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Pre-Employment Application

Central Falls Detention Facility Corporation
Correctional Officer, Donald W. Wyatt Detention Facility

Dear Candidate:

This application is for the Correctional Officer position at the Donald W. Wyatt Detention Facility in Central Falls, Rhode Island. All of the following information is required to be submitted with your application for it to be considered "COMPLETE":

Three (3) Current Letters of Recommendation
Copy of Current Driver's License
Copy of Birth Certificate
Copy of Social Security Card
Copy of High School Diploma / G.E.D. / College
Copy of DD-214, if any military service

It is recommended that you read the entire application before writing on it.

After submitting this form, email clear copies of the documents above to training@wyattdetention.com with your full name in the subject line. Your application is not complete until they are received.

"Complete" applications will be utilized to conduct a pre-employment background investigation. All documents will be reviewed, and only those candidates meeting the criteria of the Central Falls Detention Facility Corporation hiring practices will be considered further in the hiring process.

Failure to provide all required information may result in disqualification from the hiring process. Any discrepancies, misstatements, omissions, and falsifications would cause disqualification and your name to be removed from the eligibility list or cause further review and dismissal if an appointment was made.

Personal Information

Last Name *

First Name *

Middle Name

Maiden Name

Date of Birth *

Nicknames or Aliases

Street Address *

City *

State *

Zip Code *

Years at this address *

Months at this address

Height

Weight

Eye Color

Hair Color

Place of Birth (City, Town, or State)

Social Security Number (last 4 digits only)

Driver's License State *

Driver's License Number *

Telephone Number

Cell Phone Number *

Email Address *

Do you have any permanent tattoos on your body at this time? *

Yes

If yes, list all and where located on the body

Do you have any Social Media Accounts (e.g. TikTok, Instagram, Meta, X)? *

Yes

If yes, list all usernames

Family Information

Spouse's Name

Spouse's Maiden Name

Spouse's Date of Birth

Spouse's Address

Spouse's Telephone

Spouse's Email

Foreign languages you speak, read or write, and your level of proficiency

Residences

Have you ever lived in another state? *

Yes

State

From (mm/dd/yy)

To (mm/dd/yy)

Address

State

From (mm/dd/yy)

To (mm/dd/yy)

Address

Have you ever lived in another country? *

Yes

Country

From (mm/dd/yy)

To (mm/dd/yy)

Address

Country

From (mm/dd/yy)

To (mm/dd/yy)

Address

All residences for the last five (5) years, current address first

Address (Street, City, State, Zip) *

From (mm/dd/yy) *

To (mm/dd/yy) *

With whom did you live?

Their Telephone

Landlord's Name

Landlord's Telephone

Address (Street, City, State, Zip)

From (mm/dd/yy)

To (mm/dd/yy)

With whom did you live?

Their Telephone

Landlord's Name

Landlord's Telephone

Address (Street, City, State, Zip)

From (mm/dd/yy)

To (mm/dd/yy)

With whom did you live?

Their Telephone

Landlord's Name

Landlord's Telephone

Additional residences in the last five years (if any)

References

List three (3) professional references. Do not include any relatives by blood.

Reference 1

Name *

Relationship to you *

Address (Street, City, State, Zip) *

Telephone *

Reference 2

Name *

Relationship to you *

Address (Street, City, State, Zip) *

Telephone *

Reference 3

Name *

Relationship to you *

Address (Street, City, State, Zip) *

Telephone *

Employment

List all information regarding your employment for the last five (5) years, most current first.

Employer 1

Company Name *

Telephone

Address (Street, City, State, Zip)

Start date of employment

End date of employment

Position

Reason for leaving

Duties

Supervisor's Name

Weekly Hours

Employer 2

Company Name

Telephone

Address (Street, City, State, Zip)

Start date of employment

End date of employment

Position

Reason for leaving

Duties

Supervisor's Name

Weekly Hours

Employer 3

Company Name

Telephone

Address (Street, City, State, Zip)

Start date of employment

End date of employment

Position

Reason for leaving

Duties

Supervisor's Name

Weekly Hours

Additional employment in the last five years (if any)

Education

Beginning with high school.

High School

School Name *

City, State

Start Date Attended

Type of Diploma

Graduation Date

Degree Earned

School 2

School Name

City, State

Start Date Attended

Type of Diploma

Graduation Date

Degree Earned

School 3

School Name

City, State

Start Date Attended

Type of Diploma

Graduation Date

Degree Earned

Special qualifications and skills that pertain to the position you are applying for

Employment Background

Do you know any former or current Donald W. Wyatt Detention Facility employees? *

Yes

If yes, list their name(s) and relationship

Did they refer you? *

Yes

Have you ever been investigated by your employer for improper conduct, illegal activities, or equal employment violations that resulted in your being found to violate any policies, regulations, rules, or state or federal laws? *

Yes

If yes, explain the circumstance, including the date and the employer

Have you ever received a formal written reprimand, been terminated, suspended, fired, asked to resign, or resigned instead of being terminated by an employer? *

Yes

If yes, explain the circumstance, including the date and employer

Have you ever quit a job without giving sufficient (2-3 weeks) notice? *

Yes

If yes, explain the circumstance, including dates, employer, when, and why

Law Enforcement Applications

Have you ever applied for any position at the Donald W. Wyatt Detention Facility before? *

Yes

Position applied for

Date

Other police departments, correctional facilities, cities, or law enforcement agencies you have applied to

Agency

Date Applied

Address (Street, City, State, Zip)

Telephone

Hiring Status

How far did you make it in the process?

Agency

Date Applied

Address (Street, City, State, Zip)

Telephone

Hiring Status

How far did you make it in the process?

Agency

Date Applied

Address (Street, City, State, Zip)

Telephone

Hiring Status

How far did you make it in the process?

Additional agencies applied to (if any)

Military

Have you served in the military? *

Yes

Military service (list all)

Branch

Unit

Entry Date

Discharge Date

Service Number (last 4 digits only)

Highest Rank

Commanding Officer's Name

Commanding Officer's Telephone

Have you ever applied to and been rejected for military service? *

Yes

Date Applied or Rejected

Branch

Why was your application rejected?

Have you ever been investigated for any criminal activity while on Active Duty or Guard/Reserves? *

Yes

If yes, explain circumstance

Have you ever been reduced in pay grade or been the subject of any judicial or non-judicial disciplinary action while on Active Duty, National Guard, or Military Reserves? *

Yes

If yes, explain the circumstance to include dates, violations, and penalties

Did you receive an honorable discharge? *

Yes

If no, explain circumstance

Courts

Have you ever been charged with or convicted of a criminal offense? This includes charges that have been dismissed, dropped, or reduced. *

Yes

Incident 1 (if yes above)

Date of incident

Charges

Law Enforcement Agency

Disposition

Description of Incident or Circumstances

Incident 2 (if yes above)

Date of incident

Charges

Law Enforcement Agency

Disposition

Description of Incident or Circumstances

Additional incidents (if any)

Have you ever had a restraining order or a no-contact order against you for any reason? *

Yes

If yes, explain circumstance

Expunged records

Under Rhode Island General Law 12-1.3-4, Law Enforcement applicants must disclose expunged records. Provide the following information if you have had any charges expunged. Court documentation must be submitted with this application.

Date of Incident

Charges

Agency/State

Description of Events or Circumstances

Date of Incident

Charges

Agency/State

Description of Events or Circumstances

Are you now, or have you ever been involved in any civil court action as a plaintiff or defendant? *

Yes

Date of Claim

Court Location

You were the

Plaintiff

Defendant

Description of Circumstances

Drugs

Have you ever purchased, sold, supplied, manufactured, cultivated, ingested, inhaled, or injected any form of illegal drugs, pills/prescription medication, narcotic, or substance, including steroids? *

Yes

Please provide the following information. Do not leave any blank spaces. For each substance, answer Yes or No, then give the number of times and approximate date if Yes.

Substance

Yes / No

Number of times

Approximate date

Marijuana and/or (THC Vaping)

Yes

Salvia

Yes

Hashish

Yes

Speed

Yes

Methamphetamine

Yes

Heroin

Yes

Mushrooms

Yes

Peyote

Yes

LSD

Yes

Cocaine

Yes

Crack

Yes

PCP

Yes

Ice

Yes

Ecstasy

Yes

Mandrax/Quaaludes

Yes

Steroids

Yes

Amphetamines

Yes

Barbiturates

Yes

Adderall

Yes

Fentanyl

Yes

Methadone

Yes

Oxycodone

Yes

Khat

Yes

Inhalants

Yes

Bath Salts

Yes

Benzodiazepines

Yes

K-2 Spice

Yes

Synthetic Cannabinoids

Yes

Any substance you thought may be illegal

Yes

Prescription medication not prescribed to you

Yes

Any other natural, manufactured, and synthetic drugs where their use could be questionable

Yes

Other

Yes

If you answered yes to any substance listed above, explain what, where, when, and why

License / Registration

Has your license to operate a motor vehicle ever been suspended? *

Yes

Date of Suspension

State of Suspension

Reason for Suspension

Has your license been reinstated? *

Yes

Date of reinstatement

Vehicle(s) registered to you or that you utilize, with insurance information

Name on Registration

Registration Plate #

State

Insurance Provider / Policy #

Name on Registration

Registration Plate #

State

Insurance Provider / Policy #

Traffic

Starting with your most recent, list all moving and non-moving violations (speeding, parking, red-light, camera citations, etc.) received within the last two (2) years, and describe the disposition (pleaded guilty, paid fine, dismissed, etc.). Also disclose any traffic stops where warnings, but no citations, were issued.

Traffic incident 1

Date of incident

Violation

City/State

Agency

Disposition

Describe Circumstance

Traffic incident 2

Date of incident

Violation

City/State

Agency

Disposition

Describe Circumstance

Traffic incident 3

Date of incident

Violation

City/State

Agency

Disposition

Describe Circumstance

Additional traffic incidents (if any)

Additional Questions

Have you ever contacted any inmate(s), to include visitations, letters, or phone/video calls to any correctional institutions? *

Yes

Inmate's Name

Date of last contact

Correctional Institution

Inmate's Name

Date of last contact

Correctional Institution

If yes, are you still communicating/in contact with any person named above?

Yes

Are you currently or have you ever been a member or associate of any gang (i.e., street, motorcycle, etc.)? *

Yes

If yes, please explain

Have you ever used any other name or alias during your life? *

Yes

Name/Alias

Date(s)

Name/Alias

Date(s)

Is there anything in your background that you think would prevent you from being a qualified correctional officer that has not been asked on this application? *

Yes

If yes, please explain

Applicant Certification

Any discrepancies, misstatements, omissions, and falsifications would cause disqualification and your name to be removed from the eligibility list or cause further review and dismissal if an appointment was made.

I certify that all information provided in this application is true and complete to the best of my knowledge, and I understand the statement above.

Type your full legal name as your signature *

Date *

Prison Rape Elimination Act (PREA) Questionnaire

Form WN 60201, REV 4/1/2024. To be filled out by all applicants who may have contact with detainees, in accordance with the PREA Standard (28 C.F.R. Part 115) and CFDFC Policy #411 - Sexual Abuse and Sexual Harassment - Prevention and Intervention.

Name (First, Middle, Last) *

Telephone Number *

Address (Street/Number, City, State and Zip Code) *

Mailing Address (if different from residence address)

Job title for which you are applying *

1. Have you ever engaged in sexual abuse or sexual harassment in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution (as defined in 42 U.S.C. 1997)? *

Yes

If yes, please provide further details

2. Have you ever been convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse? *

Yes

If yes, please provide further details

3. Have you ever been civilly or administratively adjudicated to have engaged in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse? *

Yes

If yes, please provide further details

4. Have you had any prior incidents of sexual harassment? *

Yes

If yes, please provide further details

THIS AFFIRMATION MUST BE COMPLETED

I certify that there are no willful misrepresentations or falsifications of the above statements and answers to questions. I understand that should an investigation disclose such misrepresentations or falsifications, my application may be rejected and, should I be employed, my service may be terminated.

Type your full legal name as your signature *

Date *

Submit Application