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