Windham County Sheriff's Office Employment Application

Applicant Information
Full Name:	Date:
Last	First	M.I.
Address:
Street Address	Apartment/Unit #
City	State	ZIP Code
Phone:	( )	E-mail Address:
Date Available:	Date of Birth	Desired Wage
Position Applied for:	Deputy Dispatcher Full-time Part-time
Are you a citizen of the United States?	YES	NO	If no, are you authorized to work in the U.S.?	YES	NO
Have you ever worked for this department?	YES	NO	If yes, when?
Have you ever been convicted of a criminal offense?	YES	NO	Have you ever been refused or prohibited from owning or possessing a firearm? Yes No
If yes, explain:
Have you ever been refused employment by this department or any other law enforcement agency? Yes No (If the answer is Yes, please submit a separate page with the department name and address along with the dates and reason for refusal.) Have you ever been charged with or had probable cause found against for a charge of domestic violence or crimes against a person? Yes No If yes, submit a separate page detailing the circumstances
Education
High School:	Address:
From:	To:	Did you graduate?	YES	NO	Degree:
College:	Address:
From:	To:	Did you graduate?	YES	NO	Degree:
Other:	Address:
From:	To:	Did you graduate?	YES	NO	Degree:
List any specialized skills, training, or knowledge that you have, i.e. photography, computers, radio hobbies, languages spoken etc.

References
Please list three professional references.
Full Name:	Relationship:
Company:	Phone:	( )
Address:
Full Name:	Relationship:
Company:	Phone:	( )
Address:
Full Name:	Relationship:
Company:	Phone:	( )
Address:
Previous Employment
Company:	Phone:	( )
Address:	Supervisor:
Job Title:	:
Responsibilities:
From:	To:	Reason for Leaving:
May we contact your previous supervisor for a reference?	YES	NO
Company:	Phone:	( )
Address:	Supervisor:
Job Title:	Starting Salary:
Responsibilities:
From:	To:	Reason for Leaving:
May we contact your previous supervisor for a reference?	YES	NO
Company:	Phone:	( )
Address:	Supervisor:
Job Title:
Responsibilities:
From:	To:	Reason for Leaving:
May we contact your previous supervisor for a reference?	YES	NO
Military Service
Branch:	From:	To:
Rank at Discharge:	Type of Discharge:
If other than honorable, explain:
Law Enforcement Experience
Yes No Full-time Part-time Sworn Officer Dispatcher
Department:	From:	To:
Address	Immediate Supervisor’s Name:
Reason for leaving explain:
Please provided information about training or certifications you received and any other information you think the Windham County Sheriff's Department should know that is relevant about your law enforcement experience.
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. I understand that the Windham County Sheriff's Department may verify the information presented and that untruthful or misleading answers are cause for rejection of this application and removal from the employment process. If this application leads to employment, I understand that false or misleading information presented in my application or interview will result in my termination.
Signature:	Date:

APPLICANT PROCESS
I understand that the Windham County Sheriff's Department will conduct an investigation into my background to establish my suitability for the position(s) applied for. The Department will require that participate in the following phases and successfully complete all of them.
Phase 1: Initial screening
My application will be screened for suitability to include but not limited to the following: criminal record check, motor vehicle record check, Interstate criminal record check and police database(s) check.
Phase 2: Testing
I understand that I will be given examinations to determine my suitability for the position applied for to include but not limited to: 1. Vermont Criminal Justice Training Council entrance examination conducted at the Vermont Police Academy, Pittsford, VT (Applicant is responsible for the cost of the exam which will be reimbursed by the Department if hired and upon successful completion of the training process.) 2. MMPI Psychological examination give at the Police Academy (Applicant is responsible for the cost of the exam which will be reimbursed by the Department if hired and upon successful completion of the training process.) 3. Classifiable set of fingerprints taken at the Windham County Sheriff's Department 4. Submission to a polygraph examination to be completed Vermont State Police or examiner selected by the Department. 5. Any other tests or exams required by law or the rules established by the Vermont Criminal Justice Training Council.
Phase 3: Background Investigation
I understand that I will be subjected to an investigation of my background to determine my suitability for the position applied for. The investigation will include but not be limited to: Character, financial history, references, neighbors, friends, employment history, military career, and Internet presence such as Twitter, Instagram and Facebook. I may be asked to provide additional information or materials prior to or during the background investigation.
Phase 4: Final interview
I understand that I will undergo an oral board interview and/or an individual interview with the Sheriff or his designee and that employment offers will be considered conditional until the completion of a physical exam and final decision of the Sheriff of Windham County.
I understand that this disclosure statement is only meant to inform the applicant of the process that is about to be undertaken. I will only be considered for employment after successful completion of ALL phases and that submittal of an application does not guarantee employment nor is continuation through the phases of the process to be considered an offer of employment. Signature Date