Please read the Confidential Employment Application carefully and answer EVERY question in full. If you cannot answer or do not understand any part of this application, notify a member of the Hampshire Sheriff’s Office Human Resources immediately. If you need additional space to complete an answer, please attach additional sheets containing the information to this application. In addition to the information required below, please provide any other information you think would be helpful to us in considering you for employment. You may exclude all information indicative of age, sex, race, religion, color, national origin, and dis-ability.

* indicates required field.

General Information:

Are you a United States citizen?*
Are you at least 19 years of age?*
Have you ever filed an application here before?*
Have you ever been employed here before?*
Are you available to work:*

How were you referred to us?

Educational Background:

Grammar or Grade School


High School




Graduate School


Business or Trade School


Other education or special training


Military Experience:

Have you ever served in the U.S. armed forces?*

Dates of duty:

Under what conditions were you discharged?
Are you a U.S. Veteran?

Employment History:

Employer 1:

Employer 2:

Employer 3:

Employer 4:

Have any of the following occurrences happened to you in the last ten (10) years?

Fired from job
Quit a job after being told you would be fired.
Left a job by mutual agreement following allegations of misconduct.
Left a job by mutual agreement following allegations of unsatisfactory performance.
Left a job for other reason under unfavorable circumstances.
Are you presently on lay off and subject to recall?*

Should you be offered employment, would you consent to a medical examination, as a condition of employment, conducted solely for the purpose of determining whether you are, with reasonable accommodation, capable of performing the essential functions of the job?*

Person to be notified in case of emergency

Professional References (not relatives)

Reference 1

Reference 2

Reference 3

Reference 4

Reference 5

Are you a United States citizen or authorized to work in the United States?*

You will be required to produce documentation to establish your identity and your authorization to work in the United States in accordance with the immigration reform and control act of 1986.

Sealed Record Notice:

Read carefully!

An applicant for employment with a sealed record on file with the Commissioner of Probation may answer “no record” with respect to an inquiry herein relative to prior arrests, criminal court appearances, or convictions. 

In addition, any applicant for employment may answer “no record” with respect to any inquiry relative to prior arrests, court appearance, and adjudication in all cases of delinquency or as a child in need of services, which did not result in a complaint transferred to the superior court for criminal prosecution. 

Please provide the following information unless it has been officially annulled, expunged, or sealed by a court: 

Have you ever been convicted of a felony?*
Were you ever imprisoned for a felony conviction?*
Were you convicted of a misdemeanor within the past five (5) years with the exception of a first conviction or drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace?*