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EVANGELINE PARISH SHERIFF'S OFFICE APPLICATION FOR EMPLOYMENT

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#3:","name":"JOB-TITLE-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"SUPERVISOR #3:","name":"SUPERVISOR-3","className":"col-md-6","subtype":"text"},{"type":"date","label":"FROM #:3","name":"FROM-3","className":"col-md-6"},{"type":"date","label":"TO #3:","name":"TO-3","className":"col-md-6"},{"type":"text","label":"STARTING RATE/SALARY #3:","name":"STARTING-RATESALARY-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"ENDING RATE/SALARY #3","name":"ENDING-RATESALARY-3","className":"col-md-6","subtype":"text"},{"type":"textarea","label":"REASON FOR LEAVING #3:","name":"REASON-FOR-LEAVING-3","subtype":"textarea","className":"d-block"},{"type":"textarea","label":"DUTIES PERFORMED #3:","name":"DUTIES-PERFORMED-3","subtype":"textarea","className":"d-block"},{"type":"textarea","label":"REASON FOR APPLYING FOR A POSITION WITH THE EVANGELINE PARISH SHERIFF'S OFFICE #3?","name":"REASON-FOR-APPLYING-FOR-A-POSITION-WITH-THE-EVANGELINE-PARISH-SHERIFFS-OFFICE-3","subtype":"textarea","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"EMPLOYER #4:","name":"EMPLOYER-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"STREET NAME #4:","name":"STREET-NAME-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"PHONE #4:","name":"PHONE-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"JOB TITLE #4:","name":"JOB-TITLE-4","className":"col-md-6","subtype":"text"},{"type":"text","label":"SUPERVISOR #4:","name":"SUPERVISOR-4","className":"col-md-6","subtype":"text"},{"type":"date","label":"FROM #4:","name":"FROM-4","className":"col-md-6"},{"type":"date","label":"TO #4:","name":"TO-4","className":"col-md-6"},{"type":"text","label":"STARTING RATE/SALARY #4:","name":"STARTING-RATESALARY-4","className":"col-md-6","subtype":"text"},{"type":"text","label":"ENDING RATE/SALARY #4:","name":"ENDING-RATESALARY-4","className":"col-md-6","subtype":"text"},{"type":"textarea","label":"REASON FOR LEAVING #4:","name":"WHY-DID-YOU-GO","subtype":"textarea","className":"d-block"},{"type":"textarea","label":"DUTIES PERFORMED #4:","name":"DUTIES-PERFORMED-4","subtype":"textarea","className":"d-block"},{"type":"textarea","label":"REASON FOR LEAVING #4: ?","name":"JUMP-JOYOUS","subtype":"textarea","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"PROFESSIONAL REFERENCES","className":"d-block"},{"type":"paragraph","subtype":"p","label":"(NO CURRENT EMPLOYEES OF THE EVANGELINE PARISH SHERIFF'S OFFICE OR IMMEDIATE FAMILY MEMBERS)<br><hr>","className":"d-block"},{"type":"text","label":"NAME #1:","name":"NAME-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"PHONE #1:","name":"PHONE-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"ADDRESS #1:","name":"ADDRESS-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"TITLE #1:","name":"TITLE-1","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"NAME #2:","name":"NAME-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"PHONE #2: ?","name":"NUMBERS-MATTER","className":"col-md-6","subtype":"text"},{"type":"text","label":"ADDRESS #2:","name":"ADDRESS-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"TITLE #2:","name":"TITLE-2","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"NAME #3:","name":"NAME-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"PHONE #3: /","name":"BUSINESS-CARD","className":"col-md-6","subtype":"text"},{"type":"text","label":"ADDRESS #3:","name":"ADDRESS-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"TITLE #3:","name":"TITLE-3","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I certify that my answers to the foregoing questions and statements are true, correct, complete, and made in good faith without intentional omission of any kind whatsoever. I agree that the Evangeline Parish Sheriff's Office shall not be liable in any respect if my employment is terminated because of false statements, answers, or omissions made by me in this Application for Employment.<div><br></div><div>I authorize investigation of all statements contained herein. I further authorize the persons listed above as references to give you any and all information concerning by previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing the same to you</div><div><br></div><div>I also understand and agree to abide by all rules, regulations, and confidentiality agreement of my employer.</div>","className":"d-block"},{"type":"text","required":true,"label":"DATE:","name":"TODAY-DATE","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"FULL NAME (TYPE OR PRINT LEGIBLY):","name":"FULL-NAME-TYPE-OR-PRINT-LEGIBLY","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"SIGNATURE:","name":"YOUR-NAME","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"DATE SIGNED:","name":"DATE-SIGNED","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"RELEASE OF INFORMATION AUTHORIZATION","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I, hereby authorize any investigator, agent or representative of any federal, state, or local law enforcement or investigatory agency, to obtain any and all information and records requested related to my activites including past, present, and future criminal investigations and enforcement matters; administrative and internal investigations; disciplinary proceedings; medical records and claims; educational pursuits; and financial and credit history. Sources of such records and information may include, but are not limited to, employers, educational instiutions; criminal justice, enforcement, investigation; financial and lending instiutions; business; medical facilites; health care professionals; and relatives and acquaintances.<div><br></div><div>I authorize custodians of such records and sources of information to release such records and information, and permit the review and copying of all doucemnts, reports; records and correspondence pertaining to my activities, upon request of the representative of the agencies indicated above, regardless of any previous agreemnt to the contrary. </div><div><br></div><div>For myself, my heirs, administrators, successors, and assigns, I hereby release, remise, and forever discharge any person or entity to whom this request is preseneted, and their agents and employees, form any and all manner of actions, cause of actions, suits, debts, claims, and demands whatsover, known or unknow, in law or equity, which I ever had, now have, may have, or may claim to have against such person or entity or their agents and employees arising out of or by reason of complying with this request. </div><div><br></div><div>I agree to accept any risk of adverse public notice, embarrassment, criticism or financial loss that may result from use of information that is obtained in connection with a background investigation for the purpose listed in this document.</div><div><br></div><div>I agree to indemnify and hold harmless any person or entity to whom this reuest is lawfully presented and thir agents and employees from and against all claims, damages, lossess, and expenses, including reasonable attorney's fees, arising out of or by reason of complying with this request. </div><div><br></div><div>I understand that the information and records released by records custodians and other source of information is for the purpose of conducting a background investigation to process my application related to my employment.</div><div><br></div><div>Copies of this authorization that show my signature are as valid as the original release signed by me. I understand that this authorization remains valid for two (2) years from the date it is signed.</div><div><br></div><div>I, do hereby certify that I have read the foregoing, understand its contents, and authorize release of such records and information about myself. </div>","className":"d-block"},{"type":"text","required":true,"label":"SIGNATURE OF APPLICANT:","name":"SIGNATURE-OF-APPLICANT","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"TODAY'S DATE:","name":"THE-DATE-IS-NEAR","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"WITNESS: PRINTED NAME:","name":"WITNESS-PRINTED-NAME","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"WITNESS SIGNATURE #2:","name":"WITNESS-SIGNATURE-sECOND","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"APPLICANT/EMPLOYEE CONSENT","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I, do hereby understand and ackowledge that as a condition of employment with the Evangeline Parish Sheriff's Office that I may be asked to submit to certain examinations. These will include, but are not limited to drug, alcohol, physical, DNA, psychological, and / or polygraph. Request(s) for these examinations may be prior to employment or anytime thereafter.<div><br></div><div>I hereby consent to all testing when requested by the Evangeline Parish Sheriff's Office.</div><div><br></div><div>I understand that failure to comply with a request will result in termination of application or employment. I understand and ackowledge that employment will be contingent upon the results of such examinations being satisfactory to the Evangeline Parish Sheriff's Office. </div><div><br></div>","className":"d-block"},{"type":"text","required":true,"label":"FULL NAME:","name":"APPLICANT-CONSENT-EMPLOYEE","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"DATE: #","name":"DAY-OF-THE-WEEK","className":"col-md-6","subtype":"text"},{"type":"header","subtype":"h2","label":"CONFIDENTIAL","className":"d-block"},{"type":"header","subtype":"h2","label":"EVANGELINE PARISH SHERIFF'S OFFICE","className":"d-block"},{"type":"header","subtype":"h2","label":"BACKGROUND CHECK AUTHORIZATION","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","required":true,"label":"FIRST NAME:/","name":"FIRST-TIME-AROUND","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"MIDDLE NAME:","name":"MIDDLE-NAME","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"LAST NAME:","name":"LAST-NAME","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"FORMER NAME(S) & DATE USED:","name":"GIVE-ME-YOUR-NAMES","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"CURRENT ADDRESS:?/","name":"ADDRESS-0","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"SOCIAL SECURITY #:","name":"SOCIAL-SECURITY-","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"DATE OF BIRTH:","name":"DATE-OF-BIRTH","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"TELEPHONE:","name":"TELEPHONE","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"DRIVER'S LICENSE:","name":"DRIVERS-LICENSE","className":"col-lg-4","subtype":"text"},{"type":"select","label":"State?","name":"STATR","className":"d-block","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","required":true,"label":"FULL NAME:?","name":"NAME-YOUR-COICE","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"TODAY DATE:","name":"IS-TIME","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"WITNESS:","name":"WITNESS-1","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"WITNESS:?","name":"SOMEONE-MUST-SIGN","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"RELEVANT FILES","className":"d-block"},{"type":"file","required":true,"label":"<div><span style=\"font-family: var(--bs-body-font-family); text-align: var(--bs-body-text-align);\">Please select one or more files for upload. You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format. To upload multiple files, please hold control while clicking on multiple files before clicking \"Open\".</span></div>","name":"RELEVANT-FILES","subtype":"file","multiple":true,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"The information contained in this application is correct to the best of my knowledge. I hereby authorize Evangeline Parish Sheriff's Office and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and / or all federal, state, parish jurisdictions; driving records, and any other public record.<div><br></div><div>I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to:  Evangeline Parish Sheriff's Office or its agents. I further authorize the complete release of any records or data pertaining to corporation, public agency, or me, which the individual, company, firm, may have, to include information or data received from other sources. </div><div><br></div><div>I hereby release Evangeline Parish Sheriff's Office, The Social Security Administration, and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.</div>","className":"d-block"},{"type":"text","required":true,"label":"SIGNATURE:#","name":"SIGN-HERE","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"DATE:^^","name":"DATES","className":"col-md-6","subtype":"text"}]

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Evangeline Parish
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