Goochland County Sheriff Application for Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

APPLICATION SUBMISSION INFORMATION:

Applications that are incomplete will not be considered.
All applications should be typed.
Electronic signatures are permitted for electronic submission of applications but, all applicants must provide original signatures if invited to test.
If you prefer to print the application, tap here to save an uncompleted copy to your device. Completed applications may be emailed to [email protected], faxed (804) 556-5672 or mailed to Goochland County Sheriff's Office P.O. Box 29 Goochland, VA 23063.

Positions Applied For

Date of Application

MM slash DD slash YYYY

How Did You Learn About Us

Friend

Walk-In

Employment Agency

Relative

Other

Please let us know how you learned about us

Last Name

First Name

Middle Name

Address, Number, Street

City

State

Zip

Telephone Number

Social Security Number

Email Address

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes

Have you ever filed an application with us before?

Yes

If Yes, Give Date

MM slash DD slash YYYY

Have you ever been employed with us before?

Yes

If Yes give date

MM slash DD slash YYYY

Are you currently employed?

Yes

May we contact your present employer?

Yes

Are you prevented from lawfully becoming employed in this Country because of Visa or Immigration Status?

Proof of citizenship or immigration status will be required upon employment.

Yes

On what date would you be available for work?

MM slash DD slash YYYY

Are you available to work:

Full Time

Part Time

Shift Work

Temporary

Are you currently on “lay-off” status and subject to recall?

Yes

Can you travel if a job requires it?

Yes

Have you been convicted of a felony within the last 7 years?

Conviction will not necessarily disqualify an applicant from employment.

Yes

If Yes, please explain

Education

Elementary School

Name & Address

Course of Study

Years Completed

Diploma/Degree

High School

Name & Address

Course of Study

Years Completed

Diploma/Degree

Undergraduate School

Name & Address

Course of Study

Years Completed

Diploma/Degree

Graduate Professional

Name & Address

Course of Study

Years Completed

Diploma/Degree

Other (Specify)

Name & Address

Course of Study

Years Completed

Diploma/Degree

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States Military.

List professional, trade, business or civic activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer

Date Employed: From

MM slash DD slash YYYY

Date Employed: To

MM slash DD slash YYYY

Work Performed

Employer Address

Telephone Numbers

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Job Title

Supervisor

Reason for Leaving

Employer

Date Employed: From

MM slash DD slash YYYY

Date Employed: To

MM slash DD slash YYYY

Work Performed

Employer Address

Telephone Number

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Job Title

Supervisor

Reason for Leaving

Employer

Date Employed: From

MM slash DD slash YYYY

Date Employed: To

MM slash DD slash YYYY

Work Performed

Employer Address

Telephone Number

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Job Title

Supervisor

Reason for Leaving

Employer

Date Employed: From

MM slash DD slash YYYY

Date Employed: To

MM slash DD slash YYYY

Work Performed

Employer Address

Telephone Number

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Job Title

Supervisor

Reason for Leaving

Additional Information

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills

Check Skills/Equipment Operated

Calculator

Typewriter

Fax

Microsoft Office

Production/Mobile Machinery (1)

Production/Mobile Machinery (2)

Production/Mobile Machinery (3)

Production/Mobile Machinery (4)

Other (1)

Other (2)

Other (3)

Other (4)

State any additional information you feel may be helpful to us in considering your application.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A description of the activities involved in such a job or occupation is attached.

Yes

References

Name

Address

Phone

Applicant’s Statement

I certify that answers herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Signature of Applicant

Date

MM slash DD slash YYYY

Hidden

FOR PERSONNEL DEPARTMENT USE ONLY

Hidden

Arrange Interview

Yes

Hidden

Remarks

Hidden

Date

MM slash DD slash YYYY

Hidden

Employed

Yes

Hidden

Date of Employment

MM slash DD slash YYYY

Hidden

Job Title

Hidden

Hourly Rate/Salary

Hidden

Department

Hidden

Name & Title

Hidden

Date

MM slash DD slash YYYY

Hidden

Notes:

COUNTY OF GOOCHLAND DISCLOSURE OF CRIMINAL HISTORY RECORD FOR APPLICANTS

Article IV, “Criminal Background Check,” of Chapter 10 of Goochland County Code, states, among other things, that the County will conduct a criminal history record check on each applicant for employment under contract with any County agency, each applicant for employment by any agency or intergovernmental authority of which the County is a member, and each applicant for County volunteer service. In accordance with this provision, if you wish to be considered an applicant of the County, please complete the information below:

Have you ever been convicted of any violation(s) of law, including moving traffic violations or juvenile convictions committed after your fourteenth birthday?

Yes

If yes, please provide the following, in the space provided: description of offense, statue or ordinance (if known), date of charge, date of conviction, county, city, and state of conviction. For additional convictions, use plain paper. Include all information listed above.

Are charges pending against you, or are you the subject of any pending charges, for any offense inside or outside the Commonwealth of Virginia?

Yes

If yes, list all and explain:

I hereby certify that these responses are true and complete. I agree and understand that any false statement in response to these questions, regardless of time of discovery, may cause me to forfeit my employment with or service to the County of Goochland. I understand and agree that this information is subject to verification by the County. I further understand that a conviction(s) will not necessarily disqualify me from employment with the County.

Date

MM slash DD slash YYYY

Signature