Deputy Sheriff Civil Service Commission Application

1Applicant Information

2Questions

3Education Background

4Business and Employment

5Confirmation

I hereby make application for the position of Deputy Sheriff in the County of Raleigh:

NAME(Required)

First Last

EMAIL(Required)

HOME PHONE(Required)

CELL PHONE(Required)

DRIVER’S LICENSE NO(Required)

EXPIRATION DATE(Required)

DRIVER'S LICENSE(Required)

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CURRENT MAILING ADDRESS

Street(Required)

City(Required)

State(Required)

Zip(Required)

CURRENT PHYSICAL ADDRESS

Street(Required)

City(Required)

State(Required)

Zip(Required)

NEXT OF KIN(Required)

PHONE(Required)

I CERTIFY THAT I AM 18 YEARS OLD OR OLDER(Required)

Yes

DATE OF BIRTH(Required)

PLACE OF BIRTH(Required)

BIRTH CERTIFICATE(Required)

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Questions

ARE YOU A CITIZEN OF THE UNITED STATES?(Required)

Yes

PLEASE EXPLAIN(Required)

ARE YOU ADDICTED TO OR HAVE THE HABITUAL USE OF INTOXICATING LIQUORS OR DRUGS?(Required)

Yes

PLEASE EXPLAIN(Required)

HAVE YOU BEEN CONVICTED OF A FELONY?(Required)

Yes

PLEASE EXPLAIN(Required)

HAVE YOU BEEN CONVICTED OF ANY CRIME OF DOMESTIC VIOLENCE?(Required)

Yes

PLEASE EXPLAIN(Required)

HAVE YOU BEEN FOUND GUILTY OF INFAMOUS OR NOTORIOUSLY DISGRACEFUL CONDUCT?(Required)

Yes

PLEASE EXPLAIN(Required)

HAVE YOU BEEN DISMISSED FROM PUBLIC SERVICE FOR DELINQUENCY OR MISCONDUCT?(Required)

Yes

PLEASE EXPLAIN(Required)

HAVE YOU MADE A FALSE STATEMENT OF ANY MATERIAL FACT OR PRACTICED OR ATTEMPTED TO PRACTICE ANY DECEPTION OR FRAUD IN AN APPLICATION IN ANY SUCH EXAMINATION OR IN SECURING ELIGIBILITY?(Required)

Yes

PLEASE EXPLAIN(Required)

HAVE YOU BEEN DISQUALIFIED FROM OWNING OR POSSESSING A FIREARM UNDER WEST VIRGINIA OR FEDERAL LAW?(Required)

Yes

PLEASE EXPLAIN(Required)

DO YOU HAVE ANY MENTAL HEALTH OR PHYSICAL HEALTH ISSUES THAT WOULD RENDER YOU UNFIT FOR THE PERFORMANCE OF THE DUITIES OF THE POSITION OF DEPUTY SHERIFF?(Required)

Yes

PLEASE EXPLAIN(Required)

ARE YOU A CERTIFIED POLICE OFFICER?(Required)

Yes

Date of Certification(Required)

SUBMIT CERTIFICATION BY THE POLICE ACADEMY(Required)

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ARE YOU CURRENTLY WORKING AS A CERTIFIED LAW ENFORCEMENT OFFICER?(Required)

Yes

IS YOUR CERTIFICATION CONSIDERED ACTIVE STATUS?(Required)

Yes

HAVE YOU MAINTAINED COMPLIANCE WITH ONGOING TRAINING?(Required)

Yes

HAVE YOU FORMERLY SERVED AS A RALEIGH COUNTY DEPUTY SHERIFF FOR A PERIOD OF MORE THAN SIX MONTHS?(Required)

Yes

Start Date(Required)

End Date(Required)

ARE YOU SEEKING REAPPOINTMENT BY REINSTATEMENT?(Required)

Yes

DID YOU RESIGN UNDER HONORABLE CONDITIONS?(Required)

Yes

AT THE TIME OF RESIGNATION AS A DEPUTY SHERIFF, WERE THERE CHARGES OF MISCONDUCT?(Required)

Yes

AT THE TIME OF RESIGNATION AS A DEPUTY SHERIFF, WERE THERE CHARGES OF MISFEASANCE PENDING AGAINST YOU?(Required)

Yes

AT THE TIME OF RESIGNATION AS A DEPUTY SHERIFF, WERE THERE CHARGES OF MALFEASANCE PENDING AGAINST YOU?(Required)

Yes

HAVE YOU MAINTAINED YOUR LAW ENFORCEMENT CERTIFICATION WITH THE STATE OR ARE YOU IMMEDIATELY ELIGIBLE TO BE SO CERTIFIED?(Required)

Yes

HAS THE TIME YOU WERE LAST EMPLOYED AS A RALEIGH COUNTY DEPUTY SHERIFF BEEN WITHIN THE PRIOR TWO YEARS PRECEDING THE DATE OF THIS APPLICATION?(Required)

Yes

AT THE TIME OF THIS APPLICATION, DO YOU RESIDE IN RALEIGH COUNTY?(Required)

Yes

DO YOU HAVE CURRENT OR PRIOR MILITARY SERVICE?(Required)

Yes

DATE OF ENLISTMENT(Required)

DATE OF DISCHARGE/RELEASE FROM ACTIVE DUTY(Required)

BRANCH OF MILITARY(Required)

DISCHARGE OR RELEASE FROM ACTIVE DUTY WAS(Required)

HONORABLE

GENERAL

DISHONORABLE

ATTACH A COPY OF YOUR DISCHARGE DD-214 TO THIS APPLICATION(Required)

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DID YOU HAVE MORE THAN TWENTY-FOUR MONTHS OF CONTINUOUS ACTIVE DUTY OR THE FULL PERIOD CALLED OR ORDERED TO ACTIVE DUTY?(Required)

Yes

WERE YOU DISCHARGED UNDER 10 U.S.C. 1171 OR FOR HARDSHIP UNDER 10 U.S.C. 1173?(Required)

Yes

Please Explain(Required)

DID YOU RECEIVE OR WERE YOU ENTITLED TO RECEIVE A CAMPAIGN BADGE OR EXPEDITIONARY MEDAL?(Required)

Yes

ARE YOU A DISABLED VETERAN(Required)

Yes

ATTACH PROOF OF SUCH DISABLEMENT TO THIS APPLICATION (proof required for consideration)(Required)

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Education Background

Check all that apply(Required)

Graduation/Diploma Pending

GED/High School Diploma

Associate's Degree

Bachelor's Degree

Master's Degree

GRADUATION/DIPLOMA PENDING

You must complete the information requested below for the program you are currently enrolled in.

YEARS (FROM/TO)(Required)

SCHOOL ATTENDED(Required)

CITY AND STATE(Required)

YEAR OF GRADUATION(Required)

GED/HIGH SCHOOL DIPLOMA

You must complete the information requested below with the institution(s) where you earned your GED/High School Diploma AND College Degree(s) (if applicable).

YEARS (FROM/TO)(Required)

SCHOOL ATTENDED(Required)

CITY AND STATE(Required)

YEAR OF GRADUATION(Required)

GED/HIGH SCHOOL DIPLOMA(Required)

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ASSOCIATE'S DEGREE(S)

You must complete the information requested below and attach a copy of your diploma.

YEARS (FROM/TO)(Required)

SCHOOL ATTENDED(Required)

CITY AND STATE(Required)

YEAR OF GRADUATION(Required)

TYPE OF DEGREE(Required)

COLLEGE DIPLOMA(Required)

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BACHELOR'S DEGREE(S)

You must complete the information requested below and attach a copy of your diploma.

YEARS (FROM/TO)(Required)

SCHOOL ATTENDED(Required)

CITY AND STATE(Required)

YEAR OF GRADUATION(Required)

TYPE OF DEGREE(Required)

COLLEGE DIPLOMA(Required)

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Accepted file types: jpeg, pdf, jpg, png, Max. file size: 10 MB, Max. files: 1.

MASTER'S DEGREE(S)

You must complete the information requested below and attach a copy of your diploma.

YEARS (FROM/TO)(Required)

SCHOOL ATTENDED(Required)

CITY AND STATE(Required)

YEAR OF GRADUATION(Required)

TYPE OF DEGREE(Required)

COLLEGE DIPLOMA(Required)

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Accepted file types: jpeg, pdf, jpg, png, Max. file size: 10 MB, Max. files: 1.

Business and Employment

EMPLOYMENT HISTORY(Required)

Please provide at least five years of employment history, beginning with your most recent employer.

YEARS (FROM/TO)

NAME OF EMPLOYER

EMPLOYER ADDRESS (CITY AND STATE)

EMPLOYER'S PHONE #

REASON FOR LEAVING

Confirmation

I understand that in the event this application is incomplete or incorrectly completed and/or copies of the required documentation are not provided with the application, I will not be permitted to take the physical ability test and this will result in discontinuation from the application process. I acknowledge that after submission of this application, with the Raleigh County Sheriff’s Department, I will be directed to the West Virginia Division of Personnel website to complete a second application. I understand the commission may require, in connection with this application, such certificates of citizenship, physicians, or others, having pertinent knowledge, as the good of the service may require. I acknowledge the commission may refuse to examine me, or after examination to certify as eligible, if found to lack any of the established preliminary requirements for the examination or position of deputy sheriff for which I am applying. I acknowledge that the Civil Service Commission and the Raleigh County Sheriff’s office will obtain all prior records, including school and employment records. By signing below, I give permission for all necessary records to be released to the Raleigh County Deputy Sheriff Civil Service Commission and the Raleigh County Sheriff’s Office. I attest to the accuracy and truthfulness of the information provided and any misstatement of material facts will be grounds for disqualifying me from further consideration in the selection process, or, if hired, grounds for discharge. I understand that I must complete (unless exempt) a Physical Ability Standards test where I will be asked to perform the following three tasks: 18 PUSH-UPS IN ONE MINUTE; 28 SIT-UPS IN ONE MINUTE and 1.5 MILE RUN IN 14 MINUTES 36 SECONDS. I understand that I will be given specific instructions in the manner in which these physical tasks are to be performed correctly, as set forth on the Physical Ability Standards form. At any time, I fail any portion of the Physical Ability Standards test I understand that is a total failure of the entire test and my participation ceases at that moment. I am aware that the physical ability standards test is physically taxing and requires physical effort. I am physically fit to participate in the physical ability test and assume all inherent risks associated with participation, including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/ or humidity, and assume all inherent risks for any such injury that may be sustained while participating in this test, i.e.: falls, sprains, strains, joint or back injuries, heart attacks or even death. I understand that I will be required to sign a Release prior to participating in the physical ability standards test waiving any and all rights and any and all causes of action against the Raleigh County Deputy Sheriff Civil Service Commission, its agents and employees; the Raleigh County Sheriff’s Office, its agents and employees; and the Raleigh County Commission, and its agents and employees for any damages I might claim or demand, on or by reason of any damage, loss or injury, which may heretofore have ensued or which may hereafter ensue arising out of the physical ability test that I will undergo.(Required)

I understand.

I understand that in the event this application is incomplete or incorrectly completed and/or copies of the required documentation are not provided with the application, I will not be permitted to take the physical ability test and this will result in discontinuation from the application process.

I acknowledge that after submission of this application, with the Raleigh County Sheriff’s Department, I will be directed to the West Virginia Division of Personnel website to complete a second application.

I understand the commission may require, in connection with this application, such certificates of citizenship, physicians, or others, having pertinent knowledge, as the good of the service may require.

I acknowledge the commission may refuse to examine me, or after examination to certify as eligible, if found to lack any of the established preliminary requirements for the examination or position of deputy sheriff for which I am applying.

I acknowledge that the Civil Service Commission and the Raleigh County Sheriff’s office will obtain all prior records, including school and employment records. By signing below, I give permission for all necessary records to be released to the Raleigh County Deputy Sheriff Civil Service Commission and the Raleigh County Sheriff’s Office.

I attest to the accuracy and truthfulness of the information provided and any misstatement of material facts will be grounds for disqualifying me from further consideration in the selection process, or, if hired, grounds for discharge.

I understand that I must complete (unless exempt) a Physical Ability Standards test where I will be asked to perform the following three tasks: 18 PUSH-UPS IN ONE MINUTE; 28 SIT-UPS IN ONE MINUTE and 1.5 MILE RUN IN 14 MINUTES 36 SECONDS. I understand that I will be given specific instructions in the manner in which these physical tasks are to be performed correctly, as set forth on the Physical Ability Standards form. At any time, I fail any portion of the Physical Ability Standards test I understand that is a total failure of the entire test and my participation ceases at that moment.

I am aware that the physical ability standards test is physically taxing and requires physical effort. I am physically fit to participate in the physical ability test and assume all inherent risks associated with participation, including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/ or humidity, and assume all inherent risks for any such injury that may be sustained while participating in this test, i.e.: falls, sprains, strains, joint or back injuries, heart attacks or even death.

I understand that I will be required to sign a Release prior to participating in the physical ability standards test waiving any and all rights and any and all causes of action against the Raleigh County Deputy Sheriff Civil Service Commission, its agents and employees; the Raleigh County Sheriff’s Office, its agents and employees; and the Raleigh County Commission, and its agents and employees for any damages I might claim or demand, on or by reason of any damage, loss or injury, which may heretofore have ensued or which may hereafter ensue arising out of the physical ability test that I will undergo.

Ensure that all required forms/documents have been uploaded (jpeg or pdf) prior to submitting this application.
After submitting the form, you will be emailed a pdf copy and be directed to the West Virginia Division of Personnel to complete the second application.