Employment Application

Application Type

Full Time

Part Time (Must Have 3 years of prior full time service with the WCSO. At will position)

Part Time Court Officer Position (Must be MCOLES Certified or Certifiable. At will position)

Do you have 3 years of full time service with the Wayne County Sheriffs Office?

Yes

No

YOU MUST HAVE 3 YEARS OFF FULL TIME SERVICE WITH THE WAYNE COUNTY SHERIFF'S OFFICE TO APPLY FOR THIS POSITION

Are you MCOLES Certified or Certifiable?

Yes

No

Enter Your MCOLES Number

YOU MUST BE MCOLES CERTIFIED OR CERTIFIABLE TO APPLY FOR THIS POSITION

Name

First

Middle

Last

Are you 18 years of age or older?

Yes

No

Birthdate

YOU MUST BE OVER THE AGE OF 18 TO APPLY. YOU WILL NOT BE ABLE TO SUBMIT THE APPLICATION

Race

For Law Enforcement Inquiry purposes

Sex

Height

Weight

Hair Color

Eye Color

List any maiden names; aliases or former names

Scars/Marks/Tattoos

Yes

None

Describe Scars/Marks/Tattoos

Leave Blank if N/A

Address

Include apartment number if applicable

City

State/Province

Zip/Postal

On what date did you first live at your present address?

Place of Birth, City and State

Phone

Email

SS#

Driver’s License Number

DL State

Expiration Date

Have you ever been convicted of a Felony?

Yes

No

The State of Michigan prohibits law enforcement agencies from hiring individuals who have ever been convicted of a felony offense. This prohibition includes felony convictions that have been expunged.

YOU WILL NOT BE ABLE TO SUBMIT THE APPLICATION

Upload a Copy of your Drivers License

Maximum file size: 134.22MB

List approximate number of points for moving violations (in the last 2-years and last 5-years)

Have you ever been dismissed or requested to resign from a former position?

Yes

No

You answered yes to the Following question "Have you ever been dismissed or requested to resign from a former position?" Please Explain

Have you received any traffic violations/tickets in the last 5 years

Yes

No

List all traffic violation tickets you have received in the past 5-years.

Traffic Violation Tickets

Add Traffic Violation Ticket Remove

List any warning letters for poor driving record, suspensions, or revocations received. Include the date(s) and type of action. NOTE: Failure to indicate a warning letter for a poor driving record (past or current), a suspension, a restriction or a revocation is grounds for immediate rejection of your application. If yes, please explain

Have you ever been employed by Wayne County?

Yes

No

Did you graduate High School?

Yes

No

If not, do you have a GED?

Yes

No

Date of High School Graduation

Name of High School

High School Address, City/State

City

State/Province

Zip/Postal

Did you attend college?

Yes

No

College Information

Name of College

Address of College

Years Attended

Degree Attained

Add a College Remove

Upload a copy of Diploma, GED, College degree. (optional)

Maximum file size: 134.22MB

Other Schools or Training

for example: trade, vocational, Armed Forces, or business

For each, give the name and location (city, state, and Zip Code, if known) of school, dates attended, subjects studied, number of classroom hours of instruction per week, certificate and any other pertinent data.

Add Remove

What occupational license, registration, certificate, or journeyman’s card do you hold?

Type, license number, expiration date.

Upload a photo copy of the license

Maximum file size: 134.22MB

Add occupational license, registration, certificate, or journeyman’s card Remove

Was any of the education or experience claimed on this application obtained under any other name?

Yes

No

Please provide the other name and date the name was changed.

Are you a citizen of the United States?

Yes

No

Give addresses of other places that you have lived in the past five (5) years, and dates of residence.

Address

City

State/Province

Zip/Postal

Country

Add Address Remove

Have you ever been arrested or charged with a criminal offense?

Yes

No

This includes those which resulted in dismissal or acquittal and your arrest records have been returned to you. This also includes convictions which were ultimately overturned, dismissed, or expunged. The fact that you were arrested, or the number of arrests will not affect your application. However, failure to indicate an arrest is grounds for automatic disqualification of your application based on dishonesty.

List all arrests and approximate arrest dates, outcomes of case.

arrests and approximate arrest dates, outcomes of case.

Add Arrest Remove

Have you ever been convicted, (fined, placed on probation, sentenced to jail or given a suspended sentence) for any violation of law other than minor traffic violations (including expungements and dismissals)?

Yes

No

Please Explain

Are there felony charges pending against you?

Yes

No

Please Explain Pending Felony Charges

Person you wish to be notified in case of an emergency?

Name

Phone

Address

Email

Do you have any other source of income other than your salary?

Yes

No

Please Provide the Source

Do you know of anyone who may try to injure you in any way?

Yes

No

Please Provide details & Explanation

Did you serve in the Armed Forces?

Yes

No

Armed Forces Information

Which Branch?

Currently active?

Yes

No

Anticipated Discharge Date

Did you receive an honorable discharge?

Yes

No

Upload a copy of DD-214 (optional)

Maximum file size: 134.22MB

Were you ever court martialed?

Yes

No

Please Explain

Have you ever applied to another Law Enforcement Agency?

Yes

No

List the agencies and dates applied

Were you ever rejected for employment by a law enforcement/ security/corrections department?

Yes

No

Agency Information

Agency

Date Applied

Date Rejected

Reason for Rejection

Add Agency Remove

Have you ever been investigated by the Wayne County Sheriff’s Office, or by any other law enforcement agency?

Yes

No

Section

Agency

State

Date of Investigation

Provide 5 References

The References you provide may not be a relative

Name of Reference

First

Last

Address of Reference

City

State/Province

Zip/Postal

Phone Number of Reference

Email of Reference

Add Reference Remove

Authorization to Release Information

WAYNE COUNTY SHERIFF’S OFFICE
AUTHORITY TO RELEASE INFORMATION

I authorize representatives and agents of the Wayne County Sheriff’s Office to investigate all statements contained in this application, including records of any former employers, police departments, courts, my complete and unedited criminal history, and other references or sources concerning me. I authorize all such references and sources (and any company) to release this information without liability for damage resulting from such release. I waive any written notice of the release of such records that may be required by state or federal law.

I authorize a review of and full disclosure of all records, or any part thereof, concerning myself, by and to ANY duly authorized agent of the Wayne County Sheriff’s Office, within one year of its’ date, whether the said records are public, private, or confidential.

The intent of this authorization is to give my consent for full and complete disclosure of information including but not limited to: military records, the records of educational institutions, financial or credit institutions, public utility companies, employment and pre-employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me, salary records, real and personal property tax statement and records, and other financial statements and records wherever filed; records of complaint, arrest, trial and/or convictions for alleged or actual violations of law, including criminal, civil, and/or traffic records, records of complaint of a civil nature made by or against me, wheresoever filed.

I reiterate an emphasize that the intent of this authorization is to provide full and free access to the background and history of my personal life, for the specific purpose of pursuing a background investigation, which may provide pertinent data for the Wayne County Sheriff’s Office to consider in determining my suitability for employment by that department. It is my specific intent to provide access to personal information, however personal or confidential it may appear to be, and the sources of information specifically identified herein.

I understand that any information obtained by a personal history background investigation, which is developed directly or indirectly, in whole or in part, upon this release authorization will be considered in determining my suitability for employment by the Wayne County Sheriff’s Office. I understand that all materials pertaining to this background investigation become the property of the Wayne County Sheriff’s Office and will not be returned to me.

I agree to indemnify and hold harmless the person to whom this request is presented and his agents, employees and related personnel, both individually and collectively, from and against all claims, damages, losses and expenses, including reasonable attorney fees arising out of or by reason of complying with this request. I further understand that in the event my application is disapproved, the sources of confidential information cannot be revealed to me.

A photocopy of this release form will be valid as an original hereof, even though the said photocopy does not contain an original writing of my signature.

Signature

Clear

Text

Current / Prior Work History

Account for All of your time in the past TEN (10) years, and any earlier experience which qualifies you for the position for which you are applying. If more than one position was held under the same employer, describe each position separately. Periods not worked must also be indicated (homemaker, military service, unemployed, etc.)

Employer

Job Title

Address

City

State/Province

Zip/Postal

Phone

When were you employed by this employer? From-To (dates)

Your duties

Hours worked each week

Starting Salary

Last Salary

Reason for leaving

Add Employer Remove

Certificate of Applicant

I hereby certify that all information given in this application is true, and I agree and understand that any misstatement of material facts contained in this application may cause forfeiture of all my rights to employment with the County of Wayne.

I certify that this application is made under my correct legal name. I further authorize former employers to furnish all information concerning my employment record to the Wayne County Department of Personnel/Human Resources, and I release them from any liability for having furnished this information.

I hereby authorize Wayne County, as a condition of employment, to complete a check of any possible reference, along with a thorough background investigation and criminal history search. A copy of this authorization shall be considered as effective and valid as the original.

I agree that any claim I may have against the Charter County of Wayne (or its' employees, elected officials or agents) must be brought within 180 days of the day I knew or should have known of the claim. I waive any longer but not shorter periods of limitations.

Date

Signature

Clear

Printed Name

Do you have a relative employed by Wayne County?

Yes

No

Please provide relatives name, and explain relationship to you

Comments & Additional Explanations

In order to be a Police Officer with the Wayne County Sheriff's Department, you must meet all announced qualifications and requirements. You must completely and accurately answer all questions on this application. Any erroneous or missing information can lead to rejection of your application.

REQUIREMENTS:

1. Never have been convicted of a felony. (The Sheriff's Department verifies all applicant statements).

2. Have a good driving record. Applicants are considered to have less than a good driving record if their record of Traffic Violation Convictions at the time of application or appointment shows:

Twelve (12) points accumulated for moving violations within the last two (2) years.
A conviction for operating while under the influence or operating while impaired within the last three (3) years.
Any combination of six (6) or more Fail to Appear in Court (FAC) or Fail to Comply with Judgment (FCJ) type suspensions in the last ten (10) years.
Two (2) or more convictions for reckless driving within the last three (3) years.
A criminal conviction connected with the operation of a motor vehicle including but not limited to negligent homicide, fleeing the scene of an accident and fleeing or eluding a police officer.
A conviction for driving while your license is suspended or revoked in last one (1) year.
A currently restricted or probationary driving license under the Michigan point system.

NOTE: Any candidate not disqualified under the above section whose driving license is restricted, suspended or revoked or who has not paid an outstanding traffic fine, must have their license restored and have paid all fines prior to appointment.

3. Pass a pre-employment medical examination and be in good physical condition to perform essential job duties as determined by a licensed physician or qualified health care professional in compliance with Wayne County Standards including:

Free from any physical defects or chronic diseases that may impair the performance of essential job duties or endanger the lives of others.
Height and weight in relation to each other as indicated by accepted medical standards.
Free from mental or emotional instabilities that may impair the performance of essential job functions or endanger the lives of others.
Free from any impediment of the senses, physically sound and in possession of extremities.
Possess 20/20 corrected vision in each eye.
Possess normal visual functions in each eye, including peripheral vision, depth perception, stereopsis and normal color vision.
Possess normal hearing. Hearing shall be tested for each ear and be within professionally acceptable ranges.
Free from drugs. Use of controlled substance for other than medical reasons is cause for rejection. Proof of medical necessity is required.
Any other physical or mental impairment, disease or defect not mentioned above that may impair the performance of essential job duties or endangers the lives of others.

Review of Standards

I have read and understood the above standards and I believe I meet the requirements to be a Police Officer.

Signature

Clear

Date

ACCOMMODATIONS:If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Wayne County Department of Personnel/Human Resources at 313-224-5901 or via email at hrexam@waynecounty.com. Hearing or speech impaired persons using TDD's or similar devices may contact the Michigan Relay Center, toll free at (800) 649-3777 or 711 to communicate directly with the Department of Personnel/Human Resources during regular working hours.

EEO - Equal Employment Opportunity

Wayne County provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.This policy applies to all terms and conditions of employment, including but not limited to: recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Where did you hear about this position?

Please Explain Where you heard about this position

Who Referred You to This Position

Job source, family/friend, recruiter, other

Name of Person Who Referred You

Please Explain how you were referred

Which recruiter did you speak with? If applicable