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1 Revised: August 2019 G:\HR\Sheriff EMPLOYMENT APPLICATION Last Name First Name Middle Name/Initial Street and Number City County ( ) State Zip Phone Can your education and/or employment records be verified using the above name and social security number? Yes No If no, list other name(s): Name, address and phone number of person who will know where you may be contacted: ( ) Phone Please follow these general instructions: 1. Read the Examination/Position Announcement and be sure you meet, with or without reasonable accommodation, the “QUALIFICATIONS” listed. 2. Answer all questions and complete all spaces on the application. 3. Submit all transcripts and documents at the time of application. Position(s) applied for: How did you learn of the examination/position? Have you previously been employed by McLean County? Yes No If yes, from to Department Are you at least eighteen (18) years of age? Yes No Are you a U.S. citizen or an alien legally authorized to work in the United States? Yes No On what basis are you available for employment? (Check any or all that apply) Full time Part-time Summer Temporary Are you available for: Weekends and Holidays Yes Rotating Shifts Yes On Call Yes No No No Shift Preference (check any or all that apply): Days Evenings Nights Date available for work / Rate of pay expected $ per hour. 1. Have you ever been discharged or asked to resign from employment? Yes No 2. Do you object to an inquiry of you present employer in regard to your ability to work with others, work record, qualifications or abilities? Yes No If yes, explain: IF YOU HAVE ANSWERED “YES” TO ANY OF THE LAST TWO QUESTIONS, please give specifics on a separate sheet. A “yes” answer does not automatically disqualify you from employment. ---PAGE BREAK--- 2 Revised: August 2019 G:\HR\Sheriff Answer the four questions below if they are essential functions of the job for which you are applying. 1. Do you possess a valid Driver’s License? Yes No N/A 2. Do you possess a valid Commercial Drivers License Yes No N/A 3. Can you produce typed material (typewriter, computer, other)? Yes No N/A 4. Can you take notes verbatim (word for word) at a reasonable speed? Yes No N/A List any in-service training, instruction courses or programs you have completed: List any special information as to your work record you may deem of value: Are there any other experiences, skills or qualifications that you feel would especially fit you for work with McLean County and/or the position for which you are applying? If license, certificate or other authorization to practice a trade or profession is required for the position for which you are applying, complete the following: Name of trade or profession: License Number: Granted By: City and/or State of: Specialty: Licensed From: To: EDUCATION Name and Location Years Completed Diploma/Degree Course of Study High School 9 10 11 12 College 1 2 3 4 Graduate / Professional 1 2 3 4 Trade School 1 2 3 4 Describe your extra-curricular activities (e.g. professional/student organizations, leisure activities, civic, etc…): ---PAGE BREAK--- 3 Revised: August 2019 G:\HR\Sheriff EMPLOYMENT EXPERIENCE Start with your present or last job. Indicate any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, disability or other protected status. 1. Employer Dates Employed From To Address Work Performed: Telephone Job Title Supervisor Reason for Leaving 2. Employer Dates Employed From To Address Work Performed: Telephone Job Title Supervisor Reason for Leaving 3. Employer Dates Employed From To Address Work Performed: Telephone Job Title Supervisor Reason for Leaving 4. Employer Dates Employed From To Address Work Performed: Telephone Job Title Supervisor Reason for Leaving ---PAGE BREAK--- 4 REFERENCES List three business/work references who are not related to you and are NOT previous supervisors. If not applicable, list three school or personal references who are not related to you. 1. Name Relationship Years Acquainted ( Address Phone 2. Name Relationship Years Acquainted ( Address Phone 3. Name Relationship Years Acquainted ( Address Phone AGREEMENT I certify that the answers given herein are true and complete to the best of my knowledge I authorize McLean County to make such investigations and inquiries of my personal and employment history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the County. Signature of Applicant Date NOTE: If you are applying for a position with the following departments, you will need to complete a form for purposes of a background investigation. Please ask for one of these forms. CIRCUIT CLERK SHERIFF’S DEPARTMENT COURT SERVICES FACILITIES MANAGEMENT PARKS AND RECREATION METRO McLEAN COUNTY COMBINED COMMUNICATIONS CENTER (METCOM) FOR OFFICE USE ONLY – DO NOT WRITE BELOW THIS LINE Application reviewed by: Name Date Name Date Name Date Name Date Name Date Name Date SIGN ---PAGE BREAK--- TO: CORRECTIONAL OFFICER APPLICANT Attached is an application for employment with the McLean County Sheriff’s Office Jail Division. Please complete the entire application and provide the following materials, which need to be returned with the application on the night of orientation: • A certified copy of your birth certificate from the county you were born. We cannot accept birth certificates issued by the hospital. • Transcripts from the institution of your highest level of education. • Transcripts of military service discharge, if applicable. • A valid driver’s license along with two copies of said driver’s license. Applicants must reside within one hour drive time from the certified employee’s residence to the McLean County Law and Justice Center, Bloomington, IL, regardless of weather and road conditions, vehicle availability and vehicle performance. Applicants must attend a mandatory orientation meeting and successfully pass the following testing procedures: Basic Skills Written Test Oral Interview Upon successful completion of the above, the Merit Commission then certifies that the applicant is eligible for employment with the McLean County Sheriff’s Office Jail Division and the applicant will be notified by letter of his/her placement on the eligibility list. To be eligible for employment with this department, you will be subject to a medical examination and an intense background check, which will include a polygraph exam, exam and additional oral interviews with the Jail Division Command Staff. You are required to sign an Authorization for Release of Personal Information so that the background check can be conducted. Thank you for your interest in our Office. Jon Sandage McLean County Sheriff ---PAGE BREAK--- Authorization for Release of Personal Information I, , do hereby authorize a review of and full disclosure of all records concerning myself to any duly authorized agent of the McLean County Sheriff's Department, whether the said records are of a public, private or confidential nature. The intent of this authorization is to give my consent for full and complete disclosure of records of educational institutions; financial or credit institutions, including records of loans, the records of commercial or retail credit agencies (including credit reports and/or ratings); and other financial statements and records wherever filed; employment and pre-employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me and the records and recollections of attorneys at law, or of other counsel, whether representing me or another person in any case, either criminal or civil, in which I presently have or have had an interest; and any records of a police department or other law enforcement agency. I understand that any of the information obtained by a personal background investigation which is developed directly or indirectly, in whole or in part, upon this release authorization, will be considered in determining my suitability for employment by the McLean County Sheriff's Department. I also certify that any person(s) who may furnish such information concerning me shall not be held accountable for giving this information; and I do hereby release said person(s) from any and all liability which may be incurred as a result of furnishing such information. I further release the County of McLean, the McLean County Sheriff, the McLean County Sheriff's Department Merit Commission, their members, employees, agents and assigns from any and all liability which may be incurred as a result of collecting an utilizing such information. I further authorize the McLean County Sheriff's Department to conduct a polygraph examination(s), and I hereby voluntarily submit to such polygraph examination(s). A photocopy of this release form will be valid as an original thereof, even though the said photocopy does not contain an original writing of my signature. I have fully read and understand the contents of this AUTHORIZATION OF RELEASE OF PERSONAL INFORMATION. Signature, include maiden name if applicable Witness Signature Date Telephone Street Address City State Zip Date of Birth Social Security No. Driver’s License # & State