Nc F 3 form is a document that is used in the State of North Carolina to report changes in your family's situation or household. This form can be used to report changes such as a birth, death, marriage, or change of address. You can use this form to update your name, Social Security number, and much more.
You may find details about the type of form you intend to submit in the table. It will tell you how much time you'll need to complete nc f 3, what fields you will have to fill in, and so forth.
Question | Answer |
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Form Name | Nc F 3 |
Form Length | 17 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 4 min 15 sec |
Other names | f3 form, personal history statement form, are nc form fishing license, ncdoj forms form |
Form
Revised January 2021
Sheriffs’ Education and Training Standards Commission
North Carolina Department of Justice
Sheriffs’ Standards Division
Telephone: (919)
Fax: (919)
Personal History Statement
Note: This form is not designed for use as an initial application for employment and must not be used for that purpose. Rather, the applicant should complete this form prior to beginning his/her background investigation. This form should only be completed by applicants for the position of a justice officer. It is the determination of the Commission that these questions are necessary in order to fully and adequately evaluate applicants for justice officer certification. These questions are designed to ascertain whether the applicant meets the minimum standards for certification and serves no other purpose.
*The Social Security Number is used to make a positive identification of the applicant and/or law enforcement personnel. DISCLOSURE IS VOLUNTARY. However, failure to provide this information may result in a delay in the processing of application materials and may result in inaccurate records being assigned to you.
FORM
NORTH CAROLINA SHERIFFS' EDUCATION AND TRAINING STANDARDS COMMISSION
PERSONAL HISTORY STATEMENT
INSTRUCTIONS: Fill out this form completely and accurately. If you need extra space, add additional pages and identify the information by item number. All questions must be answered.
NOTE: Any statements are subject to validation and any incorrect statements or omissions may disqualify you from certification. Truthful statements to any item requested will not necessarily exclude you from consideration. This form must be notarized upon completion.
POSITION(S) APPLIED FOR:
Agency |
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Deputy |
Detention Officer |
Telecommunicator |
Have you previously submitted an application for employment with this agency? |
Yes |
No |
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If YES, approximate date: |
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PERSONAL |
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1. Name: |
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Middle |
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Last |
Maiden Name
Other previous last names:
Nicknames or Aliases
Note: If your name was legally changed after the age of 12, please submit documentation showing when that occurred.
2. Social Security |
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3. Present Mailing Address: |
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Permanent Mailing Address |
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Street and Number |
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Telephone Numbers: |
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Home: |
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Work: |
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Pager: |
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Cell/Mobile |
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4a. Date of Birth: |
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4b. Place of Birth: |
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(City/State/Country) |
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5. Citizenship: |
☐ U.S. Born ☐ U.S. Naturalized |
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☐ Other, specify: |
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1 |
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Note: |
Data solicited in questions 6 and 7 will be utilized for equal employment statistical |
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information purposes only |
6. |
Ethnicity: |
African American |
Asian American |
7. |
Gender: |
Male |
Female |
8.Do you object to wearing a uniform?
9.Do you object to working nights?
10. Do you object to working rotating shifts?
Hispanic |
Caucasian |
Other: |
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Yes |
No |
Yes |
No |
Yes |
No |
11. Do you object to occasionally being away from home overnight and/or for other periods of time to attend
meetings, acquire training or otherwise perform official duties? |
☐ Yes |
☐ No |
EDUCATIONAL
12.Indicate the type of High School you attended:
Traditional ☐ Home School ☐ GED ☐
Distance Learning ☐
Did not attend high school ☐
Other: ____________________________
A. High Schools:
NAME: |
WHEN ATTENDED: |
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CITY: |
GRADUATED: |
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STATE: |
DEGREE AWARDED: |
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YEARS COMPLETED: |
MAJOR FIELD: |
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NAME: |
WHEN ATTENDED: |
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CITY: |
GRADUATED: |
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STATE: |
DEGREE AWARDED: |
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YEARS COMPLETED: |
MAJOR FIELD: |
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B. University or Colleges:
NAME: |
WHEN ATTENDED: |
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CITY: |
GRADUATED: |
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STATE: |
DEGREE AWARDED: |
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YEARS COMPLETED: |
MAJOR FIELD: |
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NAME: |
WHEN ATTENDED: |
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CITY: |
GRADUATED: |
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STATE: |
DEGREE AWARDED: |
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YEARS COMPLETED: |
MAJOR FIELD: |
2
C. Continuing Education:
NAME: |
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WHEN ATTENDED: |
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CITY: |
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GRADUATED: |
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DEGREE AWARDED: |
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YEARS COMPLETED: |
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MAJOR FIELD: |
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NAME: |
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WHEN ATTENDED: |
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DEGREE AWARDED: |
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YEARS COMPLETED: |
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MAJOR FIELD: |
RESIDENCES
13. List addresses for the past 10 years starting with present address listed first:
From: To: (MM/YY) (MM/YY)
Address, City, State
County
Landlord
FAMILY HISTORY
NOTE: Questions included in the next section are intended to assist in the conducting of a background investigation and are not intended for use by the employing agency as disqualifying factors for employment as a justice officer
14. Marital Status: |
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Never Married |
Married |
Divorced |
15. Name of Spouse / Former Spouse(s)
Engaged |
Separated |
Widowed
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16. A. Do you have any children born to you, adopted by you, or stepchildren? |
Yes |
No |
B. If Yes, list all of your children below: |
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(1)
(2)
(3)
(4)
(5)
(6)
Name
Birthdate
Relationship
With whom
resides
Phone Number
C. Are you now supporting all these children? |
Yes |
No |
If NO, give details: |
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17. Are there persons, other than your spouse and listed children, who are presently dependent upon you
for support? |
Yes |
No |
If YES, give details: |
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18.Are you related by blood or marriage to any person (s) now employed by this agency? If YES, give name(s) and details:
Yes
No
19. Is any member of your immediate family now in prison/jail or on probation or parole? |
☐ Yes |
☐ No |
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If YES, give name(s) and details: |
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4
FINANCIAL
20.What sources of income other than salary do you have at present?
21.Have you ever been sued with a civil judgment being rendered against you? Please note this includes
repossessions, evictions, executions, etc. |
Yes |
No |
If YES, explain: |
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22. Have you ever declared bankruptcy? |
Yes |
No |
IF YES, explain: |
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23.What is the total amount of all your debts at present?
24.What is the average monthly total of all your bills, payments, and current living expenses?
25.List credit references, including businesses to which you make monthly payments:
Firm / Business
Street Address
City / State
Amount Owing
5
WORK HISTORY
26. Have you ever been denied employment by a criminal justice agency after a conditional offer of
employment was made? |
Yes |
No |
(If Yes, list agency name and reason.) |
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27.Have you ever held a position in any capacity which required certification or licensure from any Commission, Board or Agency established to certify or license that position? (Note: List any such
Commission, Board or Agency, whether in or out of North Carolina.) |
Yes |
No |
27a. If yes, was such certification or license ever suspended, revoked, or any sanctions taken against it by
the issuing authority? |
Yes |
No |
27b. If such certification or license was ever suspended, revoked, and any sanctions taken against it by
the issuing authority, please list the agency's name taking action against the certification or license, date of action, reason for the action, and period of time for the suspension, revocation, or sanction.
28. Have you ever been discharged or requested to resign from any position because of criminal misconduct
or rules violations? |
Yes |
No (If Yes, list employer, |
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29.List all jobs, positions or appointments you have held in the last ten years to include inactive, active, reserve, temporary,
Employer: |
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Address: |
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Job Title: |
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Supervisor’s Name: |
Phone Number: |
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Date Employed (MM/YY): |
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Starting Salary: |
Ending or Current Salary: |
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Per: |
Per: |
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Date Separated (MM/YY): |
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List Major Duties in Order of Importance: |
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Full Time: |
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Part Time: |
YRS |
MOS |
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If part time, hours worked per week: |
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Reason for Leaving: |
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Employer: |
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Address: |
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Job Title: |
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Supervisor’s Name: |
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Date Employed (MM/YY): |
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Starting Salary: |
Ending or Current Salary: |
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Per: |
Per: |
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Date Separated (MM/YY): |
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Full Time: |
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Part Time: |
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If part time, hours worked per week: |
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Reason for Leaving: |
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Employer: |
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Address: |
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Job Title: |
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Supervisor’s Name: |
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Date Employed (MM/YY): |
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Starting Salary: |
Ending or Current Salary: |
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Per: |
Per: |
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Date Separated (MM/YY): |
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List Major Duties in Order of Importance: |
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Full Time: |
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Part Time: |
YRS |
MOS |
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If part time, hours worked per week: |
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Reason for Leaving: |
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Employer: |
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Address: |
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Job Title: |
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Supervisor’s Name: |
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Date Employed (MM/YY): |
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Starting Salary: |
Ending or Current Salary: |
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Per: |
Per: |
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Date Separated (MM/YY): |
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List Major Duties in Order of Importance: |
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Full Time: |
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Part Time: |
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If part time, hours worked per week: |
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Reason for Leaving: |
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Employer: |
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Address: |
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Job Title: |
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Supervisor’s Name: |
Phone Number: |
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Date Employed (MM/YY): |
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Starting Salary: |
Ending or Current Salary: |
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Per: |
Per: |
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Date Separated (MM/YY): |
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List Major Duties in Order of Importance: |
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Full Time: |
YRS |
MOS |
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Part Time: |
YRS |
MOS |
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If part time, hours worked per week: |
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Reason for Leaving: |
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Employer: |
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Address: |
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Job Title: |
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Supervisor’s Name: |
Phone Number: |
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Date Employed (MM/YY): |
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Starting Salary: |
Ending or Current Salary: |
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Per: |
Per: |
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Date Separated (MM/YY): |
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Full Time: |
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Part Time: |
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Reason for Leaving: |
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If you need more space, attach additional sheets.
Explain periods of unemployment of three months or more, if you do not have a full
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8
MILITARY SERVICE
30. Were you ever in the U.S. Military service or any other military organization? (Even if you served for
only one day, list this service.) |
Yes |
No If YES, complete #31 through #38. If NO, skip to #39. |
31.What was your service number?
32.A. What was the highest rank you held?
B.What was the last rank you held?
33.A. What was the date and location of your first enlistment and/or commission?
B.List all tours of duty where a DD214 was issued.
Branch
Date Entered
Date Released
34. List all stations of assignment including active, reserve and/or National Guard (Attach additional pages if needed.)
Branch
Unit (Company or Ship)
Location
From (MM/YY) TO (MM/YY)
35.What was the date and location of your last discharge from active duty?
36.Have you ever received any of the following types of discharge:
Uncharacterized (includes entry level separations) |
Yes |
No |
Honorable |
Yes |
No |
General (under honorable conditions) |
Yes |
No |
Under other than honorable conditions (includes undesirable) |
Yes |
No |
Bad Conduct discharge |
Yes |
No |
Dishonorable discharge |
Yes |
No |
Dismissal |
Yes |
No |
37.Were you ever court martialed, tried on charges, or the subject of a summary court, deck court,
member of the military, Nation Guard or reserve unit? |
Yes |
No |
If YES, explain what occurred and what type of punishment you received: |
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38.If you are presently a member of the National Guard or any military reserve, give the unit, location, and describe your obligation, and provide your expected date of separation:
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