PERSONAL INFORMATION

CRIMINAL and DRIVER’S HISTORY CONSENT

Last Name

First Name

Middle Name

Date of Birth

Social Security No.

Sex

Race

Driver's Licence No.

I hereby authorize the Baldwin County Sheriff’s Office to obtain criminal histories through G.C.I.C. and N.C.I.C. and all driver’s license information through the Georgia Department of Public Safety or any other state for which I am personally licensed to operate a vehicle.

I hereby authorize any person(s), educational/training institution, former employer I have listed on my application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will hold the person(s), educational/training institution, former employers and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the employment process.

A photocopy of this release form will be valid as an original, thereof, even though the said photocopy does not contain an original writing of my signature.
I have read and understand both the Criminal and Driver’s History Consent and the Applicant Information Release.

Signature (use your mouse to draw your signature below)

Date

Email

Information regarding test dates etc. will be emailed to the address provided. Please
provide a valid email address that you check frequently.

Current Street Address

City

State

Zip Code

Phone #

Position Applying For

Part TimeFull Time

List three personal references with addresses and phone numbers:

EDUCATION AND TRAINING

Are you presently employed?
YesNo

Have you ever been terminated by an employer?
YesNo

If so why?

Have you ever been employed by another law enforcement agency?
YesNo

If yes, agency name and duties

List employment history below with your current or most recent employer first.
Employer

Address

Phone Number

From

To

Reason for leaving

Employer

Address

Phone Number

From

To

Reason for leaving

Employer

Address

Phone Number

From

To

Reason for leaving

High School DiplomaGED

Attach a copy or picture of your high school diploma, GED certificate, or certified transcript to this application:

DRIVING INFORMATION

Are you licensed to drive a vehicle?YesNo
If yes, attach a copy or picture of your driver’s license to this application:
If no, please be advised that a valid Georgia driver’s license is required for employment with this agency.

Do you currently own a vehicle?YesNo
If yes, attach proof of vehicle insurance to this application:
Please attach birth certificate or social security card**:

1. Do you have poor management or personal finances? (Debts, pending civil suits, garnishments, dispossessory warrants, bankruptcies, etc., will be investigated to determine a candidate's suitability for employment.)?YesNo
If yes, explain:

2. Any felony convictions?YesNo
If yes, explain:

3. Any outstanding criminal charge pending adjudication?YesNo
If yes, explain:

4. Any domestic violence/family violence convictions?YesNo
If yes, explain:

5. Any sufficient misdemeanor convictions to establish a patter of disregard for the law?YesNo
If yes, explain:

6. Any conviction or plea of nolo contendere within the past year for Driving Under the Influence of Drugs or Alcohol (DUI)? YesNo

7. Any conviction or plea of nolo contendere for a serious traffic offense within the past two years, including but not limited to: Fleeing or Attempting to Elude a Police Officer, Vehicular Homicide (misdemeanor), Failure to Stop, Render Aid or Leave Information, or Racing? YesNo

8. Do you have five or more convictions and/or pleas of nolo contendere within the past two years for any moving violations?YesNo

9. Any ongoing criminal activity or history of criminal activity other than minor traffic offenses?YesNo

10. Have you completed first offender treatment for an offense that indicates a security risk to Baldwin County Sheriff's Office facilities, records, and/or information?YesNo
If yes, explain:

11. Any current illegal drug use?YesNo
If yes, explain:

12. Any pattern of marijuana use in the last 6 months?YesNo

13. Any pattern of drug use, other than marijuana, that suggests un-rehabilitated substance abuse in the last year?YesNo

14. Any illegal sale, distribution or manufacturing (to include growing) of any drug?YesNo

15. Have you had deliberate association of a personal nature within the past year with persons who use illegal drugs in your presence?YesNo