Pcso Form 188 – Fill Out and Use This PDF

POLK COUNTY SHERIFF’S OFFICE

1891 Jim Keene Boulevard

Winter Haven, FL 33880

EMPLOYMENT APPLICATION

						Toll Free: (877) 477-7276
E-mail: hr@polksheriff.org						Fax: (863)	298-6460
Website: http://www.polksheriff.org					Human Resources: (863)		298-6440
POSITION DESIRED 1st Choice					DATE
2nd Choice			3rd Choice

INSTRUCTIONS

Application must be typewritten or printed legibly in ink. All questions must be answered. If the space provided is not sufficient for

complete answers or you wish to furnish additional information, attach sheets of the same size as this application and number answers to correspond with questions. If you require special disability accommodations, notify the agency’s hiring authority in

advance.

PERSONAL HISTORY

1.	Full Name:
	Last Name				First	Middle		Nickname
	Residence Address				Apt. No.	Mailing Address		Apt. No.
	City			County		State		Zip Code
	(	)		(	)
	Telephone Number (Home)			Work/Other
						(		)
	E-mail Addresses							Cell
2.	Social Security Number:		-	-
	Driver License Number:					State Issued:
3.	Place of Birth:
	City			County		State		Country (if not the United States)

4.Other: List all other names you have used including circumstances and time periods you used them. For example: former name(s), alias(es), and nickname(s).

The Polk County Sheriff's Office is an Equal Employment Opportunity Employer. We consider applicants for all positions without regard to race, color, national origin, sex, age, handicap, marital status, religion or any other legally protected status.

PCSO FORM 188 (REV 11/25/15)

5.	Have you ever filed an application with us before?		Yes	No	Dates
6.	Have you ever been employed by us before?		Yes	No	Dates
7.	Are you related to anyone who has worked in law enforcement?				Yes	No
	If yes, provide name and relationship:
8.	Have you ever had a relative work for the Polk County Sheriff's Office?					Yes	No
	If yes, provide name (and member number, if known):

EDUCATION/TRAINING

1.

2.

MajorMinor

3. Other Schools (Trade, Vocational, Business, Police Academies or Military):

4.Describe any awards, honors, citations or other special recognition you received while attending school and positions held in school organizations:

5.Indicate any law enforcement education/training:

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7.Indicate any special skills you possess and equipment you can use which may be related to the position for which you are applying (i.e., breathalyzer, speed detection equipment, firearms, and computers):

8.Describe any word processing or computer skills and list all software used:

9. State approximate number of words per minute:

Typing

Shorthand

10. On what date are you available for work?

EMPLOYMENT HISTORY

1.List chronologically all employment including current employment, including summer and part-time employment while attending school. All time must be accounted for. If unemployed for any length of time, indicate dates of unemployment. Please attach a separate sheet of paper for additional employment history if necessary.

1

Name of present or last employer:

Part-Time

Full-Time

Address:

Your Job Title:

Phone Number:

(

)

-

FROM:

/

/

TO:

/

/

Supervisor's Name:

Duties and Responsibilities:

Reason for Leaving:

2

Name of employer:

Part-Time

Full-Time

Address:

Your Job Title:

Phone Number:

(

)

-

FROM:

/

/

TO:

/

/

Supervisor's Name:

Duties and Responsibilities:

Reason for Leaving:

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3

Name of employer:

Part-Time

Full-Time

Address:

Your Job Title:

Phone Number:

(

)

-

FROM:

/

/

TO:

/

/

Supervisor's Name:

Duties and Responsibilities:

Reason for Leaving:

4

Name of employer:

Part-Time

Full-Time

Address:

Your Job Title:

Phone Number:

(

)

-

FROM:

/

/

TO:

/

/

Supervisor's Name:

Duties and Responsibilities:

Reason for Leaving:

5

Name of employer:

Part-Time

Full-Time

Address:

Your Job Title:

Phone Number:

(

)

-

FROM:

/

/

TO:

/

/

Supervisor's Name:

Duties and Responsibilities:

Reason for Leaving:

4.Have you had any disciplinary action, to include verbal, written warnings, reprimands, suspensions and counsellings, taken against you from any employment or position you have held?

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6. Have you ever applied or worked with any law enforcement agencies?						Yes		No If yes, please provide the
following.
Agency and/or Department							Date Applied
Address (Street, City, State, Zip)
Position applied for:				Status:
Agency and/or Department							Date Applied
Address (Street, City, State, Zip)
Position applied for:				Status:
Agency and/or Department							Date Applied
Address (Street, City, State, Zip)
Position applied for:				Status:
Agency and/or Department							Date Applied
Address (Street, City, State, Zip
Position applied for:				Status:

7.Do you own a business, or are you a partner or corporate officer in any business or organization not listed previously as a

current or former employer?	Yes	No	If yes, please provide name and address of business, corporation
or organization and describe your relationship or position.

8.Have you ever performed paid or unpaid services for a law enforcement agency not listed as an employer to include extra-

duty details and auxiliary?	Yes	No	If yes, please provide name and address of business, corporation
or organization and describe your relationship or position.

RESIDENCES

1.Actual places of residence for past 15 years - list chronologically all addresses, including residences while at school and in the military. For college or campus residences, give dormitory name, city and state. If residences in military service cannot be shown as a street address, indicate complete military unit designation and location by city and state. If a post office box, give location of post office. If any addresses listed were an apartment complex, please provide the complex name, name of manager, and phone number below. Attach a separate sheet of paper for additional residences and landlords, if necessary.

LANDLORDS

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