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911 Telecommunicator
Corrections Officer
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Personal
What position are you applying for?
911 Telecommunicator (Civilian)
911 Telecommunicator Part-Time (Civilian)
Jail Chaplain (Volunteer)
Corrections
Part-time Deputy - Highland C.C. (Certified Law Enforcement)
Patrol Deputy (Lateral Transfer)
Patrol Deputy (New Hire)
Reserve Deputy
Reserve Mounted Patrol
Court Security Deputy Part-Time (Certified Law Enforcement)
Internship (Non Paid)
Other names (including nicknames) you have been known by
Please list address at which you can be contacted
Please list the local telephone number(s) at which you can be contacted.
You must be a citizen of the United States and a resident of the United States for one year prior
Yes
No
For the purpose of identification, please provide the following:
References
During the course of the background investigation, persons who know you will be asked to comment on your suitability for the position
Please supply the appropriate information in the spaces provided below. If a category is not applicable, write in “N.A.”, If living please list below.
Please list 2 personal references and 2 professional references
Address Type
Home
Work
Other
Contact Type
Home
Work
Other
Address Type
Home
Work
Other
Contact Type
Home
Work
Other
Address Type
Home
Work
Other
Contact Type
Home
Work
Other
Address Type
Home
Work
Other
Contact Type
Home
Work
Other
Education
The Stephenson County Sheriff’s Office Merit Commission requires a peace officer to possess a high school diploma or its equivalent. Please indicate your current situation with regard to this requirement by checking one of the appropriate boxes.
I possess a high school diploma
I passed a G.E.D. (General Educational Development) test
I passed the Illinois High School Proficiency Examination
I possess other equivalent (Explain below in How)
I do not currently have a high school diploma or its equivalent, but plan to satisfy the requirement in the future, as follows;
Please indicate below all the schools you have attended, beginning with high school. During the background investigation, persons 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.
Have you ever been suspended or expelled from any high school or post-secondary school? (Post-secondary schools include colleges and universities, graduate schools, business and vocational schools—any formal education beyond high school level.)
Yes
No
Residence
Individuals who have become acquainted with you by reason of your residing in different locations are often helpful in providing useful information for the background investigation.
Please list all of your residences during the past 10 years (list no information prior to your 15th birthday). Begin with your current residence
Experience and Employment
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
Employment Type
Full-Time
Part-Time
Voluntary
Not Employed #1 Reason
Military Service
Unemployed
Employer #2
Employment Type
Full-Time
Part-Time
Voluntary
Not Employed #2 Reason
Military Service
Unemployed
Employer #3
Employment Type
Full-Time
Part-Time
Voluntary
Not Employed #3 Reason
Military Service
Unemployed
Employer #4
Employment Type
Full-Time
Part-Time
Voluntary
Not Employed #4 Reason
Military Service
Unemployed
Employer #5
Employment Type
Full-Time
Part-Time
Voluntary
Not Employed #5 Reason
Military Service
Unemployed
Employer #6
Employment Type
Full-Time
Part-Time
Voluntary
Not Employed #6 Reason
Military Service
Unemployed
Employer #7
Employment Type
Full-Time
Part-Time
Voluntary
Not Employed #7 Reason
Military Service
Unemployed
Would any problem result if your present employer was contacted during the course of the background investigation?
Yes
No
If you have had no prior employment, please explain
Have you had any extended work absences for reasons other than earned vacations?
Yes
No
Have you ever been fired or asked to resign from any place of employment?
Yes
No
Have you ever been a successful or unsuccessful candidate for another position requiring peace officer powers?
Yes
No
Legal
Have you ever been arrested or convicted for any crime (excluding traffic citations)?
Yes
No
Confirmation
I have read the description of the position that I'm applying
Yes
No
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