PLPSLA Employment Application

[{"type":"checkbox-group","required":true,"label":"Position Applying For:","inline":true,"name":"Position-Applying-For","other":true,"className":"col-md-6","values":[{"label":"Clerk","value":"Clerk"},{"label":"Corrections","value":"Corrections"},{"label":"Dispatcher","value":"Dispatcher"},{"label":"Patrol","value":"Patrol"},{"label":"Reserve","value":"Reserve"}]},{"type":"checkbox-group","required":true,"label":"Type of Employment (select all types sought):","inline":true,"name":"Employment-Type","className":"col-md-6","values":[{"label":"Full Time","value":"Full Time"},{"label":"Part Time","value":"Part Time"},{"label":"Temporary","value":"Temporary"},{"label":"Reserve","value":"Reserve"}]},{"type":"date","required":true,"label":"Date of Application","name":"Date-of-Application","className":"col-md-6 col-lg-3"},{"type":"text","required":true,"label":"Applicant Full Name ","placeholder":"First, Middle, Last","name":"Applicant-Full-Name","className":"col-md-6","subtype":"text"},{"type":"text","label":"Other Name(s) Used","description":"Examples: maiden name, former name(s), alias(es), or nickname(s)","name":"Other-Names-Used","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"Social Security Number","placeholder":"xxx-xx-xxxx","name":"Social-Security-Number","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"date","required":true,"label":"Date of Birth","name":"Date-of-Birth","className":"col-md-6 col-lg-3"},{"type":"select","required":true,"label":"Are you at least 18 years of age? Proof of age will be required upon employment.","name":"Are-you-at-least-18-years-of-age","className":"col-md-6","values":[{"label":"Yes","value":"Yes","selected":true},{"label":"No","value":"No"}]},{"type":"text","required":true,"label":"Street Address","name":"Street-Address","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"City","name":"City","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","required":true,"label":"State","name":"State-of-residence","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA","selected":true},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","required":true,"label":"Zip Code","name":"Zip-Code","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"Phone Number","name":"Phone-Number","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"email","required":true,"label":"Email","name":"email","className":"col-lg-4"},{"type":"text","subtype":"email","required":true,"label":"Email Confirmation","name":"email-confirmed","className":"col-lg-4"},{"type":"text","label":"Social Media Accounts","placeholder":"Account Username(s)","name":"Social-media-accounts","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Drivers License Number","name":"Drivers-License-number","className":"col-lg-4","subtype":"text"},{"type":"select","required":true,"label":"Drivers License Issuing State","name":"Drivers-License-Issuing-State","className":"col-lg-4","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA","selected":true},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"radio-group","required":true,"label":"Do you have any relative(s) currently employed or were employed within the last year by the Sheriff's Office?","inline":true,"name":"Do-you-have-any-relatives-currently-employed-or-were-employed-within-the-last-year-by-the-Sheriffs-Office","className":"d-block","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"paragraph","subtype":"p","label":"If yes to above question, please list the relative(s) name and division in which they were employed.","className":"d-block"},{"type":"text","label":"Relative Full Name","placeholder":"First, Last","name":"Relative-Full-Name","className":"col-md-6","subtype":"text"},{"type":"text","label":"Relative Employment Division","name":"Relative-Employment-Division","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"Background Information","className":"d-block"},{"type":"text","required":true,"label":"City of Birth","name":"City-of-Birth","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"County of Birth","name":"County-of-Birth","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","required":true,"label":"State of Birth","name":"State","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA","selected":true},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","required":true,"label":"Country of Birth","name":"Country-of-Birth","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<b>NOTE:</b> Original or Certified Copy of Birth Certificate must be brought in upon interview.","className":"d-block"},{"type":"radio-group","required":true,"label":"Are you a US Citizen? (If naturalized, original documentation must be brought in upon interview)","inline":true,"name":"Are-you-a-US-Citizen","className":"col-md-6","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"radio-group","required":true,"label":"Marital Status","inline":true,"name":"Marital-Status","className":"col-md-6","values":[{"label":"Married","value":"Married"},{"label":"Divorced","value":"Divorced"},{"label":"Separated","value":"Separated"},{"label":"Widowed","value":"Widowed"},{"label":"Never Married","value":"Never Married"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"Education/Training","className":"d-block"},{"type":"header","subtype":"h3","label":"High School","className":"d-block"},{"type":"text","required":true,"label":"High School Name","name":"High-School-Name","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","required":true,"label":"Did you Graduate High School?","name":"Did-you-graduate-high-school","className":"col-md-6 col-lg-3","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No","selected":true}]},{"type":"select","label":"Do you have a High School Diploma or GED?","name":"High-School-Diploma-Type","className":"col-md-6 col-lg-3","values":[{"label":"Diploma","value":"Diploma"},{"label":"GED","value":"GED"},{"label":"None","value":"None"}]},{"type":"date","label":"When did you Graduate High School?","name":"High-School-Graduation-Date","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":"<b>NOTE:</b> Must be able to provide Original Diploma or Certified Transcript.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"College/University","className":"d-block"},{"type":"text","label":"College Name","name":"College-Name","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"Did you Graduate College?","name":"Did-you-graduate-college","className":"col-md-6 col-lg-3","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No","selected":true},{"label":"Still Attending","value":"Still Attending"}]},{"type":"text","label":"Type of Degree","name":"College-Degree-Earned","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"date","label":"When did you Graduate College?","name":"College-Graduation-Date","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":"<b>NOTE:</b> Must be able to provide Original Diploma or Certified Transcript from last institution or higher education.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"Other Schools (Trade, Vocational, Business or Military)","className":"d-block"},{"type":"text","label":"Other School Name","name":"Other-School-Name","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Other School Area of Study","name":"Other-School-Area-of-Study","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"Did You Graduate Other School?","name":"Did-You-Graduate-Other-School","className":"col-md-6 col-lg-3","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"},{"label":"Still Attending","value":"Still Attending"}]},{"type":"date","label":"When did you Graduate Other School?","name":"Other-School-Graduation-Date","className":"col-md-6 col-lg-3"},{"type":"textarea","label":"Describe any awards, honors, citations, positions held in school organizations, and any other special recognition you received while attending school.","name":"Describe-Awards-while-in-school","subtype":"textarea","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<b>NOTE:</b> Must be able to provide additional Education Diplomas, Certificates, or Transcripts (if applicable).","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"Languages","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Please list any foreign languages known, level of proficiency, and manner proficient (e.g.: speak, read, write).","className":"d-block"},{"type":"text","label":"First Foreign Language Known","name":"First-Foreign-Language-Known","className":"col-lg-4","subtype":"text"},{"type":"text","label":"First Foreign Language Level of Proficiency ","name":"First-Foreign-Language-Level-of-Proficiency","className":"col-lg-4","subtype":"text"},{"type":"text","label":"First Foreign Language Manner of Proficiency ","description":"ex. Speak, read, write, etc.","name":"First-Foreign-Language-Manner-of-Proficiency","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Second Foreign Language Known","name":"Second-Foreign-Language-Known","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Second Foreign Language Level of Proficiency ","name":"Second-Foreign-Language-Level-of-Proficiency","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Second Foreign Language Manner of Proficiency","description":"Ex. Speak, Read, Write, etc.","name":"Second-Foreign-Language-Manner-of-Proficiency","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"Training","className":"d-block"},{"type":"select","required":true,"label":"Are you currently a licensed Peace Officer in the state of Louisiana?","name":"Are-you-currently-a-licensed-Peace-Officer-in-the-state-of-Louisiana","className":"col-md-6 col-lg-3","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No","selected":true}]},{"type":"text","label":"If yes, please enter P.O.S.T. number.","name":"POST-Number","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"textarea","label":"List any law enforcement education/training.","name":"List-any-law-enforcement-educationtraining","subtype":"textarea","className":"col-md-6"},{"type":"textarea","required":true,"label":"Describe any special abilities, interests and/or hobbies including the degree of proficiency.","name":"Describe-any-special-abilities-interests-andor-hobbies-including-the-degree-of-proficiency","subtype":"textarea","className":"d-block"},{"type":"textarea","label":"List any type of special license (such as pilot, radio operator, etc.) to include licensing authority, where license issued, and date current license expires (excepting vehicle operator's license).","name":"List-any-type-of-special-license-such-as-pilot-radio-operator-etc-to-include-licensing-authority-where-license-issued-and-date-current-license-expires-excepting-vehicle-operators-license","subtype":"textarea","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"Military","className":"d-block"},{"type":"select","required":true,"label":"Have you ever served in the military?","name":"Have-you-served-in-the-military","className":"col-lg-4","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No","selected":true}]},{"type":"select","label":"If yes, what is your military status?","name":"military-status","className":"col-lg-4","values":[{"label":"Active Duty","value":"Active Duty"},{"label":"Reserve/National Guard","value":"Reserve/National Guard"},{"label":"Inactive","value":"Inactive","selected":true}]},{"type":"text","label":"If yes, what is your discharge type?","name":"Military-Discharge-Type","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<b>NOTE:</b> Must be able to provide DD214.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"Employment History","className":"d-block"},{"type":"paragraph","subtype":"p","label":"List chronologically all employment for the previous 10 years beginning with present employment, including summer and part-time employment while attending school. All time must be accounted for, if unemployed for a period, set forth dates of unemployment.","className":"d-block"},{"type":"header","subtype":"h4","label":"Employer 1","className":"d-block"},{"type":"text","required":true,"label":"Employer One Name","placeholder":"First, Last","name":"Employer-One-Name","className":"col-md-6","subtype":"text"},{"type":"date","label":"Employer One Start Date","name":"Employer-One-Start-Date","className":"col-md-6 col-lg-3"},{"type":"date","label":"Employer One End Date","name":"Employer-One-End-Date","className":"col-md-6 col-lg-3"},{"type":"text","required":true,"label":"Employer One Street Address","name":"Employer-One-Street-Address","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Employer One City","name":"Employer-One-City","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"Employer One State","name":"Employer-One-State","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA","selected":true},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"Employer One Zip Code","name":"Employer-One-Zip-Code","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"Employer One Supervisor Name","name":"Employer-One-Supervisor-Name","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","label":"Employer One Phone Number","name":"Employer-One-Phone-Number","className":"col-md-6"},{"type":"text","required":true,"label":"Position at Employer One","name":"Position-at-Employer-One","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","required":true,"label":"Employer One Employment Status","name":"Employer-One-Employment-Status","className":"col-md-6 col-lg-3","values":[{"label":"Full Time","value":"Full Time"},{"label":"Part Time","value":"Part Time"},{"label":"Internship","value":"Internship"},{"label":"Temporary","value":"Temporary"}]},{"type":"text","label":"Employer One Salary","name":"Employer-One-Salary","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","required":true,"label":"Employer One Salary Type","name":"Employer-One-Salary-Type","className":"col-md-6 col-lg-3","values":[{"label":"Hourly","value":"Hourly"},{"label":"Weekly","value":"Weekly"},{"label":"Bi-Weekly","value":"Bi-Weekly"},{"label":"Monthly","value":"Monthly"},{"label":"Annually","value":"Annually"}]},{"type":"textarea","required":true,"label":"Description of Duties at Employer One","name":"Description-of-Duties-at-Employer-One","subtype":"textarea","className":"col-md-6"},{"type":"textarea","required":true,"label":"Reason for Leaving Employer One","name":"Reason-for-Leaving-Employer-One","subtype":"textarea","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"header","subtype":"h4","label":"Employer 2","className":"d-block"},{"type":"text","label":"Employer Two Name","placeholder":"First, Last","name":"Employer-Two-Name","className":"col-md-6","subtype":"text"},{"type":"date","label":"Employer Two Start Date","name":"Employer-Two-Start-Date","className":"col-md-6 col-lg-3"},{"type":"date","label":"Employer Two End Date","name":"Employer-Two-End-Date","className":"col-md-6 col-lg-3"},{"type":"text","label":"Employer Two Street Address","name":"Employer-Two-Street-Address","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Employer Two City","name":"Employer-Two-City","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"Employer Two State","name":"Employer-Two-State","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA","selected":true},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"Employer Two Zip Code","name":"Employer-Two-Zip-Code","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Employer Two Supervisor Name","name":"Employer-Two-Supervisor-Name","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","label":"Employer Two Phone Number","name":"Employer-Two-Phone-Number","className":"col-md-6"},{"type":"text","label":"Position at Employer Two","name":"Position-at-Employer-Two","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"Employer Two Employment Status","name":"Employer-Two-Employment-Status","className":"col-md-6 col-lg-3","values":[{"label":"Full Time","value":"Full Time"},{"label":"Part Time","value":"Part Time"},{"label":"Internship","value":"Internship"},{"label":"Temporary","value":"Temporary"}]},{"type":"text","label":"Employer Two Salary","name":"Employer-Two-Salary","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"Employer Two Salary Type","name":"Employer-Two-Salary-Type","className":"col-md-6 col-lg-3","values":[{"label":"Hourly","value":"Hourly"},{"label":"Weekly","value":"Weekly"},{"label":"Bi-Weekly","value":"Bi-Weekly"},{"label":"Monthly","value":"Monthly"},{"label":"Annually","value":"Annually"}]},{"type":"textarea","label":"Description of Duties at Employer Two","name":"Description-of-Duties-at-Employer-Two","subtype":"textarea","className":"col-md-6"},{"type":"textarea","label":"Reason for Leaving Employer Two","name":"Reason-for-Leaving-Employer-Two","subtype":"textarea","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"header","subtype":"h4","label":"Employer 3","className":"d-block"},{"type":"text","label":"Employer Three Name","placeholder":"First, Last","name":"Employer-Three-Name","className":"col-md-6","subtype":"text"},{"type":"date","label":"Employer Three Start Date","name":"Employer-Three-Start-Date","className":"col-md-6 col-lg-3"},{"type":"date","label":"Employer Three End Date","name":"Employer-Three-End-Date","className":"col-md-6 col-lg-3"},{"type":"text","label":"Employer Three Street Address","name":"Employer-Three-Street-Address","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Employer Three 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Be sure to include student loans and charge accounts. Also, list any debt where payment is past due, regardless of amount.","name":"If-yes-please-list-all-debts-over-50000-Be-sure-to-include-student-loans-and-charge-accounts-Also-list-any-debt-where-payment-is-past-due-regardless-of-amount","subtype":"textarea","className":"col-md-6"},{"type":"radio-group","required":true,"label":"Have you, your spouse, or a company controlled by you filed for bankruptcy?","inline":true,"name":"Have-you-your-spouse-or-a-company-controlled-by-you-filed-for-bankruptcy","className":"col-lg-4","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"radio-group","required":true,"label":"Have you had a legal judgment rendered against you for a debt?","inline":true,"name":"Have-you-had-a-legal-judgment-rendered-against-you-for-a-debt","className":"col-lg-4","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"radio-group","required":true,"label":"Have you been subject to a tax 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provided in this \"Confidential Employee History\" and \"Drug History\".  I further accept that by entering my name in the signature box below, I am agreeing that the answers provided are true and correct to the best of my knowledge.","className":"d-block"},{"type":"text","required":true,"label":"Applicants Certification","placeholder":"Disclaimer: By typing your name, you are signing this document.","name":"By-entering-your-name-in-the-box-you-are-agreeing-that-the-answers-provided-are-true-and-correct-to-the-best-of-your-knowledge","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Date signed","name":"date-signed","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"Applicants Certification","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Read each box carefully and check each box upon completion certifying you have read and understand each 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I agree to the conditions and certify that all statements made by me on this application are true, correct and complete, to the best of my knowledge. I further fully understand and consent to a polygraph examination concerning the veracity of my responses to the information requested on this application or which is discovered as a result of the background investigation, or any physical examination or drug test. I also understand that I will be fingerprinted. I understand that this employment application shall become the property of the Sheriff's Office and that it and the information received in response to the background examination are public records.","name":"I-am-aware-that-any-omission-falsification-misstatement-or-misrepresentation-will-be-the-basis-for-my-disqualification-as-an-applicant-or-dismissal-from-the-Sheriffs-Office","className":"d-block","values":[{"label":"I understand","value":"I understand"}]},{"type":"checkbox-group","required":true,"label":"I understand and agree that my employment or appointment will be contingent upon the results of a complete drug test and that I may be required to take drug tests during the term of my employment or appointment with the Sheriff's Office.","name":"I-understand-and-agree-that-my-employment-or-appointment-will-be-contingent-upon-the-results-of-a-complete-drug-test-and-that-I-may-be-required-to-take-drug-tests-during-the-term-of-my-employment-or-appointment-with-the-Sheriffs-Office","className":"d-block","values":[{"label":"I understand","value":"I understand"}]},{"type":"checkbox-group","required":true,"label":"I understand that the use of drugs or alcohol is not permitted during work or duty time, whether paid or unpaid, in the areas, including vehicles, where work is performed by employees or appointees.","name":"I-understand-that-the-use-of-drugs-or-alcohol-is-not-permitted-during-work-or-duty-time-whether-paid-or-unpaid-in-the-areas-including-vehicles-where-work-is-performed-by-employees-or-appointees","className":"d-block","values":[{"label":"I understand","value":"I understand"}]},{"type":"checkbox-group","required":true,"label":"I understand that my continued employment or appointment may be contingent upon the results of medical or psychological examinations that I may be required to take during the term of my employment or appointment and the maintenance of personal physical fitness, to the degree necessary, to satisfactorily perform the duties of my position or assignment.","name":"I-understand-that-my-continued-employment-or-appointment-may-be-contingent-upon-the-results-of-medical-or-psychological-examinations-that-I-may-be-required-to-take-during-the-term-of-my-employment-or-appointment-and-the-maintenance-of-personal-physical-fitness-to-the-degree-necessary-to-satisfactorily-perform-the-duties-of-my-position-or-assignment","className":"d-block","values":[{"label":"I understand","value":"I understand"}]},{"type":"checkbox-group","required":true,"label":"I further authorize the Sheriff's Office or agent of the Sheriff's Office, without need of further authorization, to obtain medical records allowed by law if I claim rights to payment or receipt of any benefit pursuant to state or federal law.","name":"I-further-authorize-the-Sheriffs-Office-or-agent-of-the-Sheriffs-Office-without-need-of-further-authorization-to-obtain-medical-records-allowed-by-law-if-I-claim-rights-to-payment-or-receipt-of-any-benefit-pursuant-to-state-or-federal-law","className":"d-block","values":[{"label":"I understand","value":"I understand"}]},{"type":"checkbox-group","required":true,"label":"I agree to execute any authorization as may be required by the Health Insurance Portability Accountability Act of 1996 (HIPAA) for health care providers to release the necessary medical information to process my application for employment.","name":"I-agree-to-execute-any-authorization-as-may-be-required-by-the-Health-Insurance-Portability-Accountability-Act-of-1996-HIPAA-for-health-care-providers-to-release-the-necessary-medical-information-to-process-my-application-for-employment","className":"d-block","values":[{"label":"I understand","value":"I understand"}]},{"type":"checkbox-group","required":true,"label":"I understand and agree that any employment or appointment offered to me will be contingent upon my acceptance of compensatory time off, instead of cash, in payment for overtime hours that I work, to the extent allowed by law. 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Because of this, are you aware of any information about yourself or any person with whom you are or had been closely associated (including relatives, roommates, etc.) which might tend to reflect unfavorably on your reputation, morals, character or ability?","inline":true,"name":"I-understand-an-investigation-will-be-conducted-on-all-of-the-information-listed-on-this-application-Because-of-this-are-you-aware-of-any-information-about-yourself-or-any-person-with-whom-you-are-or-had-been-closely-associated-including-relatives-roommates-etc-which-might-tend-to-reflect-unfavorably-on-your-reputation-morals-character-or-ability","className":"col-md-6","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"textarea","label":"If applicable, provide your version or explain fully any such incident.","name":"If-applicable-provide-your-version-or-explain-fully-any-such-incident","subtype":"textarea","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"file","required":true,"label":"Please attach the signed Employment Applicant Certification (link is available at the top of this form).","name":"Employment-Applicant-Certification","subtype":"file","multiple":true,"className":"col-lg-4"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"By entering my name in the box below, I am certifying that I have fully read and understand the above certifications. I also agree that such entry of my name shall act as my digital signature of this application.","className":"d-block"},{"type":"text","required":true,"label":"Signature of applicant as usually written","placeholder":"Disclaimer: By typing your name, you are signing this document.","name":"Signature-of-applicant-as-usually-written","className":"col-lg-4","subtype":"text"},{"type":"date","required":true,"label":"Date Signed","name":"Date-Signed","className":"col-lg-4"},{"type":"text","required":true,"label":"Witnessed by:","name":"Witnessed-by","className":"col-lg-4","subtype":"text"}]