Email*


First name*


Middle name*


Last name*


Suffix

Date of Birth*

Address*

Cell Phone


Home Phone


Other Phone

Sex*
MaleFemale
Height*


Weight*

Alias Names (include maiden name if applicable)

List all relatives/family members and their division that are employed by Jasper County.

Employment Type*
Full TimePart Time

Positions Applied For*
Civil ProcessClericalCourt Security/BailiffDetentionInvestigative UnitMaintenancePatrolReservesTransportationWarrantsOther

Do you currently possess a High School Diploma or GED?*
YesNo
Are you currently a United States Citizen?*
YesNo
Do you currently have a valid driver license?*
YesNo
Are you at least 21 years of age (18 for Detention or Clerical positions)?*
YesNo
Have you ever been convicted of a felony offense?*
YesNo

Have you ever been convicted of a domestic violence offense or any charge that was reduced from the charge of domestic violence?*
YesNo
Have you ever been convicted of more than one DWI/Excessive BAC offense?*
YesNo
Have you been convicted of a DWI/Excessive BAC offense within the last five years?*
YesNo
Have you used any illegal substances during the last 12 months?*
YesNo
Have you ever been a member of a terrorist group, street gang, or other organization that promotes or participates in criminal activity?*
YesNo

Operator License Information

License Number*


State*
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Expiration date*

Law Enforcement/Military Experience

Are you POST Certified
YesNo
Do you have previous law enforcement experience?
YesNo

Did you serve in the United States Military?
YesNo