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Williamson County Sheriffs Office Sheriff Dusty Rhoades (Williamson County Tennessee Government)

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BROWSE WILLIAMSON COUNTY TENNESSEE GOVERNMENT (TN) FORMS

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1
Williamson County Sheriff’s Office
Sheriff Dusty Rhoades
408 Century Court
Franklin, Tennessee 37064
(615) 786-1540
www.williamsoncountysheriff-tn.com
Application for Employment
The Williamson County Sheriff’s Office is an equal opportunity employer, dedicated to a place
of non-discrimination in employment on any basis including age, sex, color, race,
creed, national origin, religious persuasion, marital status, political belief, military service, or
disability that does not prohibit performance of essential job functions.
*ANY INCOMPLETE APPLICATION SUBMITTED WILL NOT BE
PROCESSED FOR FURTHER CONSIDERATION.
Clear Form
2
Introductory Benefits for Employees of the Williamson County Sheriff’s Office
1
Starting Pay Rate for Civilian Jail Staff (amount subject to change)
Booking: $16.66 Food Services: $16.38
Starting Pay Rate for T.C.I. Certified Tower Operator (amount subject to change)
$15.60
Starting Pay Rate for T.C.I. Certified Deputy Sheriff(amount subject to change)
$18.00 (experience pay up to 5 years added extra)
Starting Pay Rate P.O.S.T. Certified Deputy Sheriff (amount subject to change)
$19.00 and $20.61 (depending on division assignment)
These additions are NOT included in the pay rates above:
Shift differentials – 2
nd
shift = $0.57
3
rd
shift = $0.86
Education Incentive – Associate’s degree = $0.36
Bachelor’s degree = $0.72
Employer paid Life Insurance: $40,000
Different Insurance plans to choose from (reference Williamson County Benefits)
Medical Coverage Offered to Employee: Medical Coverage, Prescription Coverage, Dental Coverage
(Optional coverage for spouse & dependents for a cost)
Flexible Spending Account (money taken out pre-taxed)
Employee Assistance Program – Free, 24/7, 365 days a year, (reference Williamson County EAP)
Retirement Plan – employee portion taken out pre-taxed (5%), County adds a portion as well (TCRS)
Voluntary Benefits – are paid 100% by the employee
401K additional Retirement Plan
Supplemental life for employee, spouse or dependents
Short term disability, long term disability,
Vision insurance for employee, spouse or dependents
Accident insurance, Critical Illness, Long & short term care.
13 paid Holidays each year
8 sick hours per month (after first month of employment) – can be used for spouse or dependents
6.66 hours up to 16 hours vacation per month (after first month of employment) – based on years of service
Longevity Pay – after 5 years of continual service ($50 per year)
Paid 5 week Detention Training Academy
Uniforms & equipment provided
Opportunities for Advancement
_________________________
1
These benefits are representative of the current benefits offered to Williamson County Sheriff’s Office employees. They
are not contractual in nature and may change at any time upon determination by the employer.
3
Williamson County Sheriff’s Office
Application for Employment
General Instructions:
This application should be submitted as soon as you have all questions answered and all
requested documents copied and ready to submit. A National Crime Information Center
(“NCIC”) check will be completed, and if you meet the criteria to move forward in the process, you
will be contacted. Applicants for Deputy Sheriff will undergo a functional fitness test, an initial
interview, and a keyboarding test. If you are applying for a position other than a Deputy Sheriff, you
will have an initial interview.
In the application process, the information requested is obtained to determine applicant suitability to
work at the Williamson County Sheriff’s Office. Do not misstate or omit any facts since the statements
made herein are subject to verification. If any misrepresentations are found, the applicant will be
permanently disqualified.
Applications may be submitted by: Drop off in person at 408 Century Court, Franklin, TN 37064
Mail – 408 Century Court, Franklin, TN 37064
Scan and email:
Vickie.Pittenger@williamsoncounty-tn.gov
4
Williamson County Sheriff’s Office
Franklin, Tennessee
Application for position of: Date:
GENERAL INSTRUCTIONS: USE BLACK INK ONLY
Typewrite or print answers to every question. If the question does not apply to you, put N/A. If additional
space is needed, use a separate sheet of paper and identify each answer with the number of the
question, page number, or section being answered. DO NOT MISSTATE OR OMIT material facts since
the statements made herein are subject to verification to determine your qualifications for employment.
1. Last Name First Name Middle Name
2. Alias(es), Nickname(s), Other changes in name
3. Social Security No.
4. Present Residential Address City State Zip Code
6. Cell Phone
7. Work Phone
8. Email Address:
The best time to call, if necessary, is: ____________
___________. Preferred contact number Cell Home Work
May we contact you at work? Yes No If Yes, what time is best to call: ________________
Have you submitted an application here before? Yes, when ____/____/____ No
Have you ever been employed here before? Yes, from ____/____/____ to ____/____/____ No
Is this application a request for re-employment following an extended military leave of absence from the county?
Yes No
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States
and to complete the required employment eligibility verification document form upon hire.
Are you legally eligible to work in the United States? Yes No
Are you currently P.O.S.T Certified?
Yes
No If yes, what state? ____________________
Yes
No
Are you a legal resident of the United States?
If required, have you registered for Selective Service?
Yes
No
20. Employment:
a. Have you ever been discharged, asked to resign, laid-off, or put on inactive status for cause, subjected to
disciplinary action while in any position (except Military)? Yes No
b. Have you ever resigned (quit) after being informed that your employer intended to discharge you for any reason?
Yes No
If you answered yes to either question, please attach a separate sheet of paper explaining the reason, including
the name and location of the agency/company and the date of your departure.
c. At this time do you agree to allow the Williamson County Sheriff’s Office to contact your present employers?
Yes No
__________________________________ ________________
SIGNATURE OF APPLICANT DATE
Start with your present employer and work backwards for 10 years. Include ALL part-time,
temporary, and/or seasonal employment. During periods of unemployment or attending school,
indicate where appropriate. Ensure that there are NO GAPS. If more space is needed, include extra
sheets of paper with your information on it.
*Any law enforcement experience prior to the 10 year requirement must be listed.
List complete address (number, street, city, state and zip code) and telephone numbers with area codes.
Employer #1 Telephone #
Date Hired:
Street Address City State Zip
Date Left:
Starting Job Title/Final Job Title:
Final Salary:
Immediate supervisor and title (for most recent position held) and their phone number
Why did you leave and in what manner? I.E. Resigned, terminated, resigned in lieu of termination etc.
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
5
9.
6
List complete address (number, street, city, state and zip code) and telephone numbers with area codes.
Employer #2 Telephone # Date Hired:
Street Address City State Zip Date Left:
Starting Job Title/Final Job Title: Final Salary:
Immediate supervisor and title (for most recent position held) and their phone number
Why did you leave and in what manner? I.E. Resigned, terminated, resigned in lieu of termination etc.
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
Employer #3
Telephone #
Date Hired:
Street Address City State Zip
Date Left:
Starting Job Title/Final Job Title:
Final Salary:
Immediate supervisor and title (for most recent position held) and their phone number
Why did you leave and in what manner? I.E. Resigned, terminated, resigned in lieu of termination etc.
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
7
List complete address (number, st
reet, city, state and zip code) and telephone numbers with area codes.
Employer #4
Telephone #
Date Hired:
Street Address City State Zip
Date Left:
Starting Job Title/Final Job Title:
Final Salary:
Immediate supervisor and title (for most recent position held) and their phone number
Why did you leave and in what manner? I.E. Resigned, terminated, resigned in lieu of termination etc.
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
Employer #5
Telephone #
Date Hired:
Street Address City State Zip
Date Left:
Starting Job Title/Final Job Title:
Final Salary:
Immediate supervisor and title (for most recent position held) and their phone number
Why did you leave and in what manner? I.E. Resigned, terminated, resigned in lieu
of termination etc.
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
8
10. Pre-Employment Drug History Questionnaire
Directions:
A. Type or print answers in the correct block or section. Use only black ink.
B. This questionnaire pertains only to illegal or illicit drug use. If you are currently taking, or have taken in the
past, any scheduled medications/narcotics prescribed by a licensed physician, respond “NO” to the referenced
question.
C. If you have taken any scheduled medications/narcotics illegally, respond “YES” to the referenced question.
DRUG CATEGORY
Ever used?
Bought/Sold/Transported
Yes
Stimulants: Methamphetamine- speed, cocaine,
ice, crank, crack cocaine, etc.
Illegal Use of Amphetamines/Other
Stimulants: Ritalin, Benzedrine, Dexedrine, etc.
Illegal Use of Benzodiazepines/ Tranquilizers:
Valium, Xanax, Diazepam, “Roofies”, etc.
Heroin
Illegal Sedatives/ Hypnotics/ Barbiturates:
Quaalude, Amytal, Phenobarbital, etc.
Street or illicit Methadone
Illegal Use of Other Opioids: Tylenol #2/ #3,
Percocet, Opium, Morphine, Demerol, Dilaudid,
Lortab, etc.
Hallucinogens: LSD, PCP, MDA, DAT, peyote,
mushrooms, ecstasy (MDMA), nitrous oxide, etc.
Inhalants:
Glue, gasoline, aerosols, paint, paint
thinners, etc.
Illegal Use of Marijuana: Dabs, Wax, THC oil,
Hash oil, vape juice w/THC, edibles, etc.
Anabolic Steroids
Others
: (Specify)
______________________________
10. PREA: The Prison Rape Elimination Act (PREA) requires that all applicants for employment with the Williamson
County Sheriff’s Office answer the following questions:
a. Have you ever engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or
other institution? Yes No
b. Have you ever been convicted of engaging or attempting to engage in sexual activity in the community facilitated by
force, overt or implied threats of forc
e, or coercion, or if the victim did not consent or was unable to consent or refuse?
Yes No
c. Have you ever been civilly or admi
nistratively adjudicated to have engaged in the activity described above in
subsection b.? Yes No
If you answer
ed yes to any of these questions, please provide an explanation on a separate piece of paper.
11.
Yes
No
No
Date Last Used
9
11. Criminal History and Litigation: Show all convictions including juvenile and traffic, excluding parking tickets.
Arrests and convictions are not an absolute bar to employment. However, pursuant to state law, applicants with a felony
conviction will not be eligible for deputy positions. Pursuant to Sheriff’s Office Policy, individuals with misdemeanor
convictions for crimes related to force, violence, theft, dishonesty, gambling, alcoholic beverages (other than a first
offense DUI that is over three years old), controlled substances, domestic violence, sexual misconduct, abuse of
authority, bribery, destruction or tampering with government records, criminal impersonation, or misuse of official
information are also disqualified from employment as a deputy.
a. Have you ever been arrested for any reason? Yes No
Yes No
Yes No
b. Have you ever been convicted of, pled guilty to, or pled no contest to a felony?
c. Have you ever been convicted of, pled guilty to, or pled no contest to a misdemeanor?
d. Have you ever been convicted of a traffic offense, excluding parking violations?
Yes No
e. Have you ev
er been involved in any CIVIL court action? Yes No
f. Have you ever been formally charged with or accused of, any of the previously listed offenses?
g. Have the police been called to your residence for any domestic related issues in the past 10 years?
If the answer to any of the above questions is Yes, list an explanation below. Include the date and place of incident, a brief
explanation and final outcome of the incident (court action).
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
12.
13. Military Record:
Have you ever served in the U.S. Armed Forces? Yes No
Branch of Service: ________________________ Service Number: __________________
Dates of Service: ____/____/____ to ____/____/____
Was your release an honorable discharge? Yes No
a. While in the military service, were you ever convicted of an offense in a trial by deck court or by summary, special
or general court martial? Yes No
If Yes, give the date, place, law enforcement authority or type of court or court martial, charge and action taken for
each incident, using a separate sheet of paper.
Yes No b. Are you presently a member of the U.S. Reserve/National/State Guard organization?
If YES, Complete the following:
Grade and Service No./SSN: Service and Component:
Organization and State or Unit and Location:
Indicate Reserve Obligation, if any:
Previous or current commanding officer's name and phone number:
Selective Service No. Last Classification Date Classified
Local Board Address
14. Education:
a. List all elementary, juni
or high and high schools attended.
NAME OF SCHOOL LOCATION DATE GRADUATED
No
Yes
Yes
No
10
b. List all colleges or universities attended.
NAME & LOCATION OF SCHOOL
CREDIT HRS/# OF
SEMESTERS COMPLETED
Location DATE GRADUATED
Major and Minor: _______________________________________________________________
Were you ever dismissed from school, or subject to any disciplinary action, including scholastic probation?
Yes No
If Yes:
School: __________________________ Date: ______________ Type of action: ________________________
c. Other schools or training (trade, vocational, business or military). Give the name and location of each school, dates
attended, subjects studied, certificate and any other pertinent information:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
15. Foreign Language: Enter foreign language and your aptitude by checking your appropriate level under each
category:
Language
Reading
Speaking
Understanding
Writing
Exc. Good Fair Exc. Good Fair Exc. Good Fair Exc. Good Fair
Exc. Good Fair
Exc. Good Fair Exc. Good Fair Exc. Good Fair
Exc. Good Fair Exc. Good Fair Exc. Good Fair Exc. Good Fair
Exc. Good Fair Exc. Good Fair Exc. Good Fair Exc. Good Fair
16. Special Qualifications and Skills:
a. Indicate type of special license such as pilot, radar operator, etc., showing license authority, when the license was first
issued and date current license expires: (except vehicle operator’s license).
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
b. Special skills you possess and machines or equipment you can use (for example: short wave radio, comptometer, key
punch, turret lathe, transcribing machines, scientific or professional devices).
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
c. Special qualifications not covered in the application (for example: patents or inventions, public speaking and
publications, membership in professional or scientific societies, honors or fellowships received).
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
17. Vehicle Operator’s License: (Driver’s, Chauffeur’s, etc.) Give the following information concerning any vehicle
operator’s license you have or now hold:
License Number
Class
State
Date of Expiration
Restrictions
11
Have you ever been denied issuance
of a license of have you ever had a license suspended or revoked? Yes No
Explain: _____________________________________
_____________________________________________________
_________________________________________________________________________________________________
Have you ever had auto insurance withdrawn or revoked or have you ever been refused auto insurance? Yes No
If Yes, give details including reasons, names of companies, dates, etc. ________________________________________
_________________________________________________________________________________________________
Current Insurance Company (Name and Address) ________________________________________________________
_________________________________________________________________________________________________
Do you have, at minimum, limited liability auto coverage? Yes No
List all traffic accidents in which you were determined to be at fault, include the approximate date and location:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
17. Subversive Organizations:
a. Are you now or have you ever advocated the overthrow of our constitutional form of government, or adopted the
policy of advocating or approving the commission of acts of force or violence to deny other persons their rights under
the Constitution of the United States or sought to alter the form of government of the United States by unconstitutional
means? Yes No
b. Are you now or have you ever bee
n a member of an organization that advocates the overthrow of our constitutional
form of government or approves the commission of acts of force (other than in self-defense or defense of others) or
violence? Yes No
c. Are you now or have you ever bee
n associated with any gang, club or other organization that is or has been involved
in any illegal conspiracy, drug trafficking, or other unlawful activity or criminal act? Yes No
[T.C.A. 40-35-121. Criminal Gang Off
enses – Enhanced Punishment – Procedure.
(a) As used in this section, unless the context otherwise requires:
(1) “Criminal Gang” means a formal or informal on-going organization, association, or group consisting of
three (3) or more persons that has:
(a) As one (1) of its activities the commission of criminal acts; and
(b) Two (2) or more members who, individually or collectively, engage in or have engaged in a
pattern of criminal gang activity.]
If the answer to any of the above questions is Yes, describe the circumstances in detail on a separate sheet and
attach it to the application.
19. Equal Treatment:
The Williamson County Sheriff’s Office is dedicated to maintaining a work environment wi
thout discrimination on any basis
including, age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, military service,
or disability. As an employee of the Williamson County Sheriff’s Office, you would interact with other employees, inmates
and arrestees, and the general public. Is there any reason that you would be unable to refrain from unfavorable treatment
toward an individual on any prohibited basis including age, sex, color, race, creed, national origin, religious persuasion,
marital status, political beliefs, or disability? Yes No
If yes, please include an explanation on a separate sheet and attach it to this application.
18.
12
20. References:
CHARACTER REFERENCES: LIST 8 REFERENCES (Do not include relatives, former employers, or persons living outside
of the United States or its territories). List only character references who have definite knowledge of your qualifications and
fitness for the position in which you are applying.
NAME
YEARS
KNOWN ADDRESS PHONE NUMBER
21. Residences: List all residences for the past 10 years beginning with your present address and including the dates
you lived at each place.
ADDRESS (STREET, CITY, COUNTY, STATE) FROM TO
13
22. Marriages: Please list the names of your current spouse and all former spouses, if applicable, and provide the
requested information.
Name of Spouse Place of Marriage Date of Marriage
Reason for end of marriage: (death, divorce, annulment, separation) Date ended
Spouse’s Current Address Phone Number
Name of Spouse Place of Marriage Date of Marriage
Reason for end of marriage: (death, divorce, annulment, separation) Date ended
Spouse’s Current Address Phone Number
Name of Spouse Place of Marriage Date of Marriage
Reason for end of marriage: (death, divorce, annulment, separation) Date ended
Spouse’s Current Address Phone Number
23. Financial Information: Are you currently overdue or behind on payments for child support or student loans?
_________________________________________
Applicant Signature
______________________
Date
Yes
No
Applicants Name: __________________________ DOB: _____________ SSN: ________________
AFFIRMATION AND CONSENT TO NCIC INQUIRY AND BACKGROUND CHECK
I affirm that all information on this application is correct to the best of my information and belief
and that my
application will be immediately rejected if false information is provided. I understand that as part of this
Employment Application, the Williamson County Sheriff’s Office will submit an inquiry regarding any
criminal history I may have to the National Crime Information Center (NCIC). I understand that if I have
been convicted of or plead guilty or no contest to a felony or certain misdemeanor offenses as outlined in
the Williamson County policy, I will be disqualified from service. I understand that this check will be
conducted prior to any interview or interaction. I also authorize the Williamson County Sheriff's Office to
conduct a background check and verification of my current and previous educational and employment
positions as well as any additional criminal or financial verifications upon completion of my first face to face
interview. I authorize this inquiry by the Williamson County Sheriff’s Office.
14
SIGNATURE MUST BE DONE IN THE PRESENCE OF THE NOTARY!!!
Read each of the following statements carefully. You must place your initials at the beginning
of each statement indicating that you have read and understand each statement. If you
do not understand one of the statements, ask for an explanation prior to initialing.
24. ________ I certify that there are no misrepresentations, omissions, or falsifications in the foregoing
statements and answers, and that the entries made by me above, are true and complete to the best
of my knowledge and belief and are made in good faith.
25. ________ I agree and consent in advance to being immediately disqualified and/or discharged if
any of the above information contains any misrepresentations or falsifications or if any material is
missing.
26. ________ I further verify that the initials noted above are my initials and made by me. I also verify
that I have read and understand each of the statements listed above.
Notary Acknowledgments
Acknowledgment of Individual
STATE OF _________________________
COUNTY OF __________________________
On this ___________ day of _______________, 20_____, before me personally appeared
_______________________________________________, to me known to be the person (or
person’s) described here in and who executed the foregoing, instrument, and acknowledged that such
person (or person’s) executed the same as such (or person’s) free act and deed.
________________________________
Notary Public
Printed Name: ___________________________
Commission expires: ______________________
15
PERSONAL INQUIRY WAIVER
*THIS FORM MUST BE SIGNED IN THE PRESENCE OF THE NOTARY*
TO: ___________________________
(For Sworn Personnel ONLY)
I respectfully request and authori
ze you to furnish the Williamson County Sheriff’s Office any and all information that you
may have concerning my work record, my school record, my reputation, my financial and credit status, and my criminal
record. This information is to be used to assist the Williamson County Sheriff’s Office in determining my qualifications and
fitness for the position I am seeking with them.
I understand that the source of any negati
ve information will remain confidential. I further understand that all information
and materials gathered are property of the investigating agency. I hereby release you, your organization or others from
the liability or damage which may result from furnishing the information requested above.
_______________________________________ __________________________
Applicant Signature Date
Address: ___________________________________________________________________
Numerical Street City State Zip Code
NOTARY ACKNOWLEDGMENT
State of _________________________
County of ________________________
Personally appeared before me, the undersigned notary public for said county and state,
______________________________________, to me known (or proved to me on the basis of
satisfactory evidence) to be the person who executed the within instrument for the purpose therein
contained.
Witness my hand, at office, this ________________ Day of _______________, ___________.
_________________________
Notary Public
My Commission expires: __________________________________
CURRENT PHOTO
OF APPLICANT
MUST BE
AFFIXED HERE.
(PICTURES PRINTED ON REGULAR PAPER ARE
ACCEPTABLE)
Clear Form
Please attach copies of the following documents, if applicable. Failure to do so may result in a delay
of the hiring process or possible disqualification.
1. Driver’s License – Required
2. High School diploma/G.E.D. Certificate – Required
3. Military Discharge papers (DD-214 or NGB-22) – If
applicable
4. Credit Report - Obtained within the last six months (entire report, not just credit
score - Required
5. College Diploma - If Applicable
6. Documentation of Name Changes - If Applicable
7. P.O.S.T. / T.C.I. Certificates - If Applicable
16
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Williamson County Sheriffs Office Sheriff Dusty Rhoades (Williamson County Tennessee Government)

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Completed 30 March 2021

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