Form Center

Fredericksburg Sheriff's Office
Application for Appointment

2. Appointment Type*

   1. Full-Time

   1. Auxiliary

   1. Part-Time

4. Last Name*

5. First Name*

6. MI*

8. Address*

10. City*

11. State*

12. Zip*

14. Sex*

    1. Male

    1. Female

15. Last 4 Digits of SSN*

17. Home Phone*

18. Work Phone

22. EDUCATION

24. Are you a high school graduate?*

    1. Yes

    1. No

25. If yes, what school did you attend?

27. Year Graduated

29. If you did not, do you have a high school equivalency diploma?

    1. Yes

    1. No

31. College Credits

    Please specify course and college.

35. WORK EXPERIENCE
    Start with the most recent employer and work back.

    Start with the most recent employer and work back.

37. Employer

39. Job Title

40. Immediate Supervisor

42. Length of Employment
    Length of Employment Start Date

    —

    Length of Employment End Date

43. Phone Number

45. Duties

47. Reason for Leaving

51. Employer

53. Job Title

54. Immediate Supervisor

56. Length of Employment
    Length of Employment Start Date

    —

    Length of Employment End Date

57. Phone Number

59. Duties

61. Reason for Leaving

65. Employer

67. Job Title

68. Immediate Supervisor

70. Length of Employment
    Length of Employment Start Date

    —

    Length of Employment End Date

71. Phone Number

73. Duties

75. Reason for Leaving

79. Employer

81. Job Title

82. Immediate Supervisor

84. Length of Employment
    Length of Employment Start Date

    —

    Length of Employment End Date

85. Phone Number

87. Duties

89. Reason for Leaving

93. Additional Information

    Special skills, hobbies, comments, etc.

97. Personal References
    List five (5) personal references. Do NOT include relatives or employers.

    List five (5) personal references. Do NOT include relatives or employers.

99. Name

100. Telephone #

102. Address

104. City

105. State

106. Zip Code

110. Name

111. Telephone #

113. Address

115. City

116. State

117. Zip Code

121. Name

122. Telephone #

124. Address

126. City

127. State

128. Zip Code

132. Name

133. Telephone #

135. Address

137. City

138. State

139. Zip Code

143. Name

144. Telephone #

146. Address

148. City

149. State

150. Zip Code

154. Miscellaneous Information

156. Do you have a VA Driver's License?*

     1. Yes

     1. No

157. Are you a US Citizen?*

     1. Yes

     1. No

159. Have you ever been convicted of a law violation, including moving traffic violations but excluding offenses committed as a minor?*

     1. Yes

     1. No

161. If yes, please list:

163. When are you able to start work?*

165. Have you ever applied to another law enforcement agency?*

     1. Yes

     1. No

167. If yes, list the approximate date, agency and disposition below.

169. Date
     Date

170. Agency

171. Disposition

173. Date
     Date

174. Agency

175. Disposition

177. Date
     Date

178. Agency

179. Disposition

181. Date
     Date

182. Agency

183. Disposition

185. Have you ever attended a criminal justice academy?*

     1. Yes

     1. No

187. If yes, explain below:

189. Have you ever applied for employment with the City of Fredericksburg?*

     1. Yes

     1. No

191. If yes, list date, department and disposition below.

193. Date
     Date

194. Department

195. Disposition

197. Date
     Date

198. Department

199. Disposition

201. Date
     Date

202. Department

203. Disposition

205. By signing this application you certify that all the information that you have provided is true and accurate to the best of your knowledge and you understand that discovery of any falsification is grounds for termination and I understand that the Sheriff is a Constitutional Officer of the Commonwealth and as such, all deputies and others are appointed to position by him into the Fredericksburg Sheriff’s Office and serve at his pleasure according to State Code (VA. Code 15.2-1603). As such, their appointment is subject to termination by the Sheriff for any reason at any time, and such termination of appointment is not a grievable matter. The Sheriff will have the final say with regards to both appointments to position within his office and the termination of such appointments.

207. Applicant's Signature: I understand that checking the box below is the equivalent of signing my name.*

     1. I Accept:

209. Signature of Applicant*

210. Date*
     Date

212. When you report for your interview, you will need to bring the following documents:
     
     
     - Birth Certificate or Naturalization Certificate
     
     
     - College Degree or Transcript showing graduation
     
     
     - High School Diploma or G.E.D. Certificate
     
     
     - DD-214 (if veteran)
     
     
     - Virginia Drivers License
     
     
     - Social Security Card

Leave This Blank:


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

     This field is not part of the form submission.

215. Submit Submit and Print

* indicates a required field