Taney County Sheriff's Office Employment Application

Please inform us if you require assistance in filling out an application or taking a pre-em ploym ent test.
Individuals with disabilities should request reasonable accom m odations in accordance with
the American with Disabilities Act prior to testing or appointment.

Last, First, MI
Name
- c.h E R IF F ' s J — 6
Applying for Position
TANEY COUNTY SHERIFFS DEPT.

(Please print)
P.O. Box 1005
Forsyth MO, 6565 3
EOE M/F/V/D

________________________________________________________________________________
(417) 546-7250 FAX (417) 546-3348
http://www.taneycounty.org

INSTRUCTIONS TO APPLICANT: Type or print legibly in completing all pages of this application. Please
SIGN LAST PAGE. The application and any attachments become the property of the Sheriff's Department.
1. Name: Last First Middle 2. Telephone: Home 3 TELEPHONE: Business/Day
(Area Code) (Area Code)

4. EMAIL ADDRESS: (if applicable)

5. ADDRESS: Num ber Street Apt. No.

6. CITY, STATE 7. ZIP 8. COUNTY 9. SOCIAL SECURITY #

10. Are you a United States citizen? YES NO
If you are not a citizen, give the number of your permanent resident card, work permit, or employment
authorization card (provide copy of front and back of card): # __________________ Exp Date:__________

11. How did you hear about the position?_________________________________________________________
(if you heard from a newspaper of website, please specify which one)

12. Do you have any relative(s) working for the Sheriff's Department? YES NO

Name(s) and relationship(s):_________________________________________________________________

13. Have you ever been convicted of, or plead guilty to, any federal, state or municipal criminal offense?
(This includes ALL TRAFFIC VIOLATION S, including speeding, etc.)
YES NO (If YES, list complete conviction record - use additional sheets, if necessary.)

DATE: OFFENSE: LOCATION:

EXPLANATION (M isdemeanor or Felony- Please give full details):

A conviction will not automatically disqualify you from consideration. W e will consider the nature of the offense in relation to the job for which you are
applying. We will also consider your record since the offense was committed.
18. Name of High School Attended:

Address:

Did you graduate or obtain equivalency diploma? YES NO

VOCATIONAL EDUCATION (BUSINESS SCHOOL, TRADES SCHOOL, SERVICE SCHOOLS, ETC)
COLLEGE AND UNIVERSITY (UNDERGRADUATE, GRADUATE, PROFESSIONAL)
DIPLOMA, CREDIT
CERTIFICATE, HOURS
OR DEGREE
NAME AND LOCATION COURSES OF STUDY EARNED
RECEIVED
19. In the space below, list your complete record of employment for the PAST TEN YEARS and any other relevant
work/volunteer experience. Start with your present or most recent position and continue in descending order. List
positions in the order you held them. List any periods of unemployment. If the vacancy announcement includes an
experience requirement, be sure to show clearly that you meet such requirement. If more space is needed, attach
separate sheet(s) to this application.
Em ployer Dates of Employment

Supervisor's Name and Title FROM (M onth/Year) TO (M onth/Year)

Address Starting Salary Final Salary

City State Phone Reason For Leaving

Your Exact Title Circle One

Full Time Part Time
Specific Duties

Employer Dates of Employment

Supervisor's Name and Title FROM (M onth/Year) TO (M onth/Year)

Address Starting Salary Final Salary

City State Phone Reason For Leaving

Your Exact Title Circle One

Full Time Part Time
Specific Duties

Employer Dates of Employment

Supervisor's Name and Title FROM (M onth/Year) TO (M onth/Year)

Address Starting Salary Final Salary

City State Phone Reason For Leaving

Your Exact Title Circle One

Full Time Part Time
Specific Duties

It is our practice not to contact a present employer without the candidate's consent. Please DO NO T subm it references at this tim e.
 Additional remarks

APPLICANT CERTIFICATION, RELEASE OF INFORMATION, AND AUTHORIZATIONS
I hereby certify that all the statements and answers set forth on the application form and/or my resume are time and complete to
the best of my knowledge, and I understand that if prior to employment any such statements and/or answers are found false or that
information has been omitted, such false statements or omissions will be just cause for the denial of employment. I also understand
that if subsequent to employment any such statements and/or answers are found false or that information has been omitted, such
false statements or omissions may be just cause for termination of my employment. Further, I understand that by requesting this
information, no promise of employment is being made.
I, the undersigned, do hereby authorize the Taney County Sheriff and/or its designated provider to conduct an investigation with
respect to my application for employment and my qualifications and fitness for the position I have applied for and for employment
with the County. I release the County, my former employers, and personal references from any liability or damage caused by giving
and receiving information or opinions as to my employment or character. Information obtained may include residential,
achievement, job performance, attendance, employment history, personal references, credit reports, driving records, and criminal
history records.
I agree to hold the County harmless and in no event shall the County be liable to me for special, indirect, or consequential damages
for the refusal of employment due to information obtained during my background security check. Any information obtained through
former employers and/or personal references will become property of the Taney County Sheriff.
I authorize the Taney County Sheriff's Office or its designated provider to perform pre-employment urine drug screening. I
understand that I must successfully pass the drug screening in order to be eligible to begin employment with the Sheriff's Office. I
understand I have the right to request a copy of the County's Substance Abuse Policy.
I understand that if I have questions regarding any portion of the employment procedure, I have the right to contact the Sheriff's
Office for clarification.

Applicant Signature_________________________________________________ Date

The Taney County Sheriff's Department is committed to workforce diversity and a drug-free workplace. Pre-employment drug
testing is required. Women, minorities, and individuals with disabilities are encouraged to apply.
Revised 05/08
Taney County Sheriff’s Office

Background Investigation Information For:

Name:

Date: _
 Taney County Sheriff’s Office
Background Investigation Packet

INVESTIGATION PACKET

Please complete this packet as accurately as possible. The information furnished on
this application is confidential and is to be utilized for the purposes of enabling the
Taney County Sheriff’s Office to determine your qualifications.

This application is subject to a complete and thorough review which will consist of
verifying the information you have submitted regarding your personal background. As
part of this review, family members and character references will be contacted, previous
and current employment will be examined, your military service (if applicable) will be
investigated, your driving record and arrest history will be verified and any financial
information provided will be evaluated. All areas of your background will be
investigated.

The Taney County Sheriff’s Office has relatively few circumstances that would cause an
automatic failure or rejection from the application process. You are encouraged to answer
all questions completely and honestly. While some issues of prior misconduct, such as
prior illegal drug use, driving under the influence, theft or even arrest or convictions may
be embarrassing or uncomfortable, they may not necessarily cause a rejection when
evaluated with your entire personal history. Deliberate misstatements or omissions,
however, will most likely be interpreted as untruthfulness. Since honesty and integrity are
core traits necessary for employment with the Taney County Sheriff’s Office, deception in
the application process is usually a cause for rejection regardless of the nature or reason
for the untruthfulness.

MEDICAL INFORMATION

In compliance with the Americans with Disabilities Act, the Taney County Sheriff’s
Office will not request any medical or other disability information from you prior to
receiving a conditional offer of employment.

EQUAL OPPORTUNITY EMPLOYER

The Taney County Sheriff’s Office is an equal opportunity employer. All candidates
receive consideration for employment without regard to age, race, color, ancestry,
national origin, irrelevant physical disability, religious beliefs, sex, marital status, or
other non-job related factors except as limited by law, personnel rules, collective
bargaining agreements, or bona fide occupational qualifications.

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 Taney County Sheriff’s Office
Background Investigation Packet
The Background Investigation is a critical examination of an applicant's past work and
personal history. Certain information will be needed to complete this personal history
application. It is suggested that you have the information and documents listed below
available when you begin to fill out this form. Additionally, your background
investigator will request these forms when you submit your completed Background

THE FOLLOWING DOCUMENTS AND INFORMATION WILL BE REQUIRED
DOCUMENTS (IF APPLICABLE)

• Birth Certificate and/or naturalization papers.
• Name change documents
• Military Separation Document DD214 Long Form and Evaluations
• Marriage License
• Divorce Decree
• High school records or GED equivalency documentation
• College records
• All documents related to any arrests to include the police report and court dispositions.
• Personal credit history

INFORMATION NEEDED (IF APPLICABLE)

• Dates of birth and address for dependents not living with you.
• Dates of birth and address for prior spouse.
• Dates and location of any traffic or criminal history.
• Company name, address and dates worked at all past employers.
• Character references, name, address and contact information.

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APPLICANT PERSONAL INFORMATION
FIRST NAME LAST NAME MIDDLE NAME

PREVIOUS NAME GENDER SSN AGE RACE

DATE OF BIRTH BIRTH COUNTY BIRTH CITY BIRTH STATE

ARE YOU A RESIDENT ALIEN?

ARE YOU LEGALLY AUTHORIZED TO ACCEPT WORK AND REMAIN IN DRIVERS LICENSE STATE DRIVERS LICENSE NUMBER
THE UNITED STATES?

HEIGHT (FT) HEIGHT (IN) W EIG HT (LBS) HAIR COLOR EYE COLOR

WERE YOU NATURALIZED?

CELL PHONE WORK PHONE

CURRENT ADDRESS

EMAIL

POSITION APPLIED FOR
DESIRED POSITION

REASON FOR APPLYING

LANGUAGE(S) SPOKEN
LANGUAGE PROFICIENCY

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DO YOU HAVE ANY SCARS, MARKS, PIERCINGS OR LOCATION ON BODY TYPE
TATTOOS?

DESCRIPTION

MEANING

DO YOU HAVE ANY SCARS, MARKS, PIERCINGS OR LOCATION ON BODY TYPE
TATTOOS?

DESCRIPTION

MEANING

DO YOU HAVE ANY SCARS, MARKS, PIERCINGS OR LOCATION ON BODY TYPE
TATTOOS?

DESCRIPTION

MEANING

DO YOU HAVE ANY SCARS, MARKS, PIERCINGS OR LOCATION ON BODY TYPE
TATTOOS?

DESCRIPTION

MEANING

RESIDENCY HISTORY

DATES OF RESIDENCY NAME ON LEASE OR MORTGAGE

ADDRESS

DID YOU RENT THIS PROPERTY?

LANDLORD NAME APARTMENT COMPLEX

LANDLORD PHONE LANDLORD EMAIL

DID SOMEONE OTHER THAN YOURSELF LIVE AT THIS ADDRESS, IF YES, WHO?

WERE ANY MEMBERS OF THE HOUSEHOLD ARRESTED, IF YES, NAME(S) AND REASON(S)?

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DATES OF RESIDENCY NAME ON LEASE OR MORTGAGE

ADDRESS

DID YOU RENT THIS PROPERTY?

LANDLORD NAME APARTMENT COMPLEX

LANDLORD PHONE LANDLORD EMAIL

DID SOMEONE OTHER THAN YOURSELF LIVE AT THIS ADDRESS, IF YES, WHO?

WERE ANY MEMBERS OF THE HOUSEHOLD ARRESTED, IF YES, NAME(S) AND REASON(S)?

DATES OF RESIDENCY NAME ON LEASE OR MORTGAGE

ADDRESS

DID YOU RENT THIS PROPERTY?

LANDLORD NAME APARTMENT COMPLEX

LANDLORD PHONE LANDLORD EMAIL

DID SOMEONE OTHER THAN YOURSELF LIVE AT THIS ADDRESS, IF YES, WHO?

WERE ANY MEMBERS OF THE HOUSEHOLD ARRESTED, IF YES, NAME(S) AND REASON(S)?

HAVE YOU EVER BEEN EVICTED, ASKED TO LEAVE A RESIDENCE OR LEFT A RESIDENCE OWING RENT, UTILITITES, OR OTHER
HOUSEHOLD EXPENSES? IF YES, DESCRIBE.

DRIVING HISTORY
HAVE YOU BEEN DENIED A LICENSE OR HAD A LICENSE SUSPENDED OR REVOKED?

HAVE YOU BEEN DENIED INSURANCE OR HAD YOUR INSURANCE SUSPENDED OR REVOKED?

HAVE YOU EVER FAILED TO APPEAR FOR A TRAFFIC CITATION?

HAVE YOU EVER FAILED TO PAY A TRAFFIC CITATION?

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HAVE YOU EVER BEEN ISSUED A TRAFFIC VIOLATION?

OFFENSE DISPOSITION DATE VIOLATION TYPE

CITY STATE

OFFENSE DESCRIPTION

HAVE YOU EVER BEEN ISSUED A TRAFFIC VIOLATION?

OFFENSE DISPOSITION DATE VIOLATION TYPE

CITY STATE

OFFENSE DESCRIPTION

HAVE YOU EVER BEEN INVOLVED IN A TRAFFIC ACCIDENT AS A DRIVER OF THE VEHICLE?

DATE

CITY STATE

ACCIDENT DETAILS

DO YOU CURRENTLY HAVE VEHICLE INSURANCE?

TYPE OF COVERAGE VEHICLE MAKE VEHICLE YEAR VEHICLE REGISTRATION NUMBER

INSURANCE COMPANY NAME POLICY NUMBER EXPIRATION DATE

HAVE YOU EVER DRIVEN A VEHICLE WITHOUT AUTO INSURANCE AS REQUIRED BY LAW?

HAVE YOU EVER BEEN REFUSED A DRIVER'S LICENSE BY ANY STATE? IF YES, EXPLAIN:

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FAMILY INFORMATION
SPOUSE’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

CHILD ’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

CHILD ’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

CHILD ’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

CHILD ’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

PARENT’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

PARENT’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

SIBLING’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

SIBLING’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

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SIBLING’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

SIBLING’S FIRST NAME MIDDLE INITIAL LAST NAME IS HE/SHE STILL ALIVE?

CONTACT PHONE NUMBER EMAIL ADDRESS DATE OF BIRTH OCCUPATION

HAVE YOU EVER BEEN DIVORC: e d ?

CRIMINAL/CIVIL HISTORY
HAVE YOU EVER BEEN CHARGED WITH A CRIME? IF YES, EXPLAIN:

HAVE YOU EVEN BEEN INVOLVED IN A DOMESTIC VIOLENCE INCIDENT? IF YES, EXPLAIN:

HAVE YOU OR A MEMBER OF YOUR FAMILY EVER BEEN INVOLVED IN ANY CRIMINAL GANG OR GANG RELATED ACTIVITY?
IF YES, EXPLAIN:

HAVE YOU EVER BEEN INVOLVED IN A CIVIL LITIGATION? IF YES, EXPLAIN:

HAVE YOU EVER BEEN DETAINED OR QUESTIONED BY A LAW ENFORCEMENT AGENCY? IF YES, REASON AND WHEN.
IF YES, EXPLAIN:

HAVE YOU EVER BEEN FINGERPRINTED BY ANY LAW ENFORCEMENT AGENCY? IF YES, EXPLAIN:

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FINANCE HISTORY
ARE YOU REQUIRED TO PAY ALIMONY?

ARE YOU REQUIRED TO PAY CHILD SUPPORT?

ARE YOU CURRENTLY MORE THAN 30 DAYS BEHIND PAYMENT TO ANY CREDITOR? IF YES, EXPLAIN:

DO YOU HAVE ANY OUTSTANDING STUDENT LOANS?

HAVE YOU EVER BEEN DELINQUENT ON ANY INSTALLMENT LOANS? IF YES, EXPLAIN:

HAVE ANY OF YOUR BILLS EVER BEEN TURNED OVER TO A COLLECTION AGENCY? IF YES, EXPLAIN:

HAVE YOU EVER HAD YOUR WAGES GARNISHED? IF YES, EXPLAIN:

HAVE YOU EVER BEEN DELINQUENT IN FILING YOUR FEDERAL OR STATE INCOME TAX? IF YES, EXPLAIN:

HAVE YOU EVER HAD ANY PERSONAL PROPERTY REPOSED? IF YES, EXPLAIN:

HAVE YOU EVER BEEN EVICTED? IF YES, EXPLAIN:

HAVE YOU EVER BEEN REFUSED CREDIT? IF YES, EXPLAIN:

HAVE YOU EVER FILED FOR BANKRUPTCY? IF YES, EXPLAIN:

HAVE YOU EVER HAD ANY COURT ORDERED JUDGEMENTS? IF YES, EXPLAIN:

PREVIOUS LAW ENFORCEMENT APPLICATIONS
HAVE YOU EVER APPLIED TO ANOTHER LAW ENFORCEMENT AGENCY? IF YES, WHAT AGENCY AND WHEN.

STATUS OF APPLICATION

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DRUG HISTORY
HAVE YOU EVER USED ILLEGAL DRUGS OR PRESCRIPTION DRUGS ILLEGALLY?

DRUG TYPE

DATE LAST USED NUMBER OF TIMES USED

DURING THE PAST FIVE YEARS, HAVE YOU ASSOCIATED WITH FRIENDS, ACQUAINTANCES, HOUSEMATES, OR FAMILY MEMBERS
WHO HAVE ILLEGALLY USED DRUGS OR NARCOTICS, AND/OR ILLEGALLY USED PRESCRIPTION MEDICATIONS? IF YES,
EXPLAIN:

GUN PERMIT INFORMATION
HAVE YOU EVER APPLIED FOR A GUN PERMIT?

HAVE YOU EVER TAKEN A CARRYING A CONCEALED WEAPONS COURSE?

SOCIAL NETWORKING
SERVICE (FACEBOOK, INSTRAGRAM, TIK TOK, ETC.) USERNAME

SERVICE (FACEBOOK, INSTRAGRAM, TIK TOK, ETC.) USERNAME

SERVICE (FACEBOOK, INSTRAGRAM, TIK TOK, ETC.) USERNAME

SERVICE (FACEBOOK, INSTRAGRAM, TIK TOK, ETC.) USERNAME

ADDITIONAL QUESTIONS
HAVE YOU EVER BEEN FIRED, RELEASED DURING PROBATION, OR ASKED TO RESIGN FROM ANY PLACE OF EMPLOYMENT?
IF YES, EXPLAIN:

WERE YOU EVER INVOLVED IN A PHYSICAL/VERBAL ALTERCATION WITH A SUPERVISOR, CO-WORKER, OR CUSTOMER?
IF YES, EXPLAIN:

HAVE YOU EVER QUIT WITHOUT GIVING PROPER NOTICE? IF YES, EXPLAIN:

HAVE YOU EVER RESIGNED IN LIEU OF TERMINATION? IF YES, EXPLAIN:

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HAVE YOU EVER BEEN ACCUSED OF DISCRIMINATION (SUCH AS SEXUAL HARASSMENT, RACIAL BIAS, ETC.) BY A CO-WORKER,
SUPERIOR, SUBORDINATE, OR CUSTOMER? IF YES, EXPLAIN:

WERE YOU EVER THE SUBJECT OF A WRITTEN COMPLAINT AT WORK? IF YES, EXPLAIN:

HAVE YOU EVER BEEN COUNSELED AT WORK DUE TO TARDINESS OR ABSENCES? IF YES, EXPLAIN:

DID YOU EVER RECEIVE AN UNSATISFACTORY PERFORMANCE REVIEW? IF YES, EXPLAIN:

HAVE YOU EVER CALLED IN SICK WHEN YOU WERE NEITHER SICK NOR CARING FOR A SICK FAMILY MEMBER?
IF YES, EXPLAIN:

IN THE PAST FIVE YEARS, HAVE YOU BEEN WARNED BY AN EMPLOYER ABOUT YOUR DRINKING OR DRUG HABITS AND THEIR
IMPACT ON YOUR PERFORMANCE? IF YES, EXPLAIN:

HAVE THE POLICE EVER BEEN CALLED TO YOUR RESIDENCE FOR ANY REASON? IF YES, EXPLAIN:

HAVE YOU OR YOUR SPOUSE / PARTNER EVEN BEEN REFERRED TO CHILD PROTECTIVE SERVICES? IF YES, EXPLAIN:

HAVE YOU EVER USED FORCE OR VIOLENCE AGAINST ANOTHER? IF YES, EXPLAIN:

HAVE YOU EVER CONTRIBUTED TO THE DELINQUENCY OF A MINOR? IF YES, EXPLAIN:

HAVE YOU EVER DRIVEN UNDER THE INFLUENCE OF ALCOHOL AND DRUGS? IF YES, EXPLAIN:

HAVE YOU EVER BEEN INTOXICATED IN PUBLIC? IF YES, EXPLAIN:

HAVE YOU EVER BEEN INVOLVED IN ILLEGAL HUNTING OR FISHING? (WITHOUT A LICENSE) IF YES, EXPLAIN:

HAVE YOU EVER IMPERSONATED A POLICE OFFICER? IF YES, EXPLAIN:

HAVE YOU EVER INTENTIONALLY WRITTEN A BAD CHECK? IF YES, EXPLAIN:

DID YOU EVER POSSESS ALCOHOL AS A MINOR? IF YES, EXPLAIN:

HAVE YOU EVER SOLICITED A PROSTITUTE? IF YES, EXPLAIN:

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HAVE YOU EVER DRIVEN A VEHICLE RECKLESSLY? IF YES, EXPLAIN:

HAVE YOU EVER STOLE MONEY OR VALUABLES ENTRUSTED TO YOU? IF YES, EXPLAIN:

HAVE YOU EVER SEXUALLY ASSAULTED ANOTHER USING PHYSICAL FORCE? IF YES, EXPLAIN:

HAVE YOU EVER FALSIFIED ANY TYPE OF DOCUMENT, CHECK, CERTIFICATE, LICENSE, CURRENCY, ETC.? IF YES, EXPLAIN:

HAVE YOU EVER FRAUDULENTLY USED A CREDIT CARD, ATM CARD OR DEBIT / CHECK CARD? IF YES, EXPLAIN:

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I hereby attest and certify that I have personally com pleted this application.
The answers I have given to each question are true and com plete to the best of
m y know ledge and belief. I understand they will be used to consider m y
suitability for em ploym ent. This inform ation is furnished at m y request and for
m y benefit. As such, I release the em ployers, references and any other
individual that provides inform ation, from all liability for any dam ages of any
nature.

I understand and agree that any misstatement or falsification knowingly made to
questions on this application will subject me to possible disqualification, or if I
have been hired is cause for removal from employment either during or after
employment.

Signature of Applicant:

Date:

Signature of Witness:

Date:

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 Taney County Sheriff’s Office
Applicant Background Checklist

BACKGROUND INVESTIGATION SUPPORTING DOCUMENTATION
As part of your background investigation for a position with the Taney County Sheriff’s Office,
please obtain the following documents. (Some documents, may not apply)

An official copy of your Birth Certificate;
□ (If no record of your birth is on file at the Department of Health or the Bureau of Vital
Statistics of the State in which you were born, obtain a statement attesting to the fact.)

□ Valid Driver’s License

□ Proof of Citizenship / Naturalization documents (if born outside of US)

High School / College / Trade School Transcripts and Diploma; (Transcripts MUST be
□ submitted in a SEALED envelope from the institution or sent directly to your assigned
Background Investigator)

□ DD214 - Military Record of Separation (Long Form)

□ Passport (Including all pages with transactions)

□ Marriage Certificate

□ Separation / Divorce Decree(s) (face page and signature page only)

□ Records of any change in name

□ Missouri POST Certificate (for Police Officer Applicants)

□ Social Security Card

□ Court Orders (child support, ex--parte, full orders of protection, garnishments, etc.)

□ Credit report

FAILURE TO PRODUCE THESE DOCUMENTS WILL DELAY THE PROCESSING OF YOUR
APPLICATION.

Please deliver a signed copy of your Background Investigation Packet to the
Background Investigator at the Pre--Background Interview.

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