Reserve Deputy & Chaplain Application Job Application Type(Required)Select which type of position you are applying forSelect OneJCSO Reserve DeputyJCSO ChaplainName(Required) First Middle (Madien) Last Current Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Phone(Required)Alternate PhoneDate of Birth(Required) Month Day Year Place of Birth(Required) City, StateEmail(Required) Employment RecordClick "Add Employment Record" to begin adding your employment history. Employing Firm Actions Edit Delete There are no Employment Records. Add Employment Record Maximum number of employment records reached. Have you ever been fired or requested to resign by an employer?(Required) Yes No If yes, please explain:Have you ever been convicted of a felony, misdemeanor or of any violation of any law, ordinance , or police regulation, including traffic violations(Required) Yes No If yes, explain fully, what, where, when and results (i.e. paid fine, served time in jail)Education(Required)If not applicable, enter N/A List any other names, legal or otherwise, that you have been known by:(Required)If not applicable, enter N/AMilitary Service(Required)If not applicable, enter N/AHave you ever made application for employment with any other police agency?(Required) Yes No If yes, list departments and dates of application:Have you ever been convicted of a felony, misdemeanor or of any violation of any law, ordinance , or police regulation, including traffic violations(Required) Yes No Previous AddressesClick "Add Address" to being adding previous addresses. Please include any address you have lived at over the past 10 years. Address Actions Edit Delete There are no Addresses. Add Address Maximum number of addresses reached. ReferencesGive names and addresses of three reliable persons, other than relatives or past employers, who know you well enough to furnish information about you. Name Actions Edit Delete There are no References. Add Reference Maximum number of references reached. Do you now, or have you ever, tried, used or experimented with any type of illegal drugs or narcotics?(Required) Yes No Do you now, or have you ever used alcohol?(Required) Yes No Do you possess a valid driver's license for the State of Alabama?(Required) Yes No Was your license ever suspended or revoked?(Required) Yes No If yes, please explain:Have you ever been arrested, had to appear in court, or post bond for any reason?(Required)(Note: The existence of an arrest record si not an automatic bar ot employment.) Yes No If yes, please list type of date of charge, type of charge, agency, and disposition of caseHave you ever received any traffic citations?(Required) Yes No If yes, please list date of citation, type of citation, agency, and disposition of ticketPLEASE READ CAREFULLY BEFORE SIGNING:(Required)I HEREBY CERTIFY THAT I HAVE NEVER BEEN A MEMBER OF ANY ORGANIZATION OR GROUP WHICH SEEKS TO ALTER THE FORM OF GOVERNMENT OF THE UNITED STATES BY UNCONSTITUTIONAL MEANS. I FURTHER CERTIFY THAT ALL ANSWERS TO THE QUESTIONS HEREIN ARE TRUE AND I UNDERSTAND THAT ANY MISSTATEMENT OF MATERIAL FACTS CONTAINED IN THIS APPLICATION WILL CAUSE FORFEITURE UPON MY PART OF ALL RIGHTS TO ANY EMPLOYMENT WITH THE SHERIFF'S OFFICE OF JEFFERSON COUNTY, ALABAMA. I UNDERSTAND THAT THIS APPLICATION AND ALL PAPERS IN CONNECTION WITH THE EXAMINATION SHALL BE CONFIDENTIAL RECORDS OF THE JEFFERSON COUNTY SHERIFF'S OFFICE AND SUBJECT TO THE INSPECTION OF THE SHERIFF AND HIS PERSONNEL. I AgreeSignature(Required) Enter your full legal name below.Today's Date(Required) MM slash DD slash YYYY Δ
