Employment Application

CLEBURNE COUNTY SHERIFF'S OFFICE

Sheriff Chris Brown

914 South 9th
Heber Springs, AR 72543

Phone (501)362-8143
Fax (501)362-7386

"Service with the highest level of Integrity, Compassion, and Respect"

PERSONAL INFORMATION

Full Name*

DOB*

Physical Address*

City*

State*

Zip Code*

Mailing Address, if different from Physical Address

Mailing Address City

Mailing Address State

Mailing Address Zip Code

Email*

Email Confirmation*

Applicant Phone Number*

Social Security Number*

DL State*

DL Number*

Spouse's Name (if not married, Type N/A)*

Spouse's Phone Number

Father's Name*

Mother's Name*

Date Available*

Scheduled Hours

Employees in Patrol, Jail, Court/Transports, and Other are regularly required to work shifts that include nights, weekends, holidays, off-hours, and are subject to being on-call. This is vital to us to be able to provide 24-hour service to Cleburne County. By checking the box below, applicants for those positions are stating they understand the position they are applying for may require them to work those hours.

Admin/Records employees typically work Monday through Friday 8:30am-4:30pm in accordance with County Policy.

Position Applied For*

Patrol

Jail

Admin/Records

Court/Transport

Other

Hours Confirmation*

Yes, I understand the hours

Other

Employment Desired*

Full-time

Part-time

Reserve

SOCIAL MEDIA ACCOUNTS: List all Social Media Account Handles (Do Not Provide Passwords)

Facebook

Twitter

Snap Chat

Instagram

Other Social Media Account

Other Social Media Account #2

EMPLOYMENT ELIGIBILITY

Are you legally eligible to work in the U.S.?*

Yes

Have you ever been convicted of a misdemeanor?*

Yes

If yes, please explain. Include year of conviction

Have you ever been convicted of a felony?*

Yes

If yes, please explain. Include year of felony conviction

EDUCATION

High School *

High School City*

High School State*

Attended High School From*

Attended High School To*

High School Diploma?*

Yes

GED

College

College City

College State

Attended College From

Attended College To

College Degree?

Yes - List degree in the "other" box

Other

Attended Program From

Attended Program To

Degree/Certification Received

PREVIOUS EMPLOYMENT

Employer #1*

Employer #1 Address*

Employer #1 City*

Employer #1 State*

Employer #1 Phone Number*

Employer #1 Supervisor Name*

Employer #1 Starting Pay*

Employer #1 Ending Pay*

Employer #1 Employment Type*

Full-time

Part-time

Other

Employer #1 Job Title*

Employer #1 Duties/Responsibilities*

Employer #1 Employed From*

Employer #1 Employed To*

Employer #1 Reason for leaving*

Employer #2

Employer #2 Address

Employer #2 City

Employer #2 State

Employer #2 Phone Number

Employer #2 Supervisor Name

Employer #2 Starting Pay

Employer #2 Ending Pay

Employer #2 Employment Type

Full-time

Part-time

Other

Employer #2 Job Title

Employer #2 Duties/Responsibilities

Employer #2 Employed From

Employer #2 Employed To

Employer #2 Reason for leaving

REFERENCES (must list at least one professional, one personal, no family members)

Reference #1*

Reference #1 Phone Number*

Reference #1 City, State*

Reference #1 Relationship*

Reference #2*

Reference #2 Phone Number*

Reference #2 City, State*

Reference #2 Relationship*

Reference #3 *

Reference #3 Phone Number*

Reference #3 City, State*

Reference #3 Relationship*

MILITARY SERVICE

Are you a veteran?*

Yes

Still serving - Active Duty

Still serving - Part-time/Reserve

Branch

Rank at Discharge

Served From

Served To

Type of Discharge

If discharge was not honorable, please explain

DL PHOTO

Upload a picture of the FRONT of your Driver's License (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".*

BACKGROUND CHECK CONSENT AND DISCLAIMER

By submitting this form, I hereby authorize the County to investigate all statements in this application and to secure any necessary information from all my employers, references, and academic institutions. I hereby release all of those employers, references, academic institutions, and the County from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with the County. Cleburne County offers employment to all eligible persons regardless of race, color, national origin, religion, gender, sexual orientation, age, disability, marital or veteran status, or any other legally protected status, and is an affirmative action/equal opportunity employer. I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated. In the event of my employment with the County, I will comply with all official policies of the County policy manual and or other communications distributed by the County and the department head.

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