

I understand that the "Applicants Certification" applies in all respects to the responses provided in this "Confidential Employee History" and "Drug History."

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Lincoln County Sheriff's Department - Correctional Officer

The Sheriffs Office is an Equal Employment Opportunity Employer. We consider applicants for all positions without regard to race, color, national origin, sex, age, disability, marital status, religion or any other legally protected status.

NOTICE: The following additional documents must be attached to this application
1. A copy of birth certificate
2. A copy of high school diploma or approved G.E.D.
3. A copy of military discharge(s)

All questions must be answered. Applications which are not complete will not be considered.

I understand that the submission of this application for sponsorship to a law enforcement academy does not constitute an appllcation for employment or appointment with the sponsor-law enforcement agency. Moreover, I understand this law enforcement agency is under no obligation to sponsor me as a candidale for any law enforcement training program.

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other: List all other names you have used including circumstances and time periods you used them. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Resume {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}

{ binding firstError.message }

Background Information

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Place of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
County of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Country of Birth (if not United States) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are you a United States Citizen? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Height {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Weight {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If naturalized, please provide date, place and number. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Marital Staus {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you have or have you ever applied for a passport? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Passport Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Education/Training

School {binding ItemNumber}

Name of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Type of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Location of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Degree Received {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Major {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Number of Years Completed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Describe any awards, honors, citations, positions held in school organizations, and any other special recognition you received while attending school: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Speak any foreign languages? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
List the languages you speak, read or write. Indicate if you are fluent, good or fair. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Indicate any law enforcement education/training {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Describe any special abilities, interests, and hobbies includang the degree of proficiency: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
lndicate any special skills you possess and equipment you can use which may be related to law enforcement work. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

List all employment including summer & part time. Account for all unemployment periods.

Employment History

Employer {binding ItemNumber}
Name of Employer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date Worked From {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date Worked To {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Title or Position {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Supervisor Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Reason for leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Have you ever been dismissed or asked to resign from any employment or position you have held? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you had any disciplinary action taken against you from any employment or position you have held? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you resigned, or left a job by mutual agreement following allegations of misconduct or unsatisfactory job performance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If you answered YES to any of the three questions above, please provide details. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever applied to or performed paid or unpaid services for a law enforcement agency not listed as an employer? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If yes, please provide name of agency and date of application or service. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Do you own a business, or are you a partner or corporate officer in any business or organization not previously listed as a current or former employer? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If yes, please provide name & address of business, corporation or organization & describe your relationship/position. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Residences

Residence {binding ItemNumber}

Date From {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date To {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Arrest History/Court Data

Have you been arrested, charged or received a notice or summons to appear, convicted, pled nolo contendere or pled guilty to any criminal violation, regardless if the record was sealed or expunged? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever received a ticket or been charged with a traffic violation (exclude parking tickets)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
To your knowledge, has any member of your immediate family ever been arrested for other than traffic violations? Include juvenile records and records of arrest(s) which have been sealed, if any. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Provide details for each response for the three questions above: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you or your spouse ever been a plaintiff or defendant in a court action? (lnclude any liens, lawsuits, bankruptcy, domestic violence injunctions, etc.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If you answered yes, give date, place orcourt, case number, names of involved parties, nature of action, and final disposition. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you ever been detained by any law enforcement officer for investigative purposes or to your knowledge have you ever been the subject of or a suspect in any criminal investigation? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever been flngerprinted for any reason (arrest, job application, military, etc.)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If you answered YES to the two previous questions, please provide details. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Driving History

Are you a licensed Tennessee automobile operator or chauffeur? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
License No. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Expiration Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Restrictions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Do you hold or have you ever held an operator or chauffeur license in another state? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If yes, please provide state(s), name used, and approximate dates license(s) was/were held {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you ever been denied issuance of a license or have you ever had a license suspended or revoked? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
lf yes, please provide complete details lncluding why license was revoked. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you ever had automobile insurance refused, withdrawn, or revoked? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
lf yes, please provide complete details. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Military History

Are you registered for Selective Service? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If yes, your Selective Service Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Classification {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Classifacation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you ever served on active duty in the Armed Forces ofthe United States? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Branch of Service {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Highest Rank {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Serial Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Duty Dates - Please list the date from and the date to: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date and type of discharge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are you now or have you ever been a member of a reserve unit or the National Guard? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
lf yes state the branch of service, name and location of your unit and whether you attend drills, meetings, or camps: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Was any type of disciplinary action taken against you in the service? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If YES, please provide date, place, nature of offense and action taken: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever served In the Armed Forces of a foreign country? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If yes, please spcify countries and dates {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Organization Membership

List all clubs, societies of which you are a former or present member. Include name, city, state, and position held & describe activity. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Are you now or have you ever been a member of any foreign or domestic organization, association, movement, group or combination of persons which has adopted, or shows a policy of advocating or approving the commission of acts of force or violence to deny other persons their rights under the constitution of the United States, or which seeks to alter the form of government of the United States by unconstitutional means? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever made a financial or other material contribution to any organization of the type described in the question above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

If you answered yes to the two previous questions please answer the next two questions.

At the time of your membership, participation, or contribution, did you know of any unlawful aims of the organization? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Did you intend to promote any unlawful aims of the organization? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
If you answered YES to any question in this section, please explain including name of organization and location. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Personal References: Give three references (not relatives, former or present employers, fellow employees, or school teachers) who are responsible adults of reputable standing in their communitites, such as proprety owners, business or professional men or women who have know you well for the past five  (5) years. lf retired, give former occupation.

References

Reference {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Company {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Employee History

THE INFORMATION CONTAINED HEREIN MAY BE CONFIDENTIAL AND NOT AVAILABLE FOR PUBLIC INSPECTION.

 

Applicant's Current Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Applicants Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Spouse's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Spouse's Address (If Different) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Former Spouse's Name and Address (If Any) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Former Spouse's Name and Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Are you now able to participate in defensive tactics, firealms or physical training, operation of a motor vehicle, or otherwise perform the duties set forth in the job description or task analysis related-to tie positon for which you applied? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
This position may require a physical agility test, if such a test or examinataon is required, would you be able to take this test or examination? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide name and address of next of kin or other person to be contacted in case of an emergency: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide the name and address of your personal or family physician to be contacted in case of an emergency: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Drug History

The information contained herein MAY BE a confidential medical record under the Americans with Disabilities Act if the applicant is a rehabilitated drug or alcohol abuser or under section 119.071(4()b) whether the medical information, if disclosed, would identify the applicant.

Do you currently use any narcotic or controlled substance, such as cannabinoids, PCP, hallucinogen; methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturate, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature, or have you used such a narcotic or controlled substance within the last year? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you ever illegally experimented with or used any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogen; methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If yes, please complete the following: (Drug taken, how long, last time experimented with or used) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you now or have you ever illegally obtained, possessed, supplied, or sold any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogen; methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
lf yes, please complete the following: (Drug, circumstances, number of times illegally obtained/possesed/supplied/sold, and first and last time illegally obtained/possesed/supplied/sold) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you now or have you within the last year. abused or illegally obtained, possessed or sold any prescription drug? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
lf yes, provide details, including drug, date, and circumstances {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you claim to be a rehabilitated alcohol, narcotics or drug user of any of the controlled substances as set forth above? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
lf yes, provide details. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

I understand that the "Applicants Certification" applies in all respects to the responses provided in this "Confidential Employee History" and "Drug History."

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }