Reserve Deputy Application - Mississippi County AR Sheriff

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(or call 870-658-7024)

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Arkansas

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Mississippi County Sheriff's Department
Application for Reserve Deputy

Instructions: Fill out this application completely and accurately. All information contained in this application is subject to verification. Use complete given names as it appears on your birth certificate.

Name:

SSN:

Nicknames or Aliases:

Present Physical Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Date of Birth:

DL Number:

Place of Birth:

*Please provide copies of driver's license and birth certificate

Upload File

Optional – Attach a PDF to your application submission - copy of driver's license, birth certificate, etc. (max file size 2mb)

U.S. Citizen:

Yes No

Yes
No

Have you ever been arrested for or convicted of an offense other than a traffic citation? If so, give a brief explanation.

Have you ever been discharged or released from your employment? If so, give a brief explanation.

Present Employer:

Phone:

How long employed?

May we contact them?

Yes No

Yes
No

List the names of all clubs or civic organizations in which you are a member of or are associated with.

Have you ever been in the Military? If so, which branch?

Enlistment Date:

Discharge Date:

Type of Discharge:

Education:

High School GED Other

High School
GED
Other

*Please provide high school diploma or GED.

Upload File

Optional – Attach a PDF to your application submission - copy of diploma or GED, etc. (max file size 2mb)

Do you drink intoxicating beverages?

If so, how often?

Seldom Socially Moderate Average

Seldom
Socially
Moderate
Average

List any Physical Disabilities that you may have that would keep you from performing the duties of a law enforcement officer.

List the names, addresses, and phone numbers of five persons, other than relatives that can provide us with background information on your character, personality, and ability.

Briefly explain your reasons for applying for this position.

*Signature:

Date:

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