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Application For Employment

APPLICATION FOR EMPLOYMENT

CAPEGIRARDEAU COUNTY SHERIFF'S OFFICE

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Leaving","name":"Reason-For-Leaving-5","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"Previous Employer","name":"Previous-Employer-6","className":"d-block","subtype":"text"},{"type":"text","label":"Address(Street, City, State, Zip Code)","name":"AddressStreet-City-State-Zip-Code-6","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","label":"Employer Telephone Number","name":"Employer-Telephone-Number-6","className":"col-md-6"},{"type":"text","label":"Job Title","name":"Job-Title-6","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Duties","name":"Duties-6","className":"col-md-6","subtype":"text"},{"type":"text","label":"Starting Salary","name":"Starting-Salary-6","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Ending Salary","name":"Ending-Salary-6","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Supervisor","name":"Supervisor-6","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Date Employed","name":"Date-Employed-6","className":"col-md-6"},{"type":"date","label":"Date Separated","name":"Date-Separated-6","className":"col-md-6"},{"type":"text","label":"Reason For Leaving","name":"Reason-For-Leaving-6","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"Previous Employer","name":"Previous-Employer-7","className":"d-block","subtype":"text"},{"type":"text","label":"Address(Street, City, State, Zip Code)","name":"AddressStreet-City-State-Zip-Code-7","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","label":"Employer Telephone Number","name":"Employer-Telephone-Number-7","className":"col-md-6"},{"type":"text","label":"Job Title","name":"Job-Title-7","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Duties","name":"Duties-7","className":"col-md-6","subtype":"text"},{"type":"text","label":"Starting Salary","name":"Starting-Salary-7","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Ending Salary","name":"Ending-Salary-7","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Supervisor","name":"Supervisor-7","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Date Employed","name":"Date-Employed-7","className":"col-md-6"},{"type":"date","label":"Date Separated","name":"Date-Separated-7","className":"col-md-6"},{"type":"text","label":"Reason For Leaving","name":"Reason-For-Leaving-7","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"Previous Employer","name":"Previous-Employer-8","className":"d-block","subtype":"text"},{"type":"text","label":"Address(Street, City, State, Zip Code)","name":"AddressStreet-City-State-Zip-Code-8","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","label":"Employer Telephone Number","name":"Employer-Telephone-Number-8","className":"col-md-6"},{"type":"text","label":"Job Title","name":"Job-Title-8","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Duties","name":"Duties-8","className":"col-md-6","subtype":"text"},{"type":"text","label":"Starting Salary","name":"Starting-Salary-8","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Ending Salary","name":"Ending-Salary-8","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Supervisor","name":"Supervisor-8","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Date Employed","name":"Date-Employed-8","className":"col-md-6"},{"type":"date","label":"Date Separated","name":"Date-Separated-8","className":"col-md-6"},{"type":"text","label":"Reason For Leaving","name":"Reason-For-Leaving-8","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"CAPE GIRARDEAU COUNTY SHEIRFF'S OFFICE - APPLICANT BACKGROUND INFORMATION","className":"d-block"},{"type":"header","subtype":"h3","label":"INSTRUCTIONS","className":"d-block"},{"type":"paragraph","subtype":"p","label":"1. USE INK AND PRINT CLEARLY IN YOUR OWN HANDWRITING (UNLESS FILLING OUT ONLINE)","className":"d-block"},{"type":"paragraph","subtype":"p","label":"2. COMPLETE ALL SECTIONS. IF A SECTION DOES NOT APPLY TO YOU, WRITE “N/A”","className":"d-block"},{"type":"paragraph","subtype":"p","label":"3. IF MORE SPACE IS NEEDED TO COMPLETE A SECTION, OR IF YOU ANSWER YES TO ANYYES/NO QUESTIONS, USE SECTION K TO CONTINUE AND/OR EXPLAIN YOUR ANSWER. (REFERTO SECTION NUMBER OF THE QUESTION YOU ARE EXPLAINING).","className":"d-block"},{"type":"text","required":true,"label":"Last Name","name":"background-last-name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"First Name","name":"background-first-name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Middle Name","name":"background-middle-name","className":"col-lg-4","subtype":"text"},{"type":"select","required":true,"label":"Blood Type","name":"BACKGROUND-Blood-Type","className":"col-md-6","values":[{"label":"A+","value":"A+","selected":true},{"label":"A-","value":"A-"},{"label":"B+","value":"B+"},{"label":"B-","value":"B-"},{"label":"O+","value":"O+"},{"label":"O-","value":"O-"},{"label":"AB+","value":"AB+"},{"label":"AB-","value":"AB-"},{"label":"UNLISTED","value":"UNLISTED"},{"label":"UNKNOWN","value":"UNKNOWN"}]},{"type":"date","required":true,"label":"Date Of Birth","name":"BACKGROUND-Date-Of-Birth","className":"col-md-6"},{"type":"text","required":true,"label":"Height","description":"Feet and Inches (example: 5ft 10in)","name":"background-height","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"Weight","description":"Weight in pounds","name":"background-weight","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","required":true,"label":"Hair Color","name":"background-hair-color","className":"col-md-6 col-lg-3","values":[{"label":"Bald","value":"bld","selected":true},{"label":"Black","value":"blk"},{"label":"Blonde","value":"bln"},{"label":"Blue","value":"blu"},{"label":"Brown","value":"bro"},{"label":"Gray","value":"gray"},{"label":"Green","value":"grn"},{"label":"Orange","value":"ong"},{"label":"Pink","value":"pnk"},{"label":"Purple","value":"ple"},{"label":"Red","value":"red"},{"label":"Sandy","value":"sdy"},{"label":"White","value":"whi"}]},{"type":"select","required":true,"label":"Eye Color","name":"background-eye-color","className":"col-md-6 col-lg-3","values":[{"label":"Black","value":"blk","selected":true},{"label":"Blue","value":"blu"},{"label":"Brown","value":"bro"},{"label":"Gray","value":"gray"},{"label":"Green","value":"grn"},{"label":"Hazel","value":"haz"},{"label":"Maroon","value":"mar"},{"label":"Multicolored","value":"mul"},{"label":"Pink","value":"pnk"}]},{"type":"text","required":true,"label":"Current Address","description":"Street, City, State, Zip","name":"background-address","className":"d-block","subtype":"text"},{"type":"text","subtype":"tel","required":true,"label":"Main Phone Number","name":"background-phone-number","className":"col-md-6"},{"type":"text","subtype":"tel","label":"Alternate Phone Number","name":"background-alt-phone-number","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"A. MISCELLANEOUS ","className":"d-block"},{"type":"text","label":"1. LIST ALL NAMES (OTHER THAN ABOVE) THAT YOU HAVE EVER USED:","name":"List-all-name","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"2. STARTING WITH YOUR CURRENT ADDRESS, LIST ALL ADDRESSES WHERE YOU HAVE LIVED FOR THE PAST 10 YEARS (INCLUDING MILITARY ADDRESSES):","className":"d-block"},{"type":"date","label":"Date From","name":"Background-date-from-1","className":"col-md-6"},{"type":"date","label":"Date To","name":"Background-date-to-1","className":"col-md-6"},{"type":"text","label":"Address","description":"Street, City, State, Zip Code","name":"Background-past-address-1","className":"d-block","subtype":"text"},{"type":"text","label":"Landlord Name","name":"background-landlord-name-1","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"Landlord Phone Number","name":"background-landlord-phone-number-1","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"date","label":"Date From","name":"Background-date-from-2","className":"col-md-6"},{"type":"date","label":"Date To","name":"Background-date-to-2","className":"col-md-6"},{"type":"text","label":"Address","name":"Background-past-address-2","className":"d-block","subtype":"text"},{"type":"text","label":"Landlord Name","name":"background-landlord-name-2","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"Landlord Phone Number","name":"background-landlord-phone-number-2","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"date","label":"Date From","name":"Background-date-from-3","className":"col-md-6"},{"type":"date","label":"Date To","name":"Background-date-to-3","className":"col-md-6"},{"type":"text","label":"Address","name":"Background-past-address-3","className":"d-block","subtype":"text"},{"type":"text","label":"Landlord Name","name":"background-landlord-name-3","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"Landlord Phone Number","name":"background-landlord-phone-number-3","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"date","label":"Date From","name":"Background-date-from-4","className":"col-md-6"},{"type":"date","label":"Date To","name":"Background-date-to-4","className":"col-md-6"},{"type":"text","label":"Address","name":"Background-past-address-4","className":"d-block","subtype":"text"},{"type":"text","label":"Landlord Name","name":"background-landlord-name-4","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"Landlord Phone Number","name":"background-landlord-phone-number-4","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"date","label":"Date From","name":"Background-date-from-5","className":"col-md-6"},{"type":"date","label":"Date To","name":"Background-date-to-5","className":"col-md-6"},{"type":"text","label":"Address","name":"Background-past-address-5","className":"d-block","subtype":"text"},{"type":"text","label":"Landlord Name","name":"background-landlord-name-5","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"Landlord Phone Number","name":"background-landlord-phone-number-5","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"date","label":"Date From","name":"Background-date-from-6","className":"col-md-6"},{"type":"date","label":"Date To","name":"Background-date-to-6","className":"col-md-6"},{"type":"text","label":"Address","name":"Background-past-address-6","className":"d-block","subtype":"text"},{"type":"text","label":"Landlord Name","name":"background-landlord-name-6","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"Landlord Phone Number","name":"background-landlord-phone-number-6","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"date","label":"Date From","name":"Background-date-from-7","className":"col-md-6"},{"type":"date","label":"Date To","name":"Background-date-to-7","className":"col-md-6"},{"type":"text","label":"Address","name":"Background-past-address-7","className":"d-block","subtype":"text"},{"type":"text","label":"Landlord Name","name":"background-landlord-name-7","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"tel","label":"Landlord Phone Number","name":"background-landlord-phone-number-7","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"select","label":"3. IF REQUIRED TO SHOOT SOMEONE IN THE COURSE OF YOUR DUTIES, WOULD YOU BE RELUCTANT TO DO SO FOR ANY REASON? (Deputy Sheriff only) ","description":"POST Certified Applicant","name":"background-would-shoot","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"},{"label":"N/A","value":"na"}]},{"type":"select","required":true,"label":"4. HAVE YOU EVER BEEN SERVED A CIVIL OR CRIMINAL SUBPOENA? ","name":"background-subpoena","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"}]},{"type":"select","required":true,"label":"5. WERE YOU EVER CHARGED WITH ANY VIOLATION OF THE LAW AS A JUVENILE?","name":"background-charged-as-juvenile","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"}]},{"type":"select","required":true,"label":"6. WERE YOU EVER SUSPENDED, EXPELLED FROM, OR ASKED TO LEAVE SCHOOL FOR ANY REASON? ","name":"background-suspened-school","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"}]},{"type":"select","required":true,"label":"7. WERE YOU EVER DISMISSED FROM A JOB OR ALLOWED TO RESIGN TO AVOID DISMISSAL?","name":"background-dismissed-from-job","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"}]},{"type":"select","required":true,"label":"8. WERE YOU EVER DISCIPLINED BY ANY EMPLOYER? ","name":"background-disciplined-by-employer","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"}]},{"type":"paragraph","subtype":"p","label":"9. LIST ANY JOB APPLICATIONS THAT YOU HAVE EVER FILED WITH A LAW ENFORCEMENT AGENCY AND APPLICATION FILED WITH ANY OTHER EMPLOYERS THAT ARE CURRENT OR THAT YOU HAVE FILED WITHIN THE PAST 6 MONTHS: ","className":"d-block"},{"type":"date","label":"Date Filed","name":"background-application-date-filed-1","className":"col-md-6 col-lg-3"},{"type":"text","label":"Agency/Employer Name","name":"background-application-employer-name-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Job Applied For","name":"background-application-job-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Disposition of Application","description":"Pending Interview, Pending Hire, etc.","name":"background-application-disposition-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"date","label":"Date Filed","name":"background-application-date-filed-2","className":"col-md-6 col-lg-3"},{"type":"text","label":"Agency/Employer Name","name":"background-application-employer-name-2","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Job Applied For","name":"background-application-job-2","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Disposition of Application","name":"background-application-disposition-2","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"date","label":"Date Filed","name":"background-application-date-filed-3","className":"col-md-6 col-lg-3"},{"type":"text","label":"Agency/Employer Name","name":"background-application-employer-name-3","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Job Applied For","name":"background-application-job-3","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Disposition of Application","name":"background-application-disposition-3","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"date","label":"Date Filed","name":"background-application-date-filed-4","className":"col-md-6 col-lg-3"},{"type":"text","label":"Agency/Employer Name","name":"background-application-employer-name-4","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Job Applied For","name":"background-application-job-4","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Disposition of Application","name":"background-application-disposition-4","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"B. FAMILY","className":"d-block"},{"type":"select","required":true,"label":"Marital Status:","name":"Background-marital-status","className":"d-block","values":[{"label":"Single","value":"single","selected":true},{"label":"Engaged","value":"engaged"},{"label":"Married","value":"married"},{"label":"Separated ","value":"separated "},{"label":"Widowed","value":"widowed"},{"label":"Divorced","value":"divorced"}]},{"type":"paragraph","subtype":"p","label":"2. PROVIDE INFORMATON FOR ALL MARRIAGES (PAST AND PRESENT):","className":"d-block"},{"type":"text","label":"Spouse First and Last Name","description":"Example: John Doe","name":"background-married-spouse-1","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Date Married","name":"background-married-date-1","className":"col-lg-4"},{"type":"text","label":"Status","name":"background-married-status-1","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Date of Order","name":"background-married-date-order-1","className":"col-lg-4"},{"type":"text","label":"Location (County/State)","description":"Example: Cape Girardeau County/MO","name":"background-married-location-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Reason","name":"background-married-reason-1","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"Spouse First and Last Name","name":"background-married-spouse-2","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Date Married","name":"background-married-date-2","className":"col-lg-4"},{"type":"text","label":"Status","name":"background-married-status-2","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Date of Order","name":"background-married-date-order-2","className":"col-lg-4"},{"type":"text","label":"Location (County/State)","description":"Example: Cape Girardeau County/MO","name":"background-married-location-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Reason","name":"background-married-reason-2","className":"col-lg-4","subtype":"text"},{"type":"select","label":"3. ARE YOU LIVING WITH PARENTS, SIBLINGS OR IN-LAWS? ","name":"background-living-with-siblings","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"C. REFERENCES","className":"d-block"},{"type":"header","subtype":"h4","label":"1. LIST THREE CHARACTER REFERENCE (NO RELATIVES) WHO HAVE KNOWN YOU WELL FORAT LEAST TWO YEARS:","className":"d-block"},{"type":"text","label":"First and Last Name","name":"background-reference-name-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Years Known","name":"background-reference-years-known-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","subtype":"tel","label":"Main Phone","name":"background-reference-main-phone-1","className":"col-md-6 col-lg-3"},{"type":"text","subtype":"tel","label":"Work Phone","name":"background-reference-work-phone-1","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"First and Last Name","name":"background-reference-name-2","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Years Known","name":"background-reference-years-known-2","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","subtype":"tel","label":"Main Phone","name":"background-reference-main-phone-2","className":"col-md-6 col-lg-3"},{"type":"text","subtype":"tel","label":"Work Phone","name":"background-reference-work-phone-2","className":"col-md-6 col-lg-3"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"First and Last Name","name":"background-reference-name-3","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Years Known","name":"background-reference-years-known-3","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","subtype":"tel","label":"Main Phone","name":"background-reference-main-phone-3","className":"col-md-6 col-lg-3"},{"type":"text","subtype":"tel","label":"Work Phone","name":"background-reference-work-phone-3","className":"col-md-6 col-lg-3"},{"type":"select","required":true,"label":"2. ARE YOU ACQUAINTED WITH ANY SHERIFF OFFICE EMPLOYEES? ","name":"background-acquainted-yes-or-no","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"}]},{"type":"text","label":"IF YOU ANSWERED \"YES\" TO BEING ACQUAINTED WITH ANY SHERIFF OFFICE EMPLOYEES, PLEASE EXPLAIN:","name":"background-acquainted-explain","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"D. FREE TIME ACTIVITIES","className":"d-block"},{"type":"paragraph","subtype":"p","label":"1. LIST YOUR RECREATION AND SOCIAL ACTIVITIES:","className":"d-block"},{"type":"textarea","label":"Text Area","name":"RECREATION-AND-SOCIAL-ACTIVITIES","subtype":"textarea","className":"d-block"},{"type":"paragraph","subtype":"p","label":"2. LIST ALL ORGANIZATIONS OF WHICH YOU ARE OR EVER HAVE BEENA MEMBER:(Name of Organization and Location)","className":"d-block"},{"type":"textarea","label":"Text Area","name":"ALL-ORGANIZATIONS","subtype":"textarea","className":"d-block"},{"type":"select","label":"3. HAVE YOU EVER PARTICIPATED IN ANY DEMOSTRATION, STRIKEOR PICKET LINE SPONSORED BY ANY ORGANZATION?","name":"background-participated-in-strike","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"}]},{"type":"select","label":"4. HAVE YOU EVER BEEN A MEMBER OF ANY ACTIVIST GROUP,COMMUNIST PARTY, AMERICAN NAZI PARTY, KU KLUX KLAN,STUDENTS FOR A DEMOCRATIC SOCIETY, MINUTEMEN, STREETGANG OR ANY SIMILAR ORGANIZATION?","name":"background-activist-group","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"5. HAVE YOU EVER BEEN A MEMBER OF ANY FOREIGN OR DOMESTICGROUP OR ORGANIZATIN WHICH IS A TOTLITARIAN, FASCISTS, COMMUNIST OR SUBVERSIVE OR WHICH ADOVATES THE COMMISSION OF ACTS OF FORCE OR VIOLENCE TO DENY OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUION OF THE UNITED STATES OR THE STATE OF MISSOURI BY ANY UNLAFUL OR UNCONSTITUTIONAL MEANS?  ","name":"background-foreign-or-domestic-group","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"E. DRIVING HISTORY","className":"d-block"},{"type":"paragraph","subtype":"p","label":"1. BEGINNING WITH YOUR CURRENT, LIST ALL DRIVERS LICENSES YOU HAVE EVER HAD:","className":"d-block"},{"type":"select","label":"State ","name":"background-driving-state-1","className":"col-md-6","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"License #","name":"background-driving-lic-1","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Issued Date","name":"background-driving-issued-1","className":"col-lg-4"},{"type":"date","label":"Expiration Date","name":"background-driving-expiration-1","className":"col-lg-4"},{"type":"select","label":"Ever Suspended/Revoked?","name":"background-driving-suspended-1","className":"col-lg-4","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"select","label":"State ","name":"background-driving-state-2","className":"col-md-6","values":[{"label":"Alabama","value":"AL","selected":true},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"License #","name":"background-driving-lic-2","className":"col-md-6","subtype":"text"},{"type":"date","label":"Issued Date","name":"background-driving-issued-2","className":"col-lg-4"},{"type":"date","label":"Expiration Date","name":"background-driving-expiration-2","className":"col-lg-4"},{"type":"select","label":"Ever Suspended/Revoked?","name":"background-driving-suspended-2","className":"col-lg-4","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"2. WERE YOU EVER SENTENCED TO A DRIVER IMPROVEMENT SCHOOL?","name":"background-drive-improve","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"paragraph","subtype":"p","label":"3. LIST ALL TRAFFIC ACCIDENTS YOU HAVE BEEN INVOLVED IN OVER THE PAST 5 YEARS:","className":"d-block"},{"type":"date","label":"Date of Accident","name":"background-date-of-accident-1","className":"col-md-6 col-lg-3"},{"type":"text","label":"Location Of Accident","description":"City or County and State","name":"background-location-of-accident-1","className":"col-md-6","subtype":"text"},{"type":"date","label":"Date of Accident","name":"background-date-of-accident-2","className":"col-md-6 col-lg-3"},{"type":"text","label":"Location Of Accident","name":"background-location-of-accident-2","className":"col-md-6","subtype":"text"},{"type":"date","label":"Date of Accident","name":"background-date-of-accident-3","className":"col-md-6 col-lg-3"},{"type":"text","label":"Location Of Accident","name":"background-location-of-accident-3","className":"col-md-6","subtype":"text"},{"type":"date","label":"Date of Accident","name":"background-date-of-accident-4","className":"col-md-6 col-lg-3"},{"type":"text","label":"Location Of Accident","name":"background-location-of-accident-4","className":"col-md-6","subtype":"text"},{"type":"text","label":"4. PROVIDE THE NAME OF YOUR AUTOMOBILE INSURANCE COMPANY AND AGENT(S) NAME:","name":"background-car-insurance","className":"d-block","subtype":"text"},{"type":"select","label":"5. HAVE YOU EVER BEEN DENIED INSURANCE OR HAD IT CANCELLED?","name":"background-denied-insurance","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"F. FINANCIAL STATUS","className":"d-block"},{"type":"header","subtype":"h4","label":"1. LIST YOUR CURRENT SOURCES OF INCOME:","className":"d-block"},{"type":"paragraph","subtype":"p","label":"YOUR SALARY:","className":"d-block"},{"type":"text","label":"Income","name":"background-income-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Source/Company","name":"background-source-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Annual Amount","name":"background-amount-1","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"SPOUSE'S SALARY:","className":"d-block"},{"type":"text","label":"Income","name":"background-income-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Source/Company","name":"background-source-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Annual Amount","name":"background-amount-2","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"OTHER:","className":"d-block"},{"type":"text","label":"Income","name":"background-income-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Source/Company","name":"background-source-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Annual Amount","name":"background-amount-3","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"OTHER:","className":"d-block"},{"type":"text","label":"Income","name":"background-income-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Source/Company","name":"background-source-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Annual Amount","name":"background-amount-4","className":"col-lg-4","subtype":"text"},{"type":"header","subtype":"h4","label":"2. LIST ALL DEBTS, INCLUDING RENT THAT YOU NOW PAY, INCLUDING CREDIT CARD DEBTS,CAR PAYMENTS ETC. TYPE OF PAYMENT REFERS TO WHETHER IT IS CAR, HOUSE, CREDITCARD, ETC:","className":"d-block"},{"type":"text","label":"Type of Payment","name":"background-Type-of-Payment-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Unpaid Balance","name":"background-Unpaid-Balance-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Monthly Payment","name":"background-Monthly-Payment-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Name of Creditor","name":"background-Name-of-Creditor-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Address of Creditor","name":"background-Address-of-Creditor-1","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"Type of Payment","name":"background-Type-of-Payment-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Unpaid Balance","name":"background-Unpaid-Balance-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Monthly Payment","name":"background-Monthly-Payment-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Name of Creditor","name":"background-Name-of-Creditor-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"Address of Creditor","name":"background-Address-of-Creditor-2","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"Type of Payment","name":"background-Type-of-Payment-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Unpaid Balance","name":"background-Unpaid-Balance-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Monthly Payment","name":"background-Monthly-Payment-3","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Name of Creditor","name":"background-Name-of-Creditor-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"Address of Creditor","name":"background-Address-of-Creditor-3","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"Type of Payment","name":"background-Type-of-Payment-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Unpaid Balance","name":"background-Unpaid-Balance-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Monthly Payment","name":"background-Monthly-Payment-4","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Name of Creditor","name":"background-Name-of-Creditor-4","className":"col-md-6","subtype":"text"},{"type":"text","label":"Address of Creditor","name":"background-Address-of-Creditor-4","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"text","label":"Type of Payment","name":"background-Type-of-Payment-5","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Unpaid Balance","name":"background-Unpaid-Balance-5","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Monthly Payment","name":"background-Monthly-Payment-5","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Name of Creditor","name":"background-Name-of-Creditor-5","className":"col-md-6","subtype":"text"},{"type":"text","label":"Address of Creditor","name":"background-Address-of-Creditor-5","className":"col-md-6","subtype":"text"},{"type":"header","subtype":"h4","label":"3. LIST ALL VEHICLES YOU OR YOUR SPOUSE OWN, LEASE OR USE FOR YOUR PERSONAL USE:","className":"d-block"},{"type":"number","label":"Year","description":"Example: 2001","name":"Background-veh-year-1","min":0,"className":"col-md-6 col-lg-3"},{"type":"text","label":"Make and Model","description":"Example: Ford F150, Mitsubishi Eclipse, Honda Pilot, etc.","name":"background-Make-and-Model-1","className":"col-md-6","subtype":"text"},{"type":"text","label":"License # and State","description":"Example: ABC123 / MO, DEF456 / IL","name":"background-License--and-State-1","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"number","label":"Year","name":"Background-veh-year-2","min":0,"className":"col-md-6 col-lg-3"},{"type":"text","label":"Make and Model","name":"background-Make-and-Model-2","className":"col-md-6","subtype":"text"},{"type":"text","label":"License # and State","name":"background-License--and-State-2","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"number","label":"Year","name":"Background-veh-year-3","min":0,"className":"col-md-6 col-lg-3"},{"type":"text","label":"Make and Model","name":"background-Make-and-Model-3","className":"col-md-6","subtype":"text"},{"type":"text","label":"License # and State","name":"background-License--and-State-3","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"PERTAINING TO YOU, YOUR SPOUSE AND EX-SPOUSE(S), HAVE YOU EVER:","className":"d-block"},{"type":"select","label":"A. BEEN DELIQUENT IN A FINANCIAL OBLIGATION?","name":"background-financial-BEEN-DELIQUENT-IN-A-FINANCIAL-OBLIGATION","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"B. BEEN REFUSED CREDIT?","name":"background-financial-REFUSED-CREDIT","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"C. HAD A WAGE GARNISHMENT PLACED AGAINST YOU?","name":"background-financial-GARNISHMENT","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"D. HAD ANY PROPERTY REPOSSESSED?","name":"background-financial-PROPERTY-REPOSSESSED","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"E. BEEN EVICTED FROM ANY DWELLING? ","name":"background-financial-BEEN-EVICTED","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"F. FILED BANKRUPTCY?","name":"background-financial-BANKRUPTCY","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"G. BEEN SUED IN COURT? ","name":"background-financial-SUED-IN-COURT","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"H. FILED OR HAD A REPRESENTATIVE FILE A LAWSUIT? ","name":"background-financial-FILE-A-LAWSUIT","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"I. RECEIVED A PAYMENT IN SETTLEMENT FOR DAMAGE, INJURY,LIBEL, ETC, EITHER WITH OR WITHOUT COURT ACTION? ","name":"background-financial-RECEIVED-A-PAYMENT-IN-SETTLEMENT","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"G. MILITARY STATUS","className":"d-block"},{"type":"header","subtype":"h4","label":" 1. LIST MILITARY EXPERIENCE:","className":"d-block"},{"type":"select","label":"Branch of Military","name":"background-Branch-of-Military-1","className":"col-lg-4","values":[{"label":"Coast Guard","value":"Coast Guard"},{"label":"Marines","value":"Marines"},{"label":"Navy","value":"Navy"},{"label":"Army","value":"Army"},{"label":"Air Force","value":"Air Force"},{"label":"Space Force","value":"Space Force"},{"label":"N/A","value":"N/A"}]},{"type":"date","label":"Entry Date","name":"background-military-entry-date-1","className":"col-lg-4"},{"type":"date","label":"Discharge Date","name":"background-military-discharge-date-1","className":"col-lg-4"},{"type":"select","label":"Type of Discharge","name":"background-Type-of-Discharge-1","className":"col-lg-4","values":[{"label":"Honorable discharge","value":"Honorable discharge"},{"label":"General Discharge Under Honorable Conditions","value":"General Discharge Under Honorable Conditions"},{"label":"Other Than Honorable","value":"Other Than Honorable"},{"label":"Bad Conduct discharge","value":"Bad Conduct discharge"},{"label":"Dishonorable discharge","value":"Dishonorable discharge"},{"label":"Entry-level Separation","value":"Entry-level Separation"},{"label":"Medical Separation","value":"Medical Separation"},{"label":"Separation for Convenience of the Government","value":"Separation for Convenience of the Government"},{"label":"N/A","value":"N/A"}]},{"type":"text","label":"Serial #","name":"background-military-serial-1","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Rank","name":"background-military-rank-1","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":" ","className":"d-block"},{"type":"select","label":"Branch of Military","name":"background-Branch-of-Military-2","className":"col-lg-4","values":[{"label":"Coast Guard","value":"Coast Guard","selected":true},{"label":"Marines","value":"Marines"},{"label":"Navy","value":"Navy"},{"label":"Army","value":"Army"},{"label":"Air Force","value":"Air Force"},{"label":"Space Force","value":"Space Force"},{"label":"N/A","value":"N/A"}]},{"type":"date","label":"Entry Date","name":"background-military-entry-date-2","className":"col-lg-4"},{"type":"date","label":"Discharge Date","name":"background-military-discharge-date-2","className":"col-lg-4"},{"type":"select","label":"Type of Discharge","name":"background-Type-of-Discharge-2","className":"col-lg-4","values":[{"label":"Honorable discharge","value":"Honorable discharge","selected":true},{"label":"General Discharge Under Honorable Conditions","value":"General Discharge Under Honorable Conditions"},{"label":"Other Than Honorable","value":"Other Than Honorable"},{"label":"Bad Conduct discharge","value":"Bad Conduct discharge"},{"label":"Dishonorable discharge","value":"Dishonorable discharge"},{"label":"Entry-level Separation","value":"Entry-level Separation"},{"label":"Medical Separation","value":"Medical Separation"},{"label":"Separation for Convenience of the Government","value":"Separation for Convenience of the Government"},{"label":"N/A","value":"N/A"}]},{"type":"text","label":"Serial #","name":"background-military-serial-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Rank","name":"background-military-rank-2","className":"col-lg-4","subtype":"text"},{"type":"text","label":"2. WHAT IS YOUR SELECTIVE SERVICE NUMBER?","name":"background-military-service-number","className":"col-md-6","subtype":"text"},{"type":"select","label":"3. WERE YOU EVER REDUCED IN RANK IN THE MILITARY?","name":"background-military-REDUCED-IN-RANK","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"},{"label":"N/A","value":"N/A"}]},{"type":"select","label":"4. HAVE YOU EVER background-military-ERNMENT MILITARY?","name":"background-military-background-military-","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"},{"label":"N/A","value":"N/A"}]},{"type":"select","label":"5. WERE YOU EVER COURT MARTIALED, TRIED ON CHARGES OR SUBJECT TO SUMMARY COURT, DECK COURT, CAPTAIN'S MAST, COMPANY PUNISHMENT, OR ANY OTHER DISCIPLINARY PUNISHMENT IN THE MILITARY?","name":"background-military-COURT-MARTIALED","className":"d-block","values":[{"label":"Yes","value":"yes","selected":true},{"label":"No","value":"no"},{"label":"N/A","value":"N/A"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"H. ALCOHOL/DRUGS/GAMBLING","className":"d-block"},{"type":"header","subtype":"h4","label":"1. ALCOHOL:","className":"d-block"},{"type":"select","label":"A. DO YOU DRINK ALCOHOLIC BEVERAGS?","name":"background-alcohol-drink","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"B. HAVE YOU EVER DRANK MORE ALCOHOLIC BEVERAGES THAN YOU DO NOW?","name":"background-alcohol-drink-more","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"header","subtype":"h4","label":"2. DRUGS:","className":"d-block"},{"type":"select","label":"A. DO YOU USE NARCOTICS OR ILLEGAL DRUGS?","name":"background-alcohol-DRUGS","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"B. HAVE YOU EVER USED NARCOTIC OR ILLIEGAL DRUGS?","name":"background-alcohol-ever-used-DRUGS","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"header","subtype":"h4","label":"3. GAMBLING:","className":"d-block"},{"type":"select","label":"A. DO YOU PARTICIPATE IN GAMBLING?","name":"background-alcohol-gambling","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"B. HAVE YOU EVER GAMBLED MORE THAN YOU DO NOW?","name":"background-alcohol-gambling-more","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"C. HAVE YOU EVER HAD GAMBLING DEBTS?","name":"background-alcohol-gambling-DEBTS","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"D. HAVE YOU EVER GAMBLED WITH AN EMLOYER'S MONEY OR WITH BORROWED MONEY?","name":"background-alcohol-gambling-others-money","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"E. HAVE YOU EVER WORKED FOR A GAMBLING OPERATION OR BOOKED BETS?","name":"background-alcohol-gambling-GAMBLING-OPERATION","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"header","subtype":"h4","label":"4. IN REFERENCE TO ALCOHOL, DRUGS OR GAMBLING, HAVE YOUER EVER:","className":"d-block"},{"type":"select","label":"A. HAD ANY FAMILY PROBLEMS RELATED TO THESE ITEMS?","name":"background-alcohol-gambling-family","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"B. RECEIVED TREATMENT FOR DEPENDENCY OR PROBLEM USE? ","name":"background-alcohol-gambling-RECEIVED-TREATMENT","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"select","label":"C. KNOWN OTHERS WHO GAMBLED OR USED ALCHOLOH/DRUGS ILLEGALLY? ","name":"background-alcohol-gambling-KNOWN-OTHERS","className":"d-block","values":[{"label":"Yes","value":"yes"},{"label":"No","value":"no"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"I. DOCUMENTS AND CERTIFICATES","className":"d-block"},{"type":"header","subtype":"h4","label":"WHERE APPLICABLE, ATTACH COPIES OF THE FOLLIWNG DOCUMENTS TO THIS APPLICATION:","className":"d-block"},{"type":"file","label":"1. BIRTH CERTIFICATE","name":"BIRTH-CERTIFICATE","subtype":"file","multiple":true,"className":"d-block"},{"type":"file","label":"2. DRIVER'S LICENSE","name":"DRIVERS-LICENSE","subtype":"file","multiple":true,"className":"d-block"},{"type":"file","label":"3. POLICE ACADEMY CERTIFICATE AND POST CERTIFICATE","name":"POLICE-ACADEMY-CERTIFICATE-AND-POST-CERTIFICATE","subtype":"file","multiple":true,"className":"d-block"},{"type":"file","label":"4. HIGH SCHOOL DIPLOMA (OR GED) AND TRANSCRIPT OF GRADES","name":"HIGH-SCHOOL-DIPLOMA-OR-GED-AND-TRANSCRIPT-OF-GRADES","subtype":"file","multiple":true,"className":"d-block"},{"type":"file","label":"5. COLLEGE DIPLOMA AND TRANSCRIPT OF GRADES","name":"COLLEGE-DIPLOMA-AND-TRANSCRIPT-OF-GRADES","subtype":"file","multiple":true,"className":"d-block"},{"type":"file","label":"6. TRAINING CERTIFICATES","name":"TRAINING-CERTIFICATES","subtype":"file","multiple":true,"className":"d-block"},{"type":"file","label":"7. NATURALIZATON PAPERS","name":"NATURALIZATON-PAPERS","subtype":"file","multiple":true,"className":"d-block"},{"type":"file","label":"8. ADOPTION PAPERS","name":"ADOPTION-PAPERS","subtype":"file","multiple":true,"className":"d-block"},{"type":"file","label":"9. MILITARY CERTIFICATE OF SERVICE AND DISCHARGE PAPERS","name":"MILITARY-CERTIFICATE-OF-SERVICE-AND-DISCHARGE-PAPERS","subtype":"file","multiple":true,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"J. ADDITIONAL INFORMATION","className":"d-block"},{"type":"header","subtype":"h4","label":"USE THIS SECTION TO:","className":"d-block"},{"type":"header","subtype":"h2","label":"1. COMPLETE A PREVIOUS SECTION WHERE YOU DIDN'T HAVE ENOUGH ROOM.","className":"d-block"},{"type":"header","subtype":"h2","label":"2. EXPLAIN ANY “YES” ANSWER TO A “YES/NO” QUESTION.","className":"d-block"},{"type":"header","subtype":"h2","label":"3. PROVIDE ANY ADDITONAL INFORMATION THAT YOU FEEL IS RELEVANT TO YOURAPPLICATION.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Please provide SECTION AND QUESTION # before each item that needs additional information.  If you needed to provide information on the question \"DO YOU USE NARCOTICS OR ILLEGAL DRUGS?\" for example, you would do the following:H.2.A.  (Write your additional information)","className":"d-block"},{"type":"textarea","label":"Text Area","name":"ADDITIONAL-INFORMATION","subtype":"textarea","className":"d-block"},{"type":"header","subtype":"h4","label":"NOTE: IT IS VERY IMPORTANT THAT EACH QUESITON IN EVERY SECTION IS ANSWERED. IF A PARTICULAR SECTION DOESNOT PERTAIN TO YOU, THAT SECTION OR QUESITONS IN THE SECTION SHOULD BE MARKED “N/A”. IF THE APPLICATION ISNOT COMPLETED IN ITS ENTIRETY AND IF THE DOCUMENTS REQUESTED IN SECITON I DO NOT ACOMPANY THE APPLICATION ITMAY BE CONSIDERED INCOMPLETE AND INVALID.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"CERTIFICATION OF APPLICANT","className":"d-block"},{"type":"header","subtype":"h3","label":"AUTHORIZATION FOR RELEASE OF INFORMATION (Read carefully before signing)","className":"d-block"},{"type":"text","label":"I, (print full name),","name":"certification-of-applicant-print-full-name","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"hereby certifythat all statements made on or in connection with this questionnaire are true and complete to thebest of my knowledge and belief. I understand and agree that any misstatements or omission ofmaterial facts will be cause for denial of, or dismissal from, employment with the Cape GirardeauCounty Sheriff's Office.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I here by authorize all law enforcement agencies, military agencies, federal, state and localgovernment agencies, state and federal tax bureaus, credit bureaus, schools and universities tofurnish the holder of this release with any and all available information regarding me in order todetermine my suitability for employment with the Cape Girardeau County Sheriff's Office.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I authorize the holder of this release to make inquiry of my present and past employers regarding mycharacter, integrity, reputation and job performance.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I authorize the release of any and all information regarding my employment, credit or any otherinformation, whether personal or otherwise, that may or may not be on their records and releasesaid company or person from all liability for any damage whatsoever that may arise form furnishingsuch information to the holder of this release.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"A photocopy of this authorization will be considered as effective and valid as the original.","className":"d-block"},{"type":"text","label":"SIGNATURE OF APPLICANT ","name":"SIGNATURE-OF-APPLICANT-","className":"col-md-6","subtype":"text"},{"type":"date","label":"Date Signed","name":"Date-Signed","className":"col-lg-4"},{"type":"paragraph","subtype":"p","label":"This questionnaire and all documents submitted become property of the County of Cape Girardeauand will not be returned.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"(if this form is being filled out and submitted on-line, typed signature will be applicable the same asa written signature)","className":"d-block"}]