join us Please enable JavaScript in your browser to complete this form.Name: *FirstLastEmail: *Phone Number:SSN/DOB *I understand that my information may be used in a background into my personal history. *YesNoPosition Applying for: *Have you ever served in the Military *YesNoIn any employment or voluntary settings, including military service, have you received any verbal or written reprimands or suspensions for violations of company policy? *YesNoIf yes, Please explain.Would you have difficulty working or dealing with members of the opposite sex, different origin, race, religion, nationality or life style preferences? *YesNoWould you have difficulty following orders, even though you may not agree with them? *YesNoHave you ever left a place of employment without giving two weeks' notice? *YesNoHave the police ever been called to your home for any reason? *YesNoIf yes, please explain.Have you ever been convicted of any crime(s) including SIS(s), Diversions or alternative correction actions *YesNoIf yes, please explain.Have you ever committed any criminal violation that has gone undetected or been arrested for a criminal violation that was not charged or prosecuted? *YesNoHave you ever had an F.B.I. fingerprint check done for any reason? *YesNoHave you ever been placed on court supervision or probation? *YesNoHave you ever operated a motor vehicle while under the influence of alcohol or drugs, to the point that you knew you should not have been driving? *YesNoHave you ever engaged or attempted in any sexual abuse activity inside of a prison, jail, community confinement facility, juvenile detention facility or other institution? *YesNoHave you ever been convicted of engaging or attempting to engage in sexual activity by force, overt or implied threat of force, or coercion or if the victim did not consent or was unable to refuse? *YesNoHave you ever been civilly or administratively adjudicated to have engaged or attempt to engage in sexual activity by force, overt or implied threat of or coercion or if the victim did not consent or was unable to refuse? *YesNoHas your driver’s license ever been revoked or suspended? *YesNoHave you ever attended a court-ordered driver improvement school? *YesNoHave you ever tried or used any narcotic or dangerous drug without a doctor's prescription, or misused/abused any medication prescribe to you? *YesNoHave you ever illegally sold or furnished drugs or narcotics to anyone? *YesNoReference 1Please include name and phone numberReference 2Please include name and phone numberReference 3Please include name and phone numberEducationHigh School DiplomaGEDCollege DegreeCheck each one that you possessSchool's attendedPlease include school name and date attended example, "Lebanon High School fall 2005 - spring 2009"Employment HistoryPlease include Business, Job Title, and Dates mo/yr example, "Laclede County Sheriff's Office Jailer 04/21 - 08/22"Submit
