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Applicant Information

First Name*
Last Name*
Address*
Address Line 2
City*
State*
Zip Code*
Phone Number*
Business Number
Email Address
Positions Applying for:*
Salary or Wages Expected*
What other work can you do?
What are your hobbies?
Are you a current participant or retired from any of the Kentucky Retirement Systems?*
1. Yes
2. No
If so, what system and when?*
Are you 21 years of age or older?*
1. Yes
2. No
Do you have a valid Driver's License? *
1. Yes
2. No
Have you filed an application here before?*
1. Yes
2. No
If yes, give date:*
If yes, give date:
Have you ever been employed here before?*
1. Yes
2. No
If yes, give date:*
If yes, give date: Start Date
—
If yes, give date: End Date
Are you employed now?*
1. Yes
2. No
May we contact your present employer?*
1. Yes
2. No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
1. Yes
2. No
Proof of citizenship or immigration will be required upon employment.
On what date would you be available for work?*
On what date would you be available for work?
Are you available to work:*
1. Full-time
2. Part-time
3. Seasonal
Are you on lay-off and subject to recall?*
1. Yes
2. No
Can you perform the essential functions of the position for which you are applying?*
1. Yes
2. No
What equipment can you operate pertaining to the job you are applying for?*
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Criminal Convictions

Have you ever been convicted of an offense against the law or forfeited collateral or are you now under charges for any offense against the Law except (1) traffic violations for which you paid a fine $65.00 or less; and (2) any offense committed before your 18th birthday which was finally adjudicated in a juvenile court or under a Youth Offender law?*
1. Yes
2. No
Have you ever been convicted of a felony?*
1. Yes
2. No
While in the military service were you ever convicted by a general court-martial?*
1. Yes
2. No
3. Not Applicable
If your answer is "Yes", give details below. Show for each offense: (1) date, (2) charge, (3) place, (4) court, and (5) action taken.*
NOTE: A conviction does not automatically mean you cannot be appointed. What you were convicted of, and how long ago, are important. Give all of the facts so that a decision can be made. Use additional sheets of paper if necessary.
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Education

Highschool
Name of institution
From - Thru
From - Thru Start Date
—
From - Thru End Date
Degree/Subject/Years Completed
College
Name of institution
From - Thru
From - Thru Start Date
—
From - Thru End Date
Degree/Subject/Years Completed
College
Name of institution
From - Thru
From - Thru Start Date
—
From - Thru End Date
Degree/Subject/Years Completed
Other
From - Thru
From - Thru Start Date
—
From - Thru End Date
Degree/Subject/Years Completed
Other
From - Thru
From - Thru Start Date
—
From - Thru End Date
Degree/Subject/Years Completed
Training
From - Thru
From - Thru Start Date
—
From - Thru End Date
Degree/Subject/Years Completed
Certification
From - Thru
From - Thru Start Date
—
From - Thru End Date
Degree/Subject/Years Completed
Certification
From - Thru
From - Thru Start Date
—
From - Thru End Date
Degree/Subject/Years Completed
Certification
From - Thru
From - Thru Start Date
—
From - Thru End Date
Degree/Subject/Years Completed
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Employment History

Present or Last Employer
Phone Number
Address
Address Line 2
City
State
Zip Code
Supervisor First Name
Supervisor Last Name
From - Thru
From - Thru Start Date
—
From - Thru End Date
Reason for Leaving
Title/Occupation
Wages
Per
Nature of Work Done
Next Previous Employer
Phone Number
Address
Address Line 2
City
State
Zip Code
Supervisor First Name
Supervisor Last Name
From - Thru
From - Thru Start Date
—
From - Thru End Date
Reason for Leaving
Title/Occupation
Wages
Per
Nature of Work Done
Next Previous Employer
Phone Number
Address
Address Line 2
City
State
Zip Code
Supervisor First Name
Supervisor Last Name
From - Thru
From - Thru Start Date
—
From - Thru End Date
Reason for Leaving
Title/Occupation
Wages
Per
Nature of Work Done
Next Previous Employer
Phone Number
Address
Address Line 2
City
State
Zip Code
Supervisor First Name
Supervisor Last Name
Address
From - Thru
From - Thru Start Date
—
From - Thru End Date
Reason for Leaving
Title/Occupation
Wages
Per
Nature of Work Done
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Character References

First Name
Last Name
Email Address
Address
City
State
Zip Code
Phone Number
Business Number
First Name
Last Name
Email Address
Address
City
State
Zip Code
Phone Number
Business Number
First Name
Last Name
Email Address
Address
City
State
Zip Code
Phone Number
Fax Number
State any additional information you feel may be helpful in considering your application.
Certification
Have you been completely truthful to all questions asked? Keep in mind the Kenton County Sheriff's Office VERIFIES the information given to further evaluate applicant(s) and to insure the information furnished by the applicant(s) has been truthful to the best of his or her knowledge. By submitting, you hereby certify that every statement made on this questionnaire is true and complete to the best of your knowledge. You understand that any false, misleading or incomplete answer may be grounds for not employing you or for dismissing you after you begin work. You understand you may be required to verify all information given on this questionnaire. Employment will be contingent upon result of a complete character/background investigation. You also understand that all appointments are probationary for a period of one year, during which time you must demonstrate your fitness for continued employment by the Kenton County Sheriff's Office. All employees hired by the Kenton County Sheriff's Office are subject to work schedules that may include any day of the week, (Monday through Sunday); (Holidays); and a scheduled shift dictated by management. Any employee hired by the Kenton County Sheriff's Office may be scheduled to work at any work station that is dictated by management. (I.E. Independence or Covington).

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Email address

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