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APPLICATION FOR STATE CONSTABLE’S COMMISSION

S.C. LAW ENFORCEMENT DIVISION

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Group I

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Group III

POST OFFICE BOX 21398

COLUMBIA, SOUTH CAROLINA 29221-1398

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Group II

AD#

NOTICE: Application must be typewritten or clearly printed in ink. All questions must be answered, if applicable. If no, indicate

NA (not applicable). Applications which are not complete and legible will not be considered. If space provided is not sufficient

DATE:

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.

I. PERSONAL HISTORY

1. Name in Full (Last, First, Middle)

2. List all other names you have used including nicknames; if female, furnish

maiden name. If you have ever used any surnames other than your true name,

during what period and under what circumstances were these names used? If you

have ever legally changed your name, give place and court.

3. Birth Date (Month, Day, Year)

5. Are you a U.S. Citizen? ____ Yes ____ No

Derivative? _____ Yes

_____ No

Naturalized?

_____ Yes _____ No

4. Place of Birth (City, State)

Naturalization # ______________________

Place ______________________________

Court _______________________________ If Naturalized, Attach a Copy of Naturalization Papers

6. Social Security Number

Race

Sex

Height

Weight

Eyes

Hair

PLEASE NOTE: THE INFORMATION REQUESTED IN ITEM (6) IS NECESSARY IN ORDER TO OBTAIN AN ACCURATE CRIMINAL HISTORY CHECK

7. Driver’s License No. ____________________________________

8. Are you a resident of South Carolina?

_____ Yes _____ No

State Licensed __________________________

9. SC Voter Registration Number ________________________

NOTE: MUST BE REGISTERED TO VOTE TO RECEIVE COMMISSION

Email Address:

II. MARITAL STATUS

Place of Marriage

No. of Children

______

Single

______

Married

Date _____________

Place of Divorce or Legal Separation

Court

______

Widowed

______

Divorced

Date _____________

______

Separated

III. RESIDENCES

a.Present Residence Address: (Street, city, state, zip code)

b.Email Address: ____________________________________________________________

Telephone numbers:

Residence: __________________________

Business: ___________________________

Mobile Phone: _______________________

c. Complete address to which you wish mail or telegram sent (include zip code and telephone number if different from above.)

List chronologically ALL of your residences in the past 10 years including addresses while attending school (if away from the home) and all military addresses including any off military base.

	Dates
From	To	Street Address	City	State	Zip

Revised 2/9/2010

IV. EDUCATION

Calendar Years Attended

					Circle Last			Major Course	Did You	If Yes, Certificate or
	Name and Location	From	To		Year Completed			Of Study	Graduate	Degree Received
High School				9	10	11	12
College				1	2	3	4
Graduate
School				1	2	3	4
Technical
School				1	2	3	4
Other				1	2	3	4
			Specialized Schools

Name and Address of School

Study or Specialization

From

4. Were you ever dismissed from a school, or was any disciplinary action ever taken against you during your scholastic career? ___ Yes			___ No

School		Date	Action
	V. EMPLOYMENT HISTORY

NOTE: LIST LAST POSITION FIRST. Include chronological history of employment starting with current or most recent position. Account for all periods including casual employment and all periods of unemployment. Be sure to include military experience, if applicable. A resume of your employment will not be accepted in lieu of this information. Attach additional sheets as needed.

I.PRESENT OR LAST EMPLOYMENT (GIVE COMPLETE MAILING ADDRESSES AND ZIP CODES)

Employer ___________________________________________________________ Immediate Supervisor __________________________________________________

Employer’s Address (Street, City, State, Zip) ______________________________________________________________________________________________________

Telephone No. ______________________________ Date Employed _____________________________ Date Separated _______________________________

Job Title/Work Description __________________________________________ Starting Salary ___________________ Ending Salary ____________________________

Reason for Leaving ___________________________________________________________________________________________________________________________

II. PREVIOUS EMPLOYMENT

Employer ___________________________________________________________ Immediate Supervisor __________________________________________________

Employer’s Address (Street, City, State, Zip) ______________________________________________________________________________________________________

Telephone No. ______________________________ Date Employed _____________________________ Date Separated _______________________________

Job Title/Work Description __________________________________________ Starting Salary ___________________ Ending Salary ____________________________

Reason for Leaving ___________________________________________________________________________________________________________________________

III. PREVIOUS EMPLOYMENT

Employer ___________________________________________________________ Immediate Supervisor __________________________________________________

Employer’s Address (Street, City, State, Zip) ______________________________________________________________________________________________________

Telephone No. ______________________________ Date Employed _____________________________ Date Separated _______________________________

Job Title/Work Description __________________________________________ Starting Salary ___________________ Ending Salary ____________________________

Reason for Leaving ___________________________________________________________________________________________________________________________

IV. PREVIOUS EMPLOYMENT

Employer ___________________________________________________________ Immediate Supervisor __________________________________________________

Employer’s Address (Street, City, State, Zip) ______________________________________________________________________________________________________

Telephone No. ______________________________ Date Employed _____________________________ Date Separated _______________________________

Job Title/Work Description __________________________________________ Starting Salary ___________________ Ending Salary ____________________________

Reason for Leaving ___________________________________________________________________________________________________________________________

Have you ever been dismissed or asked to resign from any employment or position you have held? _____ Yes		______ No If your answer is “Yes”, set forth your
explanations on an attached sheet indicating the name of the company, your dates of employment and the reason(s) for your dismissal/resignation.
Revised 2/9/2010	2

VI. MILITARY RECORDS


1.	Are you registered for Selective Service? ___ Yes		___ No Location: City and State _______________________________________________________
2.	Have you ever served on active duty in the Armed Forces of the United States? ______ Yes						______ No
3.	Branch of Military Service _____________________________________________					Type of Discharge __________________________ Basis ___________________
4.	Dates of Active duty (month, day, year) From __________________ To __________________						5. Serial Number ________________________________________
6.	Member of Reserve? ___ Yes ___ No	Ready		Standby	Branch of Service ________________________ 7. Was any type of disciplinary action taken in the
service? Be sure to include non-judicial punishment(s), if applicable. ___ Yes ___ No						Details _____________________________________________________________
8.	National Guard: ___ Present ___ Former	___ None. If you are a drilling member of the N.G., give name of unit & location __________________________________
					VII. REFERENCES

Give three references (not relatives, former or present employers, fellow employees or school teachers) who are responsible adults of reputable standing in their communities, such as property owners, business or professional men or women including your physician, if you have one, who have known you well for at least five years, preferably those who have known you during the past five years. If retired, give former occupation.

Complete Name _______________________________________________________________________ Years Known _________________________________________

Home Phone ______________________________________ Business Phone _______________________________________ Occupation ________________________

Home Address _______________________________________________________________________________________________________________________________

Business Address _____________________________________________________________________________________________________________________________