Application for State Constable’s Commission

APPLICATION FOR STATE CONSTABLE’S COMMISSION

S.C. LAW ENFORCEMENT DIVISION Group I Group II Group III

POST OFFICE BOX 21398
COLUMBIA, SOUTH CAROLINA 29221-1398

AD#

NOTICE: Application must be typewritten or clearly printed in ink. All questions must be answered, if applicable. If no, indicate NA (not applicable). Applications which are not complete and legible will not be considered. If space provided is not sufficient for complete answers, or you wish to furnish additional information, attach sheets of the same size as this application, and number answers to correspond with questions.

DATE:

I. PERSONAL HISTORY

1. Name in Full (Last, First, Middle)

2. List all other names you have used including nicknames; if female, furnish maiden name.

3. Birth Date (Month, Day, Year)

4. Place of Birth (City, State)

5. Are you a U.S. Citizen? Yes No Derivative? Yes No
Naturalized? Yes No
Naturalization #
Place
Court

6. Social Security Number Race Sex Height Weight Eyes Hair

PLEASE NOTE: THE INFORMATION REQUESTED IN ITEM (6) IS NECESSARY IN ORDER TO OBTAIN AN ACCURATE CRIMINAL HISTORY CHECK

7. Driver’s License No. State Licensed

8. Are you a resident of South Carolina? Yes No

9. SC Voter Registration Number

Email Address:

II. MARITAL STATUS

Single Married Date
Place of Marriage No. of Children
Widowed Divorced Date
Separated
Place of Divorce or Legal Separation Court

III. RESIDENCES

a. Present Residence Address:

b. Email Address:

Telephone numbers:
Residence:
Business:
Mobile Phone:

c. Complete address to which you wish mail or telegram sent (include zip code and telephone number if different from above.)

List chronologically ALL of your residences in the past 10 years including addresses while attending school (if away from the home) and all military addresses including any off military base.

Dates

From To Street Address City State Zip

IV. EDUCATION

4. Were you ever dismissed from a school, or was any disciplinary action ever taken against you during your scholastic career? Yes No

School Date Action

V. EMPLOYMENT HISTORY

NOTE: LIST LAST POSITION FIRST. Include chronological history of employment starting with current or most recent position. Account for all periods including casual employment and all periods of unemployment. Be sure to include military experience, if applicable. A resume of your employment will not be accepted in lieu of this information. Attach additional sheets as needed.

I. PRESENT OR LAST EMPLOYMENT (GIVE COMPLETE MAILING ADDRESSES AND ZIP CODES)

Employer Immediate Supervisor

Employer’s Address

Telephone No. Date Employed Date Separated

Job Title/Work Description Starting Salary Ending Salary

Reason for Leaving

II. PREVIOUS EMPLOYMENT

Employer Immediate Supervisor

Employer’s Address

Telephone No. Date Employed Date Separated

Job Title/Work Description Starting Salary Ending Salary

Reason for Leaving

III. PREVIOUS EMPLOYMENT

Employer Immediate Supervisor

Employer’s Address

Telephone No. Date Employed Date Separated

Job Title/Work Description Starting Salary Ending Salary

Reason for Leaving

IV. PREVIOUS EMPLOYMENT

Employer Immediate Supervisor

Employer’s Address

Telephone No. Date Employed Date Separated

Job Title/Work Description Starting Salary Ending Salary

Reason for Leaving

Have you ever been dismissed or asked to resign from any employment or position you have held? Yes No

VI. MILITARY RECORDS

VII. REFERENCES

Reference 1

Reference 2

Reference 3

VIII. FOREIGN TRAVEL – (MILITARY SERVICE, RESIDENCE, VISIT)

1. Have you ever visited or resided in any foreign country (including travel in the Armed Forces of the U.S.)? Yes No
Passport Number Date/Place Issued

IX. COURT RECORD

1. Have you ever been arrested or charged with any violation including traffic, but excluding parking tickets? Yes No
To your knowledge, has any member of your immediate family ever been convicted of any offense other than traffic violations? Yes No

X. FINANCIAL STATUS

1. Do you have any sources of income other than your salary or that of your spouse? Yes No

2. Are you indebted to anyone? Yes No

3. Have you ever been in or petitioned for bankruptcy? Yes No

XI. SPECIAL QUALIFICATIONS AND SKILLS

1. Do you have foreign language ability? Yes No

2. Are you a member of the bar? Yes No Date State(s)
3. Are you a CPA? Yes No Date State(s)
4. Are you a licensed aircraft pilot? Yes No Rating(s)

XII. RELATIVES

XIII. RELATIVES EMPLOYED BY THE STATE OR FEDERAL GOVERNMENT

XIV. FRIENDS OR ACQUAINTANCES EMPLOYED BY THE STATE OR FEDERAL GOVERNMENT

XV. PHYSICAL DATA

XVI. PERSONAL DECLARATIONS

LIST THE POLICE AND SHERIFF’S DEPARTMENTS YOU HAVE ARRANGED TO ASSIST:

THIS STATEMENT MUST BE SIGNED

My signature hereon certifies my understanding and agreement that appointment as a state constable is without compensation from the State of South Carolina or any law enforcement department, that my commission may be revoked at the pleasure of the Governor, and that the application fee is non-refundable, whether or not this application is approved.

I certify my understanding and agreement that any appointment tendered me will be contingent upon the results of a character and fitness investigation and that withholding or submitting inaccurate information in this application package is a basis for denial of this application or revocation of my state constable commission if discovered later.

I certify my understanding and agreement that I will be participating with police officers in law enforcement training and patrol and other activities that might be strenuous and dangerous.

I certify my understanding and agreement that if I am commissioned as a Group III state constable, I will not be insured for personal injuries I might sustain or for liability arising from my actions unless the following circumstances are true: (1) I am assisting a law enforcement department that has written to SLED requesting my assistance; (2) the department has certified to SLED that I am insured by the department’s worker’s compensation and liability insurance plans; (3) SLED has approved the department’s request in writing.

I certify that all information submitted on this form and accompanying documents is true and complete.