Application

All fields marked with * are mandatory.

Please click the headers marked ">" for additional fields.

> Administrative Use Only

Personal Identification

First
Middle
Last

Please list other names you have used in the past:

Maiden name, alias, AKA, etc
Jr, Sr., III, etc
Drop a file here or click to upload Choose File
Maximum upload size: 134.22MB
Please attach a recent photo of yourself. Photo requirements:
  • Taken within the last 6 months to reflect your current appearance
  • Taken in full-face view directly facing the camera
  • With a neutral facial expression and both eyes open
  • File size less than 5mb in .jpg .bmp or .png format

> Waiver

I do hereby authorize a review and full disclosure of all records, or any part thereof, concerning myself to any duly authorized agent of the Madison County Sheriff s Office, or any agency assisting them, whether the said records are public or private, and including those which may be deemed to be a privileged or confidential nature. The intention of this authorization is to provide information which will be utilized for investigative resource material.

I authorize the full and complete disclosure of the records of educational institutions; financial or credit institutions; commercial or retail mercantile establishments and retail credit agencies; results of polygraph examinations, efficiency ratings, complaints or grievances filed by or against me; records of complaints of a civil nature made by or against me and including but not limited to the records and recollections of attorneys at law, or other counsel representing or having represented me; and any records of any type whatsoever which concern any criminal charges involving me.

I further authorize the release of information concerning all of the above mentioned areas, or any other information which has a bearing on my fitness or ability to become an employee of the Madison County Sheriff s Office, even though such information is not contained in written records and regardless of whether such information is considered privileged or confidential in nature.

A photocopy of this release form will be valid as an original hereof, even though the said photocopy does not contain an original writing of my signature.

> Employment Desired

Click all that apply
If yes, please provide details below.
One line per application

> Military History

Drop a file here or click to upload Choose File
Maximum upload size: 134.22MB
Military preference will NOT be given without a valid DD-214

> Law Enforcement Certification

> Personal History

Starting with your CURRENT employer, list complete employment history for the last 10 years

Please list ALL prior work experience

Starting with your CURRENT employer, list complete work history
Business Address
City
State/Province
Zip/Postal

Please list ALL residences for the last 10 years

Address
City
State/Province
Zip/Postal

Education

Starting with high school, list all education and/or experience relating to the position applied for:
Address
City
State/Province
Zip/Postal

References

List at least THREE persons who have knowledge of your character, work history, etc. Please refrain from listing family members.
Address
City
State/Province
Zip/Postal
Drop a file here or click to upload Choose File
Maximum upload size: 134.22MB

All the information listed by me on this application is true and correct to the best of my knowledge. I understand fully that any false and misleading statements may be cause for rejection of my application and/or if employed may be just cause for subsequent dismissal.

> Character Affidavit

THE APPLICANT, AFFIRMING THAT EACH STATEMENT IS TRUE AND CORRECT, MUST INITIAL EACH OF THE FOLLOWING STATEMENTS in the following sections. If statement cannot be answered in the affirmative, your must give full details in the box below.
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If this is true, initial the box above
If YES, provide complete information regarding the offense and a narrative description of the circumstances on the following form.

Law Violations

If YES, provide complete information regarding the offense and a narrative description of the circumstances on the following form.

Traffic Violations

Character Declarations

Any "Yes" answers will require explanation in the box below.
Statement of Health
If YES, explain below.
Type your full name indicating understanding and agreement with this statement.

> Pre-Employment Information

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

In compliance with Federal and State Equal Employment Opportunity laws, qualified applicants are considered for employment without regard to race, color, religion, sex, national origin, military status, age, marital status, or the presence of a non-job-related medical condition or handicap.

So that we can comply with Federal/State Equal Opportunity Employment record keeping requirements and other legal requirements, please complete this form.

This Pre-Employment Information will be detached and kept in a confidential file separate from the Employment Application, and shall not be used in making any hiring decision or any selection procedure.

First
Middle
Last
Please type full name in the box

> Physical Fitness

Submit

Review and submit. You will not be able to submit the application until all required fields are completed.