Baker County

Sheriff's Office                                                    

3410 K Street

Baker City, OR  97814

(541) 523-6415

Fax (541) 523-9219

                                                                      __________            _____       Mitchell Southwick, Sheriff   

 

Baker County is an equal opportunity employer and is dedicated to a policy of non-discrimination in employment because of race, sex, national origin, age, mental or physical disability, unless based upon a bona fide occupational qualification.  Application must be hand written.

 

BAKER COUNTY SHERIFF’S OFFICE EMPLOYMENT APPLICATION

 

Position applying for:

____Civil Deputy        ____Corrections Deputy        ____Patrol Deputy     

____Marine Deputy   ____ Corrections Sergeant       ____ Reserve Deputy  

____Sergeant               ____ Corrections Corporal

 

DIRECTIONS:     Supply an answer to every question.  If a question is not applicable to you, write N/A.  If additional space is needed, use the back of the page.  Because this application is going to be used for investigation purposes, DO NOT mis-state or omit material facts as the statements made herein are subject to verification to determine your qualification for employment.  Applications, which are illegible or incomplete, will not be considered.  Application must be hand written by applicant, do not type.

 

NAME ____________________________________________   DATE OF BIRTH_________________________________

 

 

PRESENT ADDRESS___________________________________________________________________________________

___________________________________________________________________________________

 

PREVIOUS ADDRESS__________________________________________________________________________________

__________________________________________________________________________________

 

PHONE NO._________________________________    SOCIAL SECURITY NO.__________________________________

E-MAIL ADDRESS________________________________

HEIGHT____________   WEIGHT_______________   ARE YOU A U.S. CITIZEN?________________________________

OREGON DRIVERS LICENSE NO.________________________________________  

HAVE YOU EVER BEEN DENIED A DRIVERS’S LICENSE OR HAD YOUR LICENSE SUSPENDED OR REVOKED? ____________________________

 If yes, explain fully_____________________________________________________________________________________

_____________________________________________________________________________________________________

HAVE YOU EVER SERVED IN THE U.S. ARMED FORCES?________________   BRANCH_________________________

 

DATES OF DUTY ________________ To _________________ TYPE OF DISCHARGE____________________________

 

HIGHEST RANK RECEIVED_________________________ RANK AT DISCHARGE______________________________

RATE/JOB IN MILITARY_______________________________________________________________________________

ARE YOU PRESENTLY A MEMBER OF THE U.S. MILITARY RESERVE OR NATIONAL GUARD?_________________

 

NAME AND LOCATION OF HIGH SCHOOL.______________________________________________________________

___________________________________________________________________DATE LEFT_______________________

GRADUATE__________________ GED ______________________ DATE_______________________________________

 

LIST ALL COLLEGES AND UNIVERSITIES ATTENDED____________________________________________________

_____________________________________________________________________________________________________

 

_____________________________________________________________________________________________________

 

COLLEGE CREDITS_______________ DEGREES_____________________ FIELDS OF STUDY____________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

LIST ANY SPECIAL TRAINING, LANGUAGES, CERTIFICATIONS, OR LICENSES YOU MAY HAVE THAT ARE PERTINENT TO THE POSITION FOR WHICH YOU ARE APPLYING.  INCLUDE INSTITUTION NAMES, ADDRESSES AND PHONE NUMBERS.

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

LIST NAME, ADDRESS AND TELEPHONE NUMBERS OF THREE REFERENCES WHO ARE NOT RELATED TO YOU AND ARE NOT PREVIOUS EMPLOYERS. _____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

DO YOU USE, OR HAVE YOU EVER USED ANY NARCOTICS OR DRUGS OTHER THAN THOSE PRESCRIBED TO YOU BY A PHYSICIAN?_____________  

If yes, explain fully______________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

HAVE YOU EVER BEEN CHARGED AND/OR CONVICTED OF A CRIME, BY EITHER A CIVILIAN AUTHORITY OR MILITARY AUTHORITY? _______________

 If yes, explain fully_____________________________________________________________________________________

_____________________________________________________________________________________________________

 

LIST ALL HOBBIES, ACTIVITIES AND INTERESTS________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

LIST ALL ORGANIZATIONS YOU CONSIDER YOURSELF A MEMBER OF (civic clubs, fraternal orders and etc.)  INCLUDE ADDRESSES AND NAME OF PERSONS TO CONTACT AND PHONE NUMBERS.

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

EMPLOYMENT HISTORY – BEGIN WITH YOUR PRESENT OR MOST RECENT JOB.

 

 

EMPLOYER______________________________________________________ FROM_____________ TO______________

 

ADDRESS________________________________________ EMPLOYER PHONE #________________________________

 

JOB TITLE__________________________ SUPERVISOR’S NAME_____________________________________________

 

SPECIFIC DUTIES_____________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

REASON FOR LEAVING _______________________________________________________________________________

 

 *****************************************************************************************************

 

EMPLOYER______________________________________________________ FROM_____________ TO______________

 

ADDRESS________________________________________ EMPLOYER PHONE #________________________________

 

JOB TITLE__________________________ SUPERVISOR’S NAME_____________________________________________

 

SPECIFIC DUTIES_____________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

REASON FOR LEAVING _______________________________________________________________________________

 

*****************************************************************************************************

 

EMPLOYER______________________________________________________ FROM_____________  TO______________

 

ADDRESS________________________________________ EMPLOYER PHONE #________________________________

 

JOB TITLE__________________________ SUPERVISOR’S NAME_____________________________________________

 

SPECIFIC DUTIES_____________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

REASON FOR LEAVING _______________________________________________________________________________

 

*****************************************************************************************************

 

EMPLOYER______________________________________________________ FROM_____________ TO______________

 

ADDRESS________________________________________ EMPLOYER PHONE #________________________________

 

 

JOB TITLE__________________________ SUPERVISOR’S NAME_____________________________________________

 

SPECIFIC DUTIES_____________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

REASON FOR LEAVING _______________________________________________________________________________

 

EMPLOYER______________________________________________________ FROM_____________ TO______________

 

ADDRESS________________________________________ EMPLOYER PHONE #:________________________________

 

JOB TITLE__________________________ SUPERVISOR’S NAME_____________________________________________

 

SPECIFIC DUTIES_____________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

REASON FOR LEAVING _______________________________________________________________________________

 

 

*****************************************************************************************************

 

EMPLOYER______________________________________________________ FROM_____________ TO______________

 

ADDRESS________________________________________ EMPLOYER PHONE #________________________________

 

JOB TITLE__________________________ SUPERVISOR’S NAME_____________________________________________

 

SPECIFIC DUTIES_____________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

 

REASON FOR LEAVING _______________________________________________________________________________

 

 

 

HAVE YOU EVER BEEN DISCHARGED FROM EMPLOYMENT OR ASKED TO RESIGN?________________________

 

If yes, explain fully______________________________________________________________________________________

 

_____________________________________________________________________________________________________

 

_____________________________________________________________________________________________________

 

_____________________________________________________________________________________________________

 

DO YOU HAVE ANY OBJECTIONS OR PROBLEMS WITH WORKING NIGHTS?  ______________________________

 

WEEKENDS? ______________  HOLIDAYS?  ____________________ ROTATING SHIFT WORK? _________________

 

 

 

 

 

 

 

 

 

 

APPLICANT’S CERTIFICATION AND RELEASE

 

 

I hereby certify that all statements made in this application or appended to it are true and correct to the best of my knowledge.  I am aware that withholding pertinent information or information found to be materially (grossly) inaccurate will be cause for refusing further consideration of my application, or will constitute grounds for my termination if I am employed.  I understand this is not to be considered as an indication of probable obligation upon the department to make an appointment, but a part of the selection process only.  I understand that failure on my part to notify the Sheriff’s Department of a change of address within thirty (30) days may subject my file to being closed.

 

Authority to Release Credit, Character, School Records, Personal History and Medical Information.

 

Having made application with the Baker County Sheriff’s Office, I hereby authorize a complete investigation of my record including personal history, school and academic records, military records, job performance, driving record and criminal arrest and conviction by the Baker County Sheriff’s Office or another police agency authorized to conduct their applicant investigation, to ascertain any and all information which may concern my credit and character, whether same is of record or not; and release your organization and all persons whomsoever from any charge because of furnishing said information.  I hereby acknowledge that I am aware the results of this investigation are confidential for Baker County Sheriff’s Office use only and will not be disclosed to myself or any other person without proper authorization.

 

 

                                                                                    _____________________________________________________________

                                                                                                                                                                NAME (Print or Type)

 

                                                                                                                                                                                                                                                                                                                                                                _____________________________________________________________

                                                                                                                                                                                                                Signature                                                                                                                                                                                                                                                              Date

 

 

 

All inquiries on Baker County Sheriff’s Office Applicants should be directed to:

 

                                      Baker County Sheriff’s Office

3410 K Street,

Baker City, OR 97814

(541) 523-6415, Fax (541) 523-9219

 

Baker County Sheriff’s Office is an Equal Opportunity Employer