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   Upson County Sheriff's Office Employment Application

6. Upson County Sheriff's Office
7. Sheriff Dan Kilgore
11. 235 Aviation Drive
12. Thomaston, GA 30286
13. 706-647-7411
15. Applicant requirements:

    Please attach to application the following:

    • 18 yrs. or older for Jail Officer
    • 21 yrs. or older for Deputy Sheriff
    • Must have a High School Diploma or G.E.D.
    • Be a United States Citizen (born or naturalized)
    • Birth Certificate
    • Possess a valid, current Georgia Driver's License
    • Military DD214
    • Ability to attain Peace Officer Certifications
    • Not prohibited by state or federal law from operating a motor vehicle
    • Must have a current working phone and transportation
    • Social Security Card

    Applicant must successfully complete an IPMA-HR Assessment Test.  Testing will be conducted at the Upson County Sheriff's Office at a date to be determined.

    DISQUALIFICATIONS Issues of prior misconduct, employee terminations, and non-felony arrests are usually not, in and of themselves, automatically disqualifying.  However, deliberate misstatements or omissions can and often will result in your application being rejected, regardless of the nature or reason for the misstatements/omissions.  In fact, the number one reason individuals "fail" background investigations is because they deliberately withhold or misrepresent job-relevant information from their prospective employer.  Be truthful, as there are criminal consequences for withholding information on a governmental document. Automatic basis for rejection: Felony Conviction or Family Violence Offense Currently under charge or indictment for any criminal offense or probation supervision Convictions for Driving While Intoxicated (DWI) within the last 5 years Conviction for crime of moral turpitude Drivers History that prohibits insurability Inability to qualify for Georgia Peace Officer Standards and Training Certification Recent drug use or excessive drug use in the past Dishonorable Discharge with any branch of the U.S. Military

    
    

17. Name
19. First*
20. Middle
21. Last*
23. Primary Job Classification(s) sought:*
25. Address
27. Number*
28. Street*
30. City*
31. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
32. Zip Code*
34. Email Address:*
35. Phone Number*
37. Alternate Phone Number*
39. Social Security Number*
40. Date of Application*
    Date of Application
42. Have you filled out an application here before?

    1. Yes
    2. No
43. If yes, When?
    If yes, When?
45. Have you been employed here before?

    1. Yes
    2. No
46. If yes, When?
    If yes, When?
48. Are you employed now?

    1. Yes
    2. No
49. May we contact your present employer?

    1. Yes
    2. No
51. If yes, please list contact information:
53. Are you prevented from lawfully becoming employed in this country because of Visa or immigration status? (Proof of citizenship or immigration status may be required upon employment)*

    1. Yes
    2. No
55. On what date would you be available to start work?*
    On what date would you be available to start work?
57. Are you available to work*

    1. Full Time
    2. Part-Time
    3. Shift
    4. Temporary
59. Are you on lay-off and subject to recall?*

    1. Yes
    2. No
61. Do you have a valid driver's license?*

    1. Yes
    2. No
63. Are you able to travel if the job requires it?*

    1. Yes
    2. No
65. Veteran of the U.S. Military Service?

    1. Yes
    2. No
66. If yes, select the appropriate Branch:
    -- Select One --ArmyNavyAir ForceCoast GuardMarine CorpsSpace Force
68. Have you been convicted of a felony?*

    1. Yes
    2. No
69. If yes, please explain
71. Indicate what foreign languages you speak, read, and/or write.
73. List professional, trade, business, or civic activities and offices held. (exclude those which indicate race, color, religion, sex, or national origin):
77. Give name, address, and telephone number of three references who are not related to you and are not previous employers.*
81. Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals with Physical or Mental Handicaps.

    Government contractors are subject to section 402 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans of the Vietnam Era, and section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.

    If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information.  The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job in a proper and safe manner. This information will be treated as confidential.  Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment.

    
    

83. If you wish to be identified, please sign below:

    1. Handicapped Individual
    2. Disabled Veteran
    3. Vietnam Era Veteran
85. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
87. Electronic Signature
89. Employment Experience

    Start with your present or last job, include military service assignments and volunteer activities.  Exclude organization names which indicate race, color, religion, sex or national origin.

91. Employer 1*
92. Dates Employed*
    Dates Employed Start Date

    —

    Dates Employed End Date
94. Address*
95. Job Title*
97. Work Performed*
98. Supervisor*
100. Reason for leaving*
104. Employer 2*
105. Dates Employed*
     Dates Employed Start Date

     —

     Dates Employed End Date
107. Address*
108. Job Title*
110. Work Performed*
111. Supervisor*
113. Reason for leaving*
117. Employer 3*
118. Dates Employed*
     Dates Employed Start Date

     —

     Dates Employed End Date
120. Address*
121. Job Title*
123. Work Performed*
124. Supervisor*
126. Reason for leaving*
130. Employer 4*
131. Dates Employed*
     Dates Employed Start Date

     —

     Dates Employed End Date
133. Address*
134. Job Title*
136. Work Performed*
137. Supervisor*
139. Reason for leaving*
141. If you need additional space, please type below.
143. Please attach your most current resume:*
144. Please attach a cover letter or other relevant file
146. Please attach optional relevant file
147. Please attach optional relevant file
149. Please attach optional relevant file
150. Please attach optional relevant file
152. Special Skills and Qualifications
154. Summarize special skills and qualifications acquired from employment or other experience.
158. Education
160. School Name*
161. Years Completed (check all that apply)*

     1. 4th Grade
     2. 5th Grade
     3. 6th Grade
     4. 7th Grade
     5. 8th Grade
163. High School Name*
164. Years Completed (check all that apply)*

     1. 9th Grade
     2. 10th Grade
     3. 11th Grade
     4. 12th Grade
166. Diploma/ Degree (describe course of study)*
168. College/University Name
169. Years Completed (check all that apply)

     1. 1
     2. 2
     3. 3
     4. 4
171. Diploma/Degree (describe course of study)
173. Graduate Professional School Name
174. Years Completed (check all that apply)

     1. 1
     2. 2
     3. 3
     4. 4
176. Diploma/ Degree (describe course of study)
178. Describe specialized training, Apprenticeship skills, and extra-curricular activities.
180. Honors Received:
182. State any additional information you feel may be helpful to us in considering your application.
184. Agreement

     I certify that the answers given 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.  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 of the rules and regulations of Upson County if I am employed.

186. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
188. Electronic Signature
190. Date
     Date
192. THIS APPLICATION WILL ONLY BE CONSIDERED FOR VACANCIES EXISTING ON OR WITHIN SIXTY (60) DAYS AFTER IT IS FILED WITH THE PERSONNEL OFFICE OF UPSON COUNTY.
194. Upson County
196. APPLICANT DATA RECORD

     Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition, handicap, or any other legally protected status.  As a governmental employer, we comply with all regulations and affirmative action responsibilities.

     The following information is required in order to comply with the permanent injunction referred to above.

198. Applicant's Full Name*
200. Applicant's Sex*

     1. Female
     2. Male
202. Applicant's Age (in years)*
204. Applicant's Race:*

     1. White
     2. Black
     3. Hispanic
     4. American Indian/ Alaskan Native
     5. Asian/ Pacific Islander
206. This information will be kept confidential and will only be utilized for the purposes required under applicable law.
210. ..

     Upson County Sheriff's Office 

     Supplemental Employment Information

212. Name:*
214. Address:*
215. City:*
217. State:*
218. Zip:*
220. Date of Birth:*
     Date of Birth:
221. Race:*
222. Sex:*
224. 1.) List all relatives employed with the Upson County Sheriff's Office:
226. Name:
227. Relationship:
229. Name:
230. Relationship;
232. Name:
233. Relationship:
235. 2.) Personal References: (List names, addresses and phone numbers of three references who are not relatives).
237. 1.) Reference Name:
239. Address
241. City
242. State
243. Zip Code
245. Telephone:
247. 2.) Reference Name
249. Address
251. City
252. State
253. Zip Code
255. Telephone:
257. 3.) Reference Name:
259. Address
261. City
262. State
263. Zip Code
265. Telephone:
267. 3.) Credit References: (If possible, please list names, addresses and telephone numbers of three active credit references within the last five years).
269. 1.) Business Name
271. Address
273. City
274. State
275. Zip Code
277. Telephone:
279. 2.) Business Name:
281. Address
283. City
284. State
285. Zip Code
287. Telephone:
289. 3.) Business Name:
291. Address
293. City
294. State
295. Zip Code
297. Telephone:
299. 4.) Have you ever served in any branch of the U.S. Military?

     1. Yes
     2. No
301. If yes, give branch, length of service, and discharge information.
303. Discharge Honorable:

     1. Yes
     2. No
304. Do you have DD214 paperwork?

     1. Yes
     2. No
306. 5.) List all states in which you have lived:
308. 6.) List all traffic citations, dates, and the court(s) dispositions.
310. 7.) List all criminal offenses you have been charged with and the dispositions.
312. 8.) Have you ever possessed or used illegal drugs?

     1. Yes
     2. No
313. If yes, please explain:
315. 9.) Have you ever consumed alcoholic beverages?

     1. Yes
     2. No
316. If yes, please explain quantity and consumption frequency:
318. 10.) Requirements for employment with the Upson County Sheriff's Office consist of the following test and documentations: Are you willing to provide and submit to upon request(s)?
320. a.) High School Diploma or G.E.D.

     1. Yes
     2. No
321. b.) Birth Certificate

     1. Yes
     2. No
323. c.) Valid Driver's License

     1. Yes
     2. No
324. d.) Military DD214

     1. Yes
     2. No
326. e.) Social Security Card

     1. Yes
     2. No
327. f.) Drug Screening

     1. Yes
     2. No
329. g.) Physical Exam

     1. Yes
     2. No
331. 11.) Can you type?

     1. Yes
     2. No
332. 12.) Do you have computer skills?

     1. Yes
     2. No
334. Under penalty of law, I hereby certify that the above information is true and correct to the best of my knowledge.
336. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
338. Electronic Signature
Leave This Blank:


340. 1. Receive an email copy of this form.
341. Email address

     This field is not part of the form submission.

342. Submit Submit and Print

* indicates a required field