Form Center

2. Natrona County Sheriff's Office
   John Harlin- Sheriff
   Victim's Response Unit
   Charity LaFountain - Victim Services Coordinator
   201 N. David - 2nd Floor
   (307) 235-9338 Telephone
   (307) 235-8252 Fax
   clafountain@natronacounty-wy.gov

6. Victim Advocate Application
8. All applicants are considered without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of non-job related medical condition or handicap.
10. First Name*
11. Last Name*
13. Address*
15. City*
16. State*
17. Zip*
19. Mailing Address*
21. City*
22. State*
23. Zip*
25. Email Address*
27. Telephone (Home)*
28. Telephone (Work)
29. Telephone (Other)
31. On what date would you be available to begin?
    On what date would you be available to begin?
32. Can you drive?

    1. Yes

    1. No
34. Driver's License Number
35. Expiration Date
37. Have you ever been convicted of a felony?

    1. Yes

    1. No
38. Have you had a traffic ticket?

    1. Yes

    1. No
40. If YES, please explain
42. Are you a Veteran of the U.S. Military Services?

    1. Yes

    1. No
43. If YES, what Branch?
45. Do you speak a foreign language?

    1. Yes

    1. No
47. If YES, please indicate what language and if you are fluent, good or fair at speaking the language. Please indicate whether you can speak, write or read that language.
51. Please list your last three employers:
53. Employer
54. Dates of Employment
56. Job Title/Description
57. Telephone
59. Address
63. Employer
64. Dates of Employment
66. Job Title/Description
67. Telephone
69. Address
73. Employer
74. Dates of Employment
76. Job Title/Description
77. Telephone
79. Address
83. Please summarize your special skills, qualifications, and experiences that you would bring to the Victim Response Team as an Advocate.
85. Please explain why you want to become a member of the Victim Response Team.
87. Please state any additional information you feel may be helpful to us in considering your application.
89. Please list at least three personal references that we may speak to. Please make sure these people are not related to you. You may have worked with them, for them or been involved in a volunteer organization with them.
91. First Name
92. Last Name
94. Telephone
95. Address
97. City
98. State
99. Zip
103. First Name
104. Last Name
106. Telephone
107. Address
109. City
110. State
111. Zip
115. First Name
116. Last Name
118. Telephone
119. Address1
121. City
122. State
123. Zip
127. First Name
128. Last Name
130. Telephone
131. Address
133. City
134. State
135. Zip
139. First Name
140. Last Name
142. Telephone
143. Address
145. City
146. State
147. Zip
151. Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals with Physical or Mental Handicaps.
     
     Government contractors are subject to 38 USC 2012 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.
     
     If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.
153. If you wish to be identified, please type your name below.
155. Check all that apply

     1. Handicapped Individual

     1. Disabled Veteran

     1. Vietnam Era Veteran
157. Are there any special requirements that need to be met during the written and oral phase of testing?

     1. Yes

     1. No
159. If YES, please explain
161. First Name
162. Last Name
166. APPLICANTS STATEMENT AND BACKGROUND INVESTIGATION WAIVER
168. I certify that the answers given herein are true and complete to the best of my knowledge. In the event of acceptance, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Agency.
     
     I authorize investigation of all statements contained in this application as may be necessary in arriving at a decision concerning acceptance or rejection as a volunteer victim advocate. I understand that this application is not intended to be a contract of employment.
     
     By typing my name below, I hereby authorize the Natrona County Sheriff's Office to conduct an intensive background investigation on my character. I understand that any and all information obtained will be held strictly confidential. I further understand that the background investigation will include the interview of my past and present employers.
170. First Name*
171. Last Name*
173. Date*
     Date
Leave This Blank:


175. 1. Receive an email copy of this form.
176. Email address

     This field is not part of the form submission.

177. Submit Submit and Print

* indicates a required field