Form Center

Step One

TAYLOR COUNTY SHERIFF'S OFFICE APPLICATION
Personal History Statement
Full Name:*
Date:*
Date:
Application For:*
1. Deputy Sheriff
2. Corrections Officer
3. Dispatcher
4. Civilian
PID#
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Step Two

INSTRUCTIONS
Read these instructions carefully before proceeding
First Name*
Last Name*
These instructions are provided as a guide to assist you in properly completing your Personal History Statement (PHS). It is essential that all information be accurate. This information will be used to conduct a background investigation that will determine your eligibility for employment.
1. Your PHS, and any additional explanation pages, should be typed or printed legibly in ink. Do NOT print double-sided. Documents submitted in pencil will be returned as unacceptable.
2. If a question is not applicable to you, enter N/A in the space provided.
3. Avoid errors by reading the directions carefully before making any entries on the form.
4. You are responsible for obtaining correct information (addresses, email accounts, and telephone numbers, etc.) You must supply all requested information to complete your PHS. If you are not sure of an address, check it by personal verification. All requested information must be supplied by you; the Taylor County Sheriff’s Office will not be responsible for acquiring information. However, do not guess at information. If you do not know an answer and you do not know where/how to find it, indicate that on the form.
5. As you complete your PHS, carefully consider each question. It is imperative that you answer each question accurately and thoroughly. Certain responses will prompt you for additional information and you will be required to “explain.” When an explanation is requested, a detailed explanation is required for each instance, no matter how insignificant the event was or how long ago it may have occurred. All responses should be attached in one separate document with the explanations in the same order as addressed in the PHS. You must print your name at the top of each page and you must sign at the bottom of each page. Each response must reference the appropriate section of the Personal History Statement and question number before continuing your answer.
6. An accurate and complete Personal History Statement will expedite your background investigation. You will have ample opportunity to explain any issues that are addressed. Intent to deceive, falsify, mislead, or withhold information will result in disqualification.
7. It is your responsibility to have the Personal Inquiry Waiver Form , Confidential Information Agreement Form, and the Certification Page notarized.
8. If you make it to the interview portion of the hiring process, this booklet will be used for the interviewers to develop questions that will be used to determine if you have been completely and totally truthful in this booklet. Do not falsify, lie, misrepresent, leave out or neglect to mention any information about your background no matter how insignificant you believe it is. You are not expected to be perfect, but you are expected to be honest. Be completely open and truthful with all your responses.
Signature*
Date*
Date
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Step Three

Confidential Information Agreement Form
PLEASE READ
In order to determine your qualifications for this Law Enforcement position, it will be necessary to conduct a comprehensive background investigation. To a great extent, an employment offer will depend upon an assessment of confidential information obtained from your interview, psychological evaluation, driving history, credit report, and other confidential documents. In addition, confidential information will be sought from previous employers and other persons with whom you have been associated. Applicants will not have access to the above-named information, nor have access to the identities of persons interviewed. Your signature below will serve as your waiver of any right to access this information under State and Federal Law.
I have read the above statement and fully understand its meaning and agree with its provisions.
Print Name
Signature*
Date*
Date
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Step Four

Personal Inquiry Waiver Form Authority to Release Information
Please type Name*
Request and authorize you to furnish the Taylor County Sheriff’s Office, any and all information that you may possess concerning me, including any and all medical, physical, and psychological records or reports. This waiver expressly includes any and all records or reports of a confidential or privileged nature, and photocopies of same, if requested. I authorize full disclosure of all records concerning myself regardless of any agreement I may have made with you previously to the contrary, or any statute or policy that may make these records confidential.
I hereby release you, your organization or others from liability or damage that may result from furnishing the requested information.
Signature*
Date*
Date
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Step Five

Personal History Statement
The information provided in this section is used for identification purposes.
First Name*
Last Name*
State your true and legal name:*
Other Names Used:
Maiden Name:
Address1*
City*
State*
Zip*
Home/Cell Telephone Number:*
Work number:
Primary Email:*
Any Additional Emails (include active and inactive accounts):
Other Phone Numbers:*
Date of Birth:*
Race:*
Sex:*
U.S. Citizen:*
1. Yes
2. No
Place of Birth (Include city, county and state):*
Concealed Handgun License (include #, State of issue and expiration):
Height:*
Weight:*
Hair Color:*
Eye Color:*
Identifying Marks:*
Scars (describe):*
Tattoos (describe):*
Preferred name:*
Do you have a Social Networking Site:*
1. Yes
2. No
List all Social Networking Sites that you are a member of (include user names):*
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Step Six

Step Seven

3.
Employment History Continued
Employer:*
Telephone Number:*
Start Date*
Start Date
End Date*
End Date
Select Appropriate Job Description:*
Address1*
City*
State*
Zip*
Start Rate:*
End Rate:*
Job Title:*
Supervisor*
Supervisor Phone #:*
Supervisor Email:*
Eligible for Rehire?*
1. Yes
2. No
Was Notice Given?*
1. Yes
2. No
If notice was given, how much? (if less than 2 weeks please explain):
List at least one Co-Worker: (Name, Phone, Email)*
Identify any disciplinary actions you may have received:
Work Performed:*
Reason for leaving:*
4.
Employer:*
Telephone Number:*
Start Date*
Start Date
End Date*
End Date
Select Appropriate Job Description:*
Address1*
City*
State*
Zip*
Start Rate:*
End Rate:*
Job Title:*
Supervisor*
Supervisor Phone #:*
Supervisor Email:*
Eligible for Rehire?*
1. Yes
2. No
Was Notice Given?*
1. Yes
2. No
If notice was given, how much? (if less than 2 weeks please explain):
List at least one Co-Worker: (Name, Phone, Email)*
Identify any disciplinary actions you may have received:
Work Performed:*
Reason for leaving:*
Continue |Go Back

Step Eight

5.
Employment History continued
Employer:*
Telephone Number:*
Start Date*
Start Date
End Date*
End Date
Select Appropriate Job Description:*
Address1*
City*
State*
Zip*
Start Rate:*
End Rate:*
Job Title:*
Supervisor*
Supervisor Phone #:*
Supervisor Email:*
Eligible for Rehire?*
1. Yes
2. No
Was Notice Given?*
1. Yes
2. No
If notice was given, how much? (if less than 2 weeks please explain):
List at least one Co-Worker: (Name, Phone, Email)*
Identify any disciplinary actions you may have received:
Work Performed:*
Reason for leaving:*
6.
Employer:*
Telephone Number:*
Start Date*
Start Date
End Date*
End Date
Select Appropriate Job Description:*
Address1*
City*
State*
Zip*
Start Rate:*
End Rate:*
Job Title:*
Supervisor*
Supervisor Phone #:*
Supervisor Email:*
Eligible for Rehire?*
1. Yes
2. No
Was Notice Given?*
1. Yes
2. No
If notice was given, how much? (if less than 2 weeks please explain):
List at least one Co-Worker: (Name, Phone, Email)*
Identify any disciplinary actions you may have received:
Work Performed:*
Reason for leaving:*
Continue |Go Back

Step Nine

Step Ten

Step Eleven

Periods of Unemployment
1. If you have never held employment, explain why.*
2.
Record any period of unemployment since graduation from High School (a period of unemployment is any time you did not have a job) If you were a full time college student and held only seasonal employment during school breaks, indicate your beginning and ending school dates and list the seasonal jobs in the Employment History Section of this packet.
From/to Dates:*
From/to Dates: Start Date
—
From/to Dates: End Date
Reason:*
From\to Dates:
From\to Dates: Start Date
—
From\to Dates: End Date
Reason:
From/to Dates:
From/to Dates: Start Date
—
From/to Dates: End Date
Reason
From/to Dates:
From/to Dates: Start Date
—
From/to Dates: End Date
Reason
From/to Dates:
From/to Dates: Start Date
—
From/to Dates: End Date
Reason
Continue |Go Back

Step Twelve

Marital and Family History
Check your current status:*
If you are Engaged:
Name of Fiancée:*
Date of Birth*
Date of Birth
Employer:*
Telephone Number:*
Work Number:*
Address1*
City*
State*
Zip*
Email:*
If you are Married or Separated:
Spouse's Name:*
Date of Birth*
Date of Birth
Date Married*
Date Married
Employer:*
Telephone Number:*
Work Number:*
Address1*
City*
State*
Zip*
Email:*
If you are Divorced:
Former Spouse's Name:*
Date of Birth:*
Date of Birth:
Telephone:
Date Married to Divorced*
Date Married to Divorced Start Date
—
Date Married to Divorced End Date
Court and State where Divorce Decree Issued:*
Address1*
City*
State*
Zip*
If you are Widowed:
Spouse's Name:
Date of birth to death*
Date of birth to death Start Date
—
Date of birth to death End Date
Continue |Go Back

Step Thirteen

Family Information
LIST IMMEDIATE FAMILY MEMBERS (including those related by marriage). IF DECEASED, INDICATE THE YEAR OF DEATH. (Step/Natural/In-Laws, Mother, Father, Brother, Sisters).
1.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
2.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
3.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
4.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
5.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
6.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
7.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
8.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
9.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
10.
Name/Relation*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
LIST ALL CHILDREN RELATED TO YOU OR YOUR SPOUSE (Natural/Step/Adopted/Foster):
1.
Child's Full Name*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
2.
Child's Full Name*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
3.
Child's Full Name:*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
4.
Child's Full Name:*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
5.
Child's Full Name:*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
6.
Child's Full Name:*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
7.
Child's Full Name*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Address1*
City*
State*
Zip*
Continue |Go Back

Step Fourteen

If you currently reside with any person(s), other than family members, list:
1.
Name*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Dates of Cohabitation*
Dates of Cohabitation Start Date
—
Dates of Cohabitation End Date
2.
Name*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Date of Cohabitation:*
Date of Cohabitation: Start Date
—
Date of Cohabitation: End Date
3.
Name*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Dates of Cohabitation:*
Dates of Cohabitation: Start Date
—
Dates of Cohabitation: End Date
4.
Name*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Dates of Cohabitation:*
Dates of Cohabitation: Start Date
—
Dates of Cohabitation: End Date
5.
Name*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Dates of Cohabitation:*
Dates of Cohabitation: Start Date
—
Dates of Cohabitation: End Date
6.
Name*
Date of Birth*
Date of Birth
Email Address:*
Phone:*
Date of Cohabitation:*
Date of Cohabitation: Start Date
—
Date of Cohabitation: End Date
Continue |Go Back

Step Fifteen

Step Sixteen

Step Seventeen

Step Eighteen

Step Nineteen

Step Twenty

Step Twenty One

Step Twenty Two

Theft from Employers/Integrity
IF YOU ANSWER YES TO ANY QUESTION IN THIS SECTION, EXPLAIN.
Read these instructions
Many people have taken things from a place where they worked, which they did not have permission to take. The items may have been cash, merchandise, or property. You may have simply borrowed one of these items and forgotten to return it, gave merchandise to another person, or padded your expense account. You will have ample opportunity to explain these issues during the interview.
Although these incidents may be minor in nature, your honesty in this area may directly reflect your character in the work environment. Therefore, the Taylor County Sheriff’s Office is interested in any incidents of theft or misappropriations from an employer that you may have committed or in which you may have been involved.
1.*
Have you taken any money from a place of employment (no matter the amount)?
1. Yes
2. No
2.*
Have you taken any equipment, tools, merchandise or supplies from a place of employment?
1. Yes
2. No
If you answered yes to either of the questions above, list items/amounts below.
Item(s) Taken
Value
Date Taken
Date Taken
Employer
Item(s) Taken
Value
Date Taken
Date Taken
Employer
Item(s) Taken
Value
Date Taken
Date Taken
Employer
Item(s) Taken
Value
Date Taken
Date Taken
Employer
Item(s) Taken
Value
Date Taken
Date Taken
Employer
Item(s) Taken
Value
Date Taken
Date Taken
Employer
Item(s) Taken
Value
Date Taken
Date Taken
Employer
Are you still in possession of any of the above listed items?
1. Yes
2. No
Have you taken anything from an employer?
1. Yes
2. No
Before going to the next section, be sure you have not failed to list ANY theft from an employer that you may have committed.
Continue |Go Back

Step Twenty Three

Step Twenty Four

Criminal activity cont.

criminal activity cont.

Criminal activity cont.

Step Twenty Eight

Step Twenty Nine

Step Thirty

Step Thirty One

Criminal Activity- Alcohol
IF YOU ANSWER YES TO ANY QUESTION IN THIS SECTION, EXPLAIN.
The legal definition of intoxication is: Not having the normal use of mental or physical faculties by reason of the introduction of alcohol, a controlled substance, a drug, a dangerous drug, a combination of two or more of those substances, or any other substance into the body or having an alcohol concentration of 0.08 or more.
1.*
Have you provided alcohol to a minor (under the age of 21)?
1. Yes
2. No
2. List the number of times in the past five years you have been intoxicated in public:*
For each incident above, please explain the circumstances in detail and include the following information: Date and location:
Date:
Date:
Address1
City
State
Zip
Type of Drinks (beer, Wine, liquor):
Number and size of drinks:
Time frame of your drinking:
Your estimated weight when you were intoxicated in public:
Date
Date
Address1
City
State
Zip
Type of Drinks (beer, Wine, liquor):
Number and size of drinks:
Time frame of your drinking:
Your estimated weight when you were intoxicated in public:
Date:
Date:
Address1
City
State
Zip
Type of Drinks (beer, Wine, liquor):
Number and size of drinks:
Time frame of your drinking:
Your estimated weight when you were intoxicated in public:
3.*
Have you ever operated a vehicle while under the influence of alcohol or drugs?
1. Yes
2. No
4. Number of times in the last five years have you operated any motor vehicle while intoxicated:*
For each incident above, please explain the circumstances in detail and include the following information:
Date:
Date:
Address1
City
State
Zip
Type of Drinks (beer, Wine, liquor):
Number and size of drinks:
Time frame of your drinking:
Your estimated weight when you were intoxicated in public:
Date:
Date:
Address1
City
State
Zip
Type of Drinks (beer, Wine, liquor):
Number and size of drinks:
Time frame of your drinking:
Your estimated weight when you were intoxicated in public:
Date:
Date:
Address1
City
State
Zip
Type of Drinks (beer, Wine, liquor):
Number and size of drinks:
Time frame of your drinking:
Your estimated weight when you were intoxicated in public:
5.*
As an adult, have you ever been convicted of DWI or DUI?
1. Yes
2. No
If yes, provide a detailed explanation:
Continue |Go Back

Step Thirty Two

Step Thirty Three

Personal References
List six (6) persons that can provide current information about you; do not list relatives, past/present employers, or acquaintances involved in law enforcement.
1.
Name/Relation*
Email Address:*
Years Known:
Phone:*
Occupation:
Address1*
City*
State*
Zip*
2.
Name/Relation*
Email Address:*
Years Known:
Phone:*
Occupation:
Address1*
City*
State*
Zip*
3.
Name/Relation*
Email Address:*
Years Known:
Phone:*
Occupation:
Address1*
City*
State*
Zip*
4.
Name/Relation*
Email Address:*
Years Known:
Phone:*
Occupation:
Address1*
City*
State*
Zip*
5.
Name/Relation*
Email Address:*
Years Known:
Phone:*
Occupation:
Address1*
City*
State*
Zip*
6.
Name/Relation*
Email Address:*
Years Known:
Phone:*
Occupation:
Address1*
City*
State*
Zip*
Continue |Go Back

Step Thirty Four

List any references who are members of law enforcement agencies.
1.
Name/Relation*
Email Address:*
Years Known:
Phone:*
Occupation:
Address1*
City*
State*
Zip*
2.
Name/Relation*
Email Address:*
Years Known:
Phone:*
Occupation:
Address1*
City*
State*
Zip*
3.
Name/Relation*
Email Address:*
Years Known:
Phone:*
Occupation:
Address1*
City*
State*
Zip*
Continue |Go Back

Step Thirty Five

Memberships in Groups/Associations/Clubs
Official Name of Organization
Type: Social, Fraternal, Professional, Etc.
Office(s) Held
Dates of Membership
Dates of Membership Start Date
—
Dates of Membership End Date
Official Name of Organization
Type: Social, Fraternal, Professional, Etc.
Office(s) Held
Dates of Membership
Dates of Membership Start Date
—
Dates of Membership End Date
Official Name of Organization
Type: Social, Fraternal, Professional, Etc.
Office(s) Held
Dates of Membership
Dates of Membership Start Date
—
Dates of Membership End Date
Official Name of Organization
Type: Social, Fraternal, Professional, Etc.
Office(s) Held
Dates of Membership
Dates of Membership Start Date
—
Dates of Membership End Date
Hobbies and Sports
Name of Sport:
Duration
Duration Start Date
—
Duration End Date
Level of Proficiency
Name of Sport:
Duration
Duration Start Date
—
Duration End Date
Level of Proficiency
Name of Sport:
Duration
Duration Start Date
—
Duration End Date
Level of Proficiency
Nepotism
1.*
Do you or your spouse have a relative currently employed with the Taylor County Sheriff’s Office?
1. Yes
2. No
2.*
Do you or your spouse have a relative currently employed with the Taylor County?
1. Yes
2. No
If “Yes”, provide Name, Relationship, and Position with the Department:
If “Yes”, provide Name, Relationship, and Position with the County:
3.*
Law Enforcement work requires working irregular hours, i.e. evening and night times, weekends, holidays, etc. Please indicate if this would be an issue:
1. Yes
2. No
If “Yes”, explain:
Continue |Go Back

Step Thirty Six

Integrity
Before you answer the following questions, we would like to inform you that each word of your answers will be evaluated. Take your time and think before you answer.
1. Are there any incidents in your life, not mentioned previously herein, which may reflect upon your suitability to perform the duties which you may be called upon to undertake?*
2. Have you deliberately falsified any information in this booklet?*
3. Have you intentionally left any information out of this booklet?*
4. How do you feel now that you have completed this questionnaire?
5. Should we believe your answers to the questions on the previous pages?
6. What will you say if it is later determined that you lied, misrepresented, or withheld significant information on this questionnaire?
7. Did you ever discuss or consider the possibility of lying, misrepresenting, or withholding significant information on this questionnaire?
8. Can you explain why the Personal History Statement has not been completely and thoroughly filled out?
Continue |Go Back

Step Thirty Seven

Certification Page
Please Read
Could you take a human life as a Law Enforcement officer?*
1. Yes
2. No
You have now completed the Personal History Statement. You should stop for a moment and think about your answers to insure that you have accurately portrayed all of the information that was requested. Should you now recall any information that was requested which you did not place in the booklet, go back and make the correction.
I HEREBY CERTIFY THAT THERE ARE NO WILLFUL MISREPRESENTATIONS, OMISSIONS, OR FALSIFICATIONS IN THIS BOOKLET. I AM FULLY AWARE THAT ANY SUCH MISREPRESENTATIONS, OMISSIONS, OR FALSIFICATIONS WILL BE GROUNDS FOR IMMEDIATE PERMANENT REJECTION OF MY APPLICATION, OR IF CURRENTLY EMPLOYED WITH THE DEPARTMENT, TERMINATION OF SAID EMPLOYMENT.
Signature*
Date*
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Taylor County Sheriff's Office Application

Steps

Step One

Step Two

Step Three

Step Four

Step Five

Step Six

Step Seven

Step Eight

Step Nine

Step Ten

Step Eleven

Step Twelve

Step Thirteen

Step Fourteen

Step Fifteen

Step Sixteen

Step Seventeen

Step Eighteen

Step Nineteen

Step Twenty

Step Twenty One

Step Twenty Two

Step Twenty Three

Step Twenty Four

Criminal activity cont.

criminal activity cont.

Criminal activity cont.

Step Twenty Eight

Step Twenty Nine

Step Thirty

Step Thirty One

Step Thirty Two

Step Thirty Three

Step Thirty Four

Step Thirty Five

Step Thirty Six

Step Thirty Seven