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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.
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.
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:


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

     This field is not part of the form submission.

216. Submit Submit and Print

* indicates a required field