Please detail employment and positions held for the past ten years.
Start with your present or last job. Include any job-related military service assignments and volunteer activities. List all full-time and part-time employment held in the past ten years.
Have any of the following happened to you in the last 10 years:
1. Fired from a job?
2. Quit a job after being told you may be fired?
3. Left a job by mutual agreement following allegations of misconduct?
4. Left a job by mutual agreement following allegations of unsatisfactory performance or attendance?
5. Left a job for other reasons under unfavorable circumstances?
If you answered YES to this question describe in detail when this occurred, what happened, the employer's identity and a detailed explanation for each instance.
Please list any additional paid or volunteer work experience relevant to the position you are applying for.
General Information (Please click yes or no)
Applicant's Agreement To Release Records and Information
Please read the following statements carefully:
I hereby affirm that I have read and understand this application and that the information that I have provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I agree that any omission or falsified information shall subject me to disqualification from further consideration for employment and shall be considered justification for my immediate dismissal if discovered at a later date. I hereby authorize all persons, schools, current employer(s) and other organizations named in this application (and accompanying resume, if any) to provide the Hampden County Sheriff's Office with any relevant information that may be helpful in arriving at an employment decision. I hereby release, indemnify and hold harmless said persons and entities and the Hampden County Sheriff's Office from any and all liability for providing and/or using this information. This release shall be considered active for a period of one (1) year.
DISCLOSURE OF NAMES OF FAMILY MEMBERS WHO ARE STATE EMPLOYEES
Disclosure Required by G.L. c. 268A, Sec. 6B
If you answered Yes, please list below the name(s) of any state employee who is your
spouse, parent, brother, sister or child, or who is the spouse of your parent, brother, sister
or child, and indicate their relationship to you. Please also list the name of the state
agency that employs those relatives.
NOTE: For purposes of this disclosure, a "state employee" is a person holding a paid or unpaid office, position, employment or membership in a Massachusetts state agency. For purposes of this disclosure, a "state agency" is any department of Massachusetts state government, including any department or agency within the executive, legislative or judicial branch, and all councils thereof and thereunder, and any division, board, bureau, commission, institution, tribunal or other instrumentality within such department or agency, and any independent state authority, commission, instrumentality or agency, but NOT INCLUDING an agency of a county, city or town.