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: