Piscataquis County Sheriff's Office Employment Application Step 1 of 4 25% We consider applicants for all positions without regard to ethnicity, age, marital status, gender, or physical/mental disability. We offer reasonable accommodations to qualified disabled persons. Incomplete applications will not be processedPosition(s) applied for Date MM slash DD slash YYYY Name(Required) First Middle Last Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone(Required)Cell PhoneEmail Date of Birth(Required) Month Day Year Place of birth(Required) Are you employed now?(Required) Yes No May we contact your current employer?(Required) Yes No Are you a veteran of the US Military?(Required) Yes No If YES which branch? Years of service Please attach a copy of DD214Max. file size: 256 MB.List professional, trade, business/civic activities and offices held. You may exclude memberships which reveal gender, ethnicity, religion, age, disability, or protected status.Are you mentally and physically able to perform all of the duties of the position for which you are applying with or without reasonable accommodations?(Required) Yes No If NO, please explain. Have you ever had a civil judgement entered against you for fraud, or for converting or misappropriating the property of another?(Required) Yes No Have you ever been denied unemployment benefits due to misconduct?(Required) Yes No If YES, why? Do you have any relatives (by blood or marriage)employed here?(Required) Yes No If YES, who? Employment ExperienceStart with your present or last job and LIST ALL EMPLOYERS DURING THE PAST TEN YEARS. Do not omit any employer of requested information within this timeframe. If you have additional employers, please attach a separate file. Employer Employer PhoneAddress Dates Employed Hourly rate/salary Supervisor's name Job title Work performed Reason for leaving May we contact employer? Yes No Employer Employer PhoneAddress Dates Employed Hourly rate/salary Supervisor's name Job title Work performed Reason for leaving May we contact employer? Yes No Employer Employer PhoneAddress Dates Employed Hourly rate/salary Supervisor's name Job title Work performed Reason for leaving May we contact employer? Yes No Upload file with additional employers from the last 10 years if needed.Max. file size: 256 MB.Other special skills and qualifications. Summarize skills and qualifications acquired from employers or other experiences. Make sure to include any certifications pertinent to the job for which you are applying.ReferencesName(Required) Address(Required) Contact number(s)(Required) Relationship(Required) Name(Required) Address(Required) Contact number(s)(Required) Relationship(Required) Name(Required) Address(Required) Contact number(s)(Required) Relationship(Required) EducationHigh School(Required) Address(Required) Highest Grade Completed(Required) Date of Graduation MM slash DD slash YYYY Date and location of GED College/University Address Highest grade completed Field of study Degree (AS/BS) Graduate School Address Highest grade completed Field of study Degree Have you completed Law Enforcement Pre-Service at MCJA?(Required) Yes No If YES, date? Have you completed A&B and C Correctional training?(Required) Yes No If YES, date? Name of institution where completed Have you ever been convicted of any crime?(Required) Yes No Have you been convicted or adjudicated of any juvenile offense or crime?(Required) Yes No If YES to either question above, please explain:In order to process your application for a position we need to conduct a background check which includes the following: Motor Vehicle records Law enforcement records Maine State Bureau of Identification Federal Bureau of Investigation Any criminal conviction and/or juvenile adjudication may disqualify you from consideration for employment. This includes motor vehicle violations that constitute crimes including OUI / DWI / OAS committed as adult and/or a juvenile. Failure to disclose any of the above may be cause for disqualification and/or termination.Signature(Required)
