General Application

Application & Background Packet

INSTRUCTION TO APPLICANT:

Please complete all sections of this packet. This will be part of your background investigation. Any falsification or omissions of information in this packet could result in a denial for hiring with our agency or denial for enrollment to the NLETC academy. Any future discovery of falsification or omissions of information in this packet could results in termination if you are hired.

If a section does not apply to you, market "N/A" for not applicable.

Please include any document files requested or referenced within this packet.

If you have any questions, please feel free to ask: Mark Ruby at mruby@gagecountyne.gov

Personal Identification

Legal Name

Current Address

Other Names Used:

Social Media

Please list the types of social media you currently use:

Company History

Please disclose any relations you have to Gage County Sherrif

Have you filled an application with us before? *
Have you been employed with us before? *
Do any of your friends or family, other than spouse, work here? *
Are you currently employed? *
May we contact your current employer? *
Are you lawfully authorized to work in the US *

Past Employer

Past Employer

Past Employer

Past Employer

Past Employer

Employment History

Please list your last 10 years of employment. List all full time and part time employment.

Past Employer

Past Employer

Past Employer

Past Employer

Past Employer

Past Employer

Education & Training History

List all schools attended starting with high school, followed by undergraduate, then graduate programs:

References

Personal References

Please list a minimum of 3 personal references who are not family members:

Authorization to Release Information

Reference:

To Whom It May Concern:

As an applicant for a position with the Gage County Sheriff's Office, I am required to furnish information for use in determining my moral, physical, and mental qualifications.

I respectfully request and authorize you to permit the background investigator(s) to review my personnel, credit, and medical records and to copy materials contained therein.

I hereby release you, you organization, or others from any liability or damage which may result from furnishing the requested information.

This authorization shall expire at the conclusion of this pre-employment background investigation.

Applicant Attestation Verification

I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the forgoing statements and answers to questions and that all statement and answers are true and correct to the best of my knowledge and belief.

I understand this information will be used in my background investigation. I understand that any misrepresentations, omissions, or falsifications could disqualify me from consideration for employment, or if hired, could be grounds for termination.