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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
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	nc f 3, ncf3 com, f 3 form, nc f3 form

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Form F-3

Revised January 2021

Sheriffs’ Education and Training Standards Commission

North Carolina Department of Justice

Sheriffs’ Standards Division

Telephone: (919) 779-8213

Fax: (919) 662-4515

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 F-3

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			Date
Deputy	Detention Officer	Telecommunicator


Have you previously submitted an application for employment with this agency?			Yes	No
If YES, approximate date:
PERSONAL
1. Name:
	First	Middle		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

3. Present Mailing Address:

Permanent Mailing Address

Street and Number

City

State

Zip Code

State

Zip Code

Telephone Numbers:

Home:

Work:

Pager:

E-Mail:

Cell/Mobile

4a. Date of Birth:

4b. Place of Birth:

(City/State/Country)

5. Citizenship:

☐ U.S. Born ☐ U.S. Naturalized

☐ Other, specify:

Note:	Data solicited in questions 6 and 7 will be utilized for equal employment statistical
	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:

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:

CITY:			GRADUATED:

STATE:			DEGREE AWARDED:

YEARS COMPLETED:			MAJOR FIELD:

NAME:			WHEN ATTENDED:

CITY:			GRADUATED:

STATE:			DEGREE AWARDED:

YEARS COMPLETED:			MAJOR FIELD:

B. University or Colleges:

NAME:			WHEN ATTENDED:

CITY:			GRADUATED:

STATE:			DEGREE AWARDED:

YEARS COMPLETED:			MAJOR FIELD:

NAME:			WHEN ATTENDED:

CITY:			GRADUATED:

STATE:			DEGREE AWARDED:

YEARS COMPLETED:			MAJOR FIELD:

C. Continuing Education:


NAME:				WHEN ATTENDED:
CITY:				GRADUATED:
STATE:				DEGREE AWARDED:
YEARS COMPLETED:				MAJOR FIELD:
NAME:				WHEN ATTENDED:
CITY:				GRADUATED:
STATE:				DEGREE AWARDED:
YEARS COMPLETED:				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:
Never Married	Married	Divorced

15. Name of Spouse / Former Spouse(s)

Engaged

Separated

Widowed

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:

(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:

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:

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

19. Is any member of your immediate family now in prison/jail or on probation or parole?	☐ Yes	☐ No
If YES, give name(s) and details:

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:

22. Have you ever declared bankruptcy?	Yes	No	IF YES, explain:

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

WORK HISTORY

26. Have you ever been denied employment by a criminal justice agency after a conditional offer of

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

27a. If yes, was such certification or license ever suspended, revoked, or any sanctions taken against it by

the issuing authority?

Yes

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, time-frame and reason.)

29.List all jobs, positions or appointments you have held in the last ten years to include inactive, active, reserve, temporary, part-time, paid or not paid employment and internships. Put your present or most recent job first. List a Reason for Leaving for each job. Include military service in proper time sequence and temporary part-time jobs. If you do not have a full ten year job history, be sure to provide an explanation.

Employer:			Address:

Job Title:			Supervisor’s Name:	Phone Number:

Date Employed (MM/YY):			Starting Salary:	Ending or Current Salary:
			Per:	Per:

Date Separated (MM/YY):			List Major Duties in Order of Importance:

Full Time:	YRS	MOS

Part Time:	YRS	MOS
If part time, hours worked per week:

Reason for Leaving:

Employer:			Address:

Job Title:			Supervisor’s Name:	Phone Number:

Date Employed (MM/YY):			Starting Salary:	Ending or Current Salary:
			Per:	Per:

Date Separated (MM/YY):			List Major Duties in Order of Importance:

Full Time:	YRS	MOS

Part Time:	YRS	MOS
If part time, hours worked per week:

Reason for Leaving:


Employer:			Address:

Job Title:			Supervisor’s Name:	Phone Number:

Date Employed (MM/YY):			Starting Salary:	Ending or Current Salary:
			Per:	Per:

Date Separated (MM/YY):			List Major Duties in Order of Importance:

Full Time:	YRS	MOS

Part Time:	YRS	MOS
If part time, hours worked per week:

Reason for Leaving:


Employer:			Address:

Job Title:			Supervisor’s Name:	Phone Number:

Date Employed (MM/YY):			Starting Salary:	Ending or Current Salary:
			Per:	Per:

Date Separated (MM/YY):			List Major Duties in Order of Importance:

Full Time:	YRS	MOS

Part Time:	YRS	MOS
If part time, hours worked per week:

Reason for Leaving:

Employer:			Address:

Job Title:			Supervisor’s Name:	Phone Number:

Date Employed (MM/YY):			Starting Salary:	Ending or Current Salary:
			Per:	Per:

Date Separated (MM/YY):			List Major Duties in Order of Importance:

Full Time:	YRS	MOS

Part Time:	YRS	MOS
If part time, hours worked per week:

Reason for Leaving:


Employer:			Address:

Job Title:			Supervisor’s Name:	Phone Number:

Date Employed (MM/YY):			Starting Salary:	Ending or Current Salary:
			Per:	Per:

Date Separated (MM/YY):			List Major Duties in Order of Importance:

Full Time:	YRS	MOS

Part Time:	YRS	MOS
If part time, hours worked per week:

Reason for Leaving:

If you need more space, attach additional sheets.

Explain periods of unemployment of three months or more, if you do not have a full ten-year job history:

__________________________________________________________________________________________________________________________

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, non-judicial punishment, captains mast, company punishment, article 15, written reprimand, and/or any other disciplinary action while a

member of the military, Nation Guard or reserve unit?	Yes	No
If YES, explain what occurred and what type of punishment you received:

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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In the segment Note If your name was legally, Social Security, Present Mailing Address, Street and Number, City, State, Zip Code, Telephone Numbers Home Pager, Permanent Mailing Address, Street and Number, City, State, Work, EMail, and Zip Code provide the details which the program requests you to do.

Write the key details in Data solicited in questions and, Ethnicity, African American, Asian American, Hispanic, Caucasian, Other, Gender, Male, Female, Do you object to wearing a uniform, Do you object to working nights, Do you object to working rotating, Yes, and Yes section.

The Traditional Home School GED, A High Schools NAME CITY STATE, NAME CITY STATE YEARS COMPLETED, WHEN ATTENDED GRADUATED DEGREE, and WHEN ATTENDED GRADUATED DEGREE segment may be used to indicate the rights and obligations of each party.

Complete the template by taking a look at the next fields: B University or Colleges NAME CITY, NAME CITY STATE YEARS COMPLETED, WHEN ATTENDED GRADUATED DEGREE, and WHEN ATTENDED GRADUATED DEGREE.

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employment was made?

(If Yes, list agency name and reason.)