Application

All fields marked with * are mandatory.

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

> Administrative Use Only

Personal Identification

First
Middle
Last
First Middle Last Date of Birth  
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Drop a file here or click to upload Choose File
Maximum upload size: 8.39MB
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.
Where applied Position applied for Result of application  
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One line per application

> Military History

Drop a file here or click to upload Choose File
Maximum upload size: 8.39MB
Military preference will NOT be given without a valid DD-214

> Law Enforcement Certification

> Personal History

Business Name Business Address Business Phone Dates Employed Supervisor Duties Reason for leaving  
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Starting with your CURRENT employer, list complete employment history for the last 10 years
Address City State Zip Code Own/Rent If rented - Landlord Date began at this residence Date ended at this residence  
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List all residences for the last 10 years
Name and Location of School Course of Study # of Years Did you graduate? Degree/Diploma?  
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Starting with high school, list all education and/or experience relating to the position applied for:
Name Address Phone Relationship What does this person know about you?  
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List at least two persons who have knowledge of your character, work history, etc.
Drop a file here or click to upload Choose File
Maximum upload size: 8.39MB

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.
  Initials
1. I have NOT used marijuana for any purpose in the last two years preceding this application.
2. I have NOT used illegal drugs or narcotics other than marijuana in the five years preceding this application for admission.
3. I have NOT been convicted of a felony or any crime which carried a possible penalty of one year or more imprisonment or any crime which would have carried such a penalty if committed in Nebraska (Class I Misdemeanor)
4. I have NOT been convicted of Driving Under the Influence / Driving While Intoxicated in the four years immediately preceding this application
5. I have NOT been convicted of either a federal or state misdemeanor which has, as an element, the use or attempted use of physical force, or the threatened use of a deadly weapon, committed against a current or former spouse, parent, or guardian of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse, parent, or guardian, or by a person similarly situated to a spouse, parent, or guardian of the victim.
6. I have NOT received a punitive discharge from the United States Armed Forces. Punitive discharges are discharges classified as Dishonorable or Bad Conduct
7. I have NOT been denied law enforcement certification status, or had my certification revoked or currently suspended in the state or another jurisdiction.
8. I have NOT been convicted of any crime involving the threat of or the actual use of physical violence that would constitute a Class I Misdemeanor in this state.
9. I have NOT been convicted of any crime involving the threat of or the actual sexual assault or abuse.
10.I have NOT been convicted of any crime of physical violence or sexual abuse against a child or children.
11.I have NOT been adjudicated or convicted or a crime of domestic violence as defined in the United States Code, 18 U.S.C. 922(g)(9), that would disqualify me from possessing a firearm.
12.I am NOT subject to an order of protection that would disqualify me from possessing a firearm under the provisions of United States Code, U.S.C. 922(g)(8).
If YES, provide complete information regarding the offense and a narrative description of the circumstances on the following form.
Original Charge/citation Arresting Agency, city and state Date of Incident Booked into jail Dispostion If guilty, what was the final charge(s)? Narrative  
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If YES, provide complete information regarding the offense and a narrative description of the circumstances on the following form.
Traffic Violation Citing/arresting agency, city and state Date of offense Disposition of case Narrative  
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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.