First Name*
Last Name*
Email Address*
Phone*
Who referred you to this position? Enter their first and last name here.
Do you have a valid driver's license?*
No answer Yes No
What's your citizenship / employment eligibility?*
No answer I am a U.S. Citizen/Permanent Resident Non-citizen allowed to work for any employer Non-citizen allowed to work for current employer Non-citizen seeking work authorization I am a Canadian Citizen/Permanent Resident Other
What's your highest level of education completed?*
No answer GED or Equivalent High School Some College College - Associates College - Bachelor of Arts College - Bachelor of Fine Arts College - Bachelor of Science College - Master of Arts College - Master of Science College - Master of Fine Arts College - Master of Business Administration College - Doctorate Medical Doctor Other
College or University
What languages do you speak fluently?
Earliest start date?*
Have you ever been convicted of a felony?*
No answer No Yes
In your own words, describe why you are applying for this job, and why you are wanting to work in this profession.*
Hours you can be contacted:*
-- No answer -- Morning Afternoon Evening Any
Are you over 21 years old?*
-- No answer -- Yes No
What is your birthday?*
What is your middle name?*
Social Security Number:
Height:*
Weight*
Hair Color:*
Eye Color:*
Scars, Tattoos, or other distinguishing marks: (List description and location. i.e. scar-2 inches-left bicep, tattoo-"Heart"-right ankle)*
Please list all of your residences during the past 10 years (list no information prior to your 15th birthday). Begin with your current residence:*
2.)
3.)
4.)
5.)
6.)
Residency: List anyone you currently live with, or have lived with in the last 10 years. This would include but is not limited to family members, roommates, past boyfriends/girlfriends, etc. You do not need to list anyone under the age of 18. Include a phone number for anyone listed.*
Beginning with your most current employment, please list all jobs (including part-time, temporary and voluntary positions) you have held in the past 10 years. (For the purpose of this personal history statement, voluntary work should be included as employment.) For identification and verification, please indicate the nature of the activity, i.e., full-time, part-time or voluntary. If you have had intervening periods of military service or unemployment, please list those periods in sequence in the spaces provided.
Employer #1 and Address:*
Supervisor:*
Name(s) of Co-Worker(s)*
Employer #1 dates of employment. Start and end:*
Titles or Duties (For Identification Purposes)*
Employer #2 and Address:
Employer #2 Supervisor
Employer #2 Co-workers
Employer #2 dates of employment. Start and end:
Employer #3 and Address:
Employer #3 Supervisor:
Employer #3 Co-Workers:
Employer #3 dates of employment. Start and end:
Employer #4 and Address:
Employer #4 Supervisor:
Employer #4 Co-Workers:
Employer #4 dates of employment: Start and end:
Employer #5 and Address:
Employer #5 Supervisor
Employer #5 Co-Workers:
Employer #5 dates of employment. Start and end:
Father's name*
Father's address*
Father's phone number*
Mother's Name*
Mother's Address*
Mother's Phone Number*
Father-n-law's name:
Father-n-law's address:
Father-n-law's phone number:
Mother-n-law's name:
Mother-n-law's address:
Mother-n-law's phone number:
Spouse's Name
Spouse's Address
Spouse's Phone Number
Former Spouse's Name
Former Spouse's Address
Former Spouse's Phone Number
References: Please list 3-5 individuals who have knowledge of you and your qualifications. Exclude relatives, former employers, and friends. Include the reference's name, address, and phone number. 3-5 references are required. If you do not list references, your application will be rejected.*
References: Please list 3-5 individuals who are social acquaintance's (i.e., persons whom you have seen frequently in the past year) and have knowledge of you and your qualifications. Exclude relatives and former employers. Include the references name, address, and phone number. 3-5 references are required. If you do not list references, your application will be rejected.*
Education: The Winnebago County Sheriff's Office Merit Commission requires a peace officer to possess a high school diploma or it's equivalent. Please select which is applicable to you.*
Education: Please indicate below all the schools you have attended, beginning with high school. During the background investigation, person(s) who have known you in a learning environment will be contacted. A review of your school records may be made in conjunction with these contacts.*
Education: Have you ever been suspended or expelled from any high school or post-secondary school, including colleges or universities.*
Education: If you have been suspended or expelled, please explain why:
Experience and Employment: Would any problem result if your present employer was contacted during the course of the background investigation?*
If "yes", to the above answer, please explain why:
Experience and Employment: If you have had no prior work experience, please explain why:
Experience and Employment: Have you had any extended work absences for reasons other than earned vacation?*
Experience and Employment: If you have you had any extended work absences for reasons other than earned vacation, please explain why:
Experience and Employment: Have you ever been fired or asked to resign from any place of employment?*
Experience and Employment: If you have you ever been fired or asked to resign from any place of employment, please explain, top include from when, from where, and relevant circumstances:
Experience and Employment: Have you ever been a successful or unsuccessful candidate for a position at another police agency or sheriff's department?*
If you have been a successful or unsuccessful candidate for a position at another police agency or sheriff's department, please give details such as date(s), agency, and circumstances:
Military Service: Have you ever served in the armed forces, National Guard, or military reserves?*
Military Service: If you have served, please list your Branch of Service, Dates of Service, and Type of Discharge.
Military Service: Are you currently participating in any military reserves or National Guard program?*
Military Service: Have you ever been the subject of any judicial or non-judicial disciplinary action while in the military, National Guard, or military reserves?
Military Service: If you have been the subject of any judicial or non-judicial disciplinary action while in the military, National Guard, or military reserves, please explain below:
Military Service: Please list past commanding officers or military acquaintances who know you well enough to provide accurate information about you. Please list their name and telephone number:
Legal: Have you ever been arrested or convicted for any crime(s) (other than traffic citations)?*
Legal: List any arrest or convictions for any crime(s) (other than traffic citations). Include Notice to Appears, dismissed charges, and disposed charges. Include the approximate date, which agency arrested you, circumstances of the case, and disposition:*
Legal: Have you ever been placed on court probation as an adult?*
Legal: If you have you ever been placed on court probation as an adult, please explain why:
Legal: Are you now or have you ever been involved as a plaintiff or defendant in any civil court action?*
Legal: If you are now or have ever been involved as a plaintiff or defendant in any civil court action, please explain why:
Motor Vehicle Operation: Have you ever been refused a driver's license by any state?*
Motor Vehicle Operation: If you have you ever been refused a driver's license by any state, please list the state and the reason:
Motor Vehicle Operation: Illinois law requires owners and operators of motor vehicles to be covered by automobile liability insurance. Please list the name, address, policy number, and expiration date of your current automobile policy:*
Motor Vehicle Operation: List all traffic citations (excluding parking violations) you have received within the last 7 years. List the nature of the violation, location (city), approximate date, and outcome of the citation:*
Motor Vehicle Operation: Have you been involved, as a driver, in a motor vehicle accident in the last 7 years?*
Motor Vehicle Operation: If you have been involved, as a driver, in a motor vehicle accident in the last 7 years, list each instance, to include the date, location, police agency who handled the case, and whether the accident involved personal injury or not:
Motor Vehicle Operation: If there is anything regarding your driving record you would like to discuss, please list it below:
Motor Vehicle Operation: Has your license ever been suspended, revoked, or placed on negligent operators probation?*
Motor Vehicle Operation: If you license has ever been suspended, revoked, or placed on negligent operators probation, please give details below:
