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2. Name

   First, MI Last

4. Address
6. City
7. State
8. ZIP
10. Phone
11. Email
13. Driver's License #
14. State
16. Date of Birth
    Date of Birth
17. Years of Education
    -- Select One --GEDHigh School DiplomaSome CollegeAssociate's DegreeBachelor's DegreeMaster's Degree
19. Have you ever applied with our agency before?

    1. Yes
    2. No
20. What Position?
21. What Year?
23. Do you have Search & Rescue experience?

    1. Yes
    2. No
24. Where?
25. What Year?
27. Have you ever been:
29. Arrested?

    1. Yes
    2. No
30. Convicted of a felony?

    1. Yes
    2. No
31. Convicted of a misdemeanor?

    1. Yes
    2. No
33. Active Military or Veteran?
    -- Select One --ActiveVeteranNeither
35. Authorization for a Background Check*

    I hereby authorize the Peoria County Sheriff’s Office to conduct a background investigation concerning my work reputation, medical, physical, and criminal records, including information of a confidential or privileged nature.

    1. I agree
37. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
39. Electronic Signature
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field