Commonwealth of Massachusetts
OFFICE OF THE SHERIFF
COUNTY OF PLYMOUTH
24 LONG POND ROAD, PLYMOUTH, MASSACHUSETTS 02360
TELEPHONE: (508) 830-6200
*Application For:
CORRECTIONAL OFFICER
MEDICAL OFFICER/RN & LPN
911 DISPATCHER
GENERAL APPLICATION
PERSONAL INFORMATION
Please provide the necessary information below. Please Note: You must complete the required fields (marked with an asterisk ("*") in order to successfully submit your application.
*Last Name:
*First Name:
MI:
*Street Address:
*City:
*State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AS
GU
MP
PR
VI
*ZIP:
*Mobile:
Provider:
AT&T
VERIZON
T-MOBILE
METRO-PCS
BOOST MOBILE
CELLULAR ONE
U.S. CELLULAR
OTHER
*E-Mail:
*Date Of Birth:
*Social Security Number:
*Are you authorized to work in the U.S. on an unrestricted basis?
Yes
No
*Are you 19 years or older?
Yes
No
*Where did you hear about us? (Facebook, LinkedIn, ZipRecruiter, etc.)
*Have you ever previously submitted an application to the Plymouth County Sheriff's Office?:
Yes
No
*If so, how many times have you submitted an application?
Nursing Board License #:
Have you ever been, or are currently being, investigated by your licensing authority or DPH?:
Yes
No
If yes, what was the date of the investigation?:
If yes, what was/is the nature of the investigation?:
Have you ever been disciplined by your licensing authority or DPH?:
Yes
No
If yes, what was the discipline for?:
If yes, what was the date of the discipline?:
NOTE: All potential offers of employment are conditional upon, among other things, verification of the above information and the successful completion of a background check.
EDUCATION INFORMATION
HIGH SCHOOL
*SCHOOL NAME
*CITY/STATE
*GRADUATE (YES/NO)
Y
N
DIPLOMA/DEGREE
COLLEGE
SCHOOL NAME
CITY/STATE
GRADUATE (YES/NO)
Y
N
DIPLOMA/DEGREE
GRADUATE
SCHOOL NAME
CITY/STATE
GRADUATE (YES/NO)
Y
N
DIPLOMA/DEGREE
OTHER
SCHOOL NAME
CITY/STATE
GRADUATE (YES/NO)
Y
N
DIPLOMA/DEGREE
MILITARY SERVICE INFORMATION
EMPLOYMENT HISTORY
Please list your employment history in the last 10 years starting with the most recent.
By submitting this application, I hereby authorize the Plymouth County Sheriff’s Office to conduct a background investigation. This background investigation may include a check with any past employers, a criminal records check and a credit check. I further understand that the Plymouth County Sheriff’s Office may make an adverse employment decision based on information obtained during the background check, including criminal offender record information.
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