APPLICATION FOR EMPLOYMENT

Douglas County Sher i f f ’ s Off ice 8470 Ear l D. Lee Blvd Douglasvi l le , GA 30134 employment@sheri f f .douglas.ga.us

APPLICATION FOR EMPLOYMENT: DOUGLAS COUNTY SHERIFF’S OFFICE, GA COMPLETING THE APPLICATION

1. The Douglas County Sheriff’s Office application is provided as a downloadable PDF document. Please complete the application on your computer and return it to us at this address: [email protected]

2. To prevent errors and to save you time, please read over the entire application before beginning.

3. All information is subject to verification and any intentional omissions or misrepresentation of facts will automatically disqualify the applicant from further consideration.

4. Answer all questions fully and to the best of your ability. Failure to provide all requested information might result in you being eliminated from the employment process.

5. If you don’t have enough room to fully answer any question(s) on this application, please note that you are including an attachment and complete your answer there. Please make sure to clearly label all responses on your attachment, so there is no confusion about your answer. Attachments may be submitted in the following formats; Microsoft Word (.doc or .docx), Plain Text (.txt), PDF Document (.pdf) or as an image (jpg. or jpeg.).

6. Please retain a copy of any document you submit. If there is a problem with your submission or if the document were to become corrupted, this will keep you from having to reproduce the document.

7. The Personnel Office will contact you for any interviews, testing or evaluations at the appropriate time. Please DO NOT call about your application, unless:

You have submitted your application and you have important information to change on your application, such as address, telephone number, etc.

You have a question about the content of the application and are unsure how to respond.

You have a question about how to properly submit your application.

8. If you have any questions about this process, please contact Deputy T. Williams at (678) 486-1313.


THE HIRING PROCESS

1. Application — All persons interested in applying for a position with the Douglas County Sheriff’s Office should download and complete the Sheriff’s Office Application Packet. This packet is approximately thirty-four pages long and is very involved. In addition to background questions, several attachments are required, which you will be required to bring with you to the initial interview (see step 4).

2. Application Submission — Completed packets should be returned to:

[email protected]

3. Application Review — Once your application packet has been received, members of the Sheriff's Office Personnel Office will review your application. Acceptable candidates are identified and contacted to arrange a preliminary interview. (Please make sure that your contact information is included and correct. If we are unable to contact you, your application will be eliminated).

4. Initial Interview — Your initial interview will be informal and typically lasts thirty to forty-five minutes. A member of the Personnel Office will go over the application packet with you to ensure that all pages are signed where appropriate, all necessary documents are provided, all pages that require notarizing are notarized, etc. Additionally, if the position requires typing, a typing test may be given. Successful completion of this interview will result in the application being forwarded to the Command Staff for review.

All applicants should bring the following items to the preliminary interview: Birth Certificate High School Diploma or GED Certificate College Diploma (if applicable) Driver’s License Social Security Card DD214 Long Form (if applicable)

Certified Peace Officers should also bring the following:

Certification Training Certificates

5. Secondary Interview — Your second interview will be a formal interview with a member of the Command Staff. This interview is approximately an hour long and is conducted by a Sheriff's Office member at the rank of Captain or above. This purpose of this interview is to further evaluate the candidate's suitability for the position. Many subjects may be discussed; prior employment, reasons for leaving, aspirations of the candidate, any questions from the application packet responses, etc. Candidates that successfully complete this phase of the application process and receive the approval of the Command Staff will be scheduled for a polygraph or computerized voice stress analysis (CVSA) test.

6. Physical Ability Test – Based on the Deputy Sheriff Recruit position, you will be required to complete this test in 2 minutes, six seconds or less. (Peace Officer Standards Training required)


7. Polygraph / CVSA – Applicants will submit to a polygraph or CVSA test, which is used to determine the candidate's veracity on their application. In addition, other subjects may be broached that are considered of importance, based on the position you are being considered for. At the conclusion of the test, the candidate will receive either a "Pass" or "Fail".

8. Background — Candidate that receive a “Pass” and are otherwise deemed an acceptable candidate will advance to the Background phase. During this phase, all background information is verified, prior employers are contacted, references are contacted, credit histories may be checked, home visits may be made, neighbors talked to, school/college records verified, etc.

9. Conditional Offer – Applicants that successfully completed the Background and all prior evaluations will be given a conditional offer of employment. Essentially, this step indicates that if the candidate successfully passes both a psychological and physical exam, they may be hired.

10. Psychological Exam — The psychological exam is very comprehensive and applicants should anticipate that this exam will take all day. This exam is conducted by a mental health professional and not by a member of the Sheriff’s Office staff. Following your exam, the results will be forwarded to the Sheriff's Office for review. Candidates that successfully complete the psychological exam with favorable results are then sent for a medical exam.

11. Medical Exam – The medical exam is conducted at the Sheriff's Office by a contracted medical provider. Tests include a drug screen, vision test, etc.

12. Firearms Qualification – Based on the Certified Deputy Sheriff or Deputy Sheriff Recruit position you are applying for, you may be required to qualify with our duty weapon. (Peace Officer Standards Training required)

13. Offer of Employment – Congratulations! If you’ve made it to this step, and successfully completed all of the previous steps, you will receive an offer of employment. You will meet with a member of the Personnel Office to discuss salary information, receive a badge number and orientation will be scheduled. You will also meet with a member of Supply to obtain your uniforms.

14. Orientation Day — Newly hired candidates are required to attend an orientation at the Douglas County Courthouse. At this orientation, you will complete some final tasks, such as filling out your tax forms and we will provide you with information, such as specifics on your insurance plan. Once you’ve complete the orientation at the Courthouse, you will return to the Sheriff's Office and meet with a member of the Command Staff. We will provide you with a copy of the Policy and Procedures Manual and you may meet briefly with Training. You will then be sent to meet with a member from the department in which you will work. Work schedules may be discussed, expectations set, and work begins.


NOTES Applicants may be directed to complete the aforementioned steps out of sequence. This is done to

efficiently move you through the hiring process. To minimize confusion, candidates are encouraged to ask questions at any point in the hiring process. The steps of the hiring process are carried out at the direction of the Sheriff’s. At the Sheriff’s

discretion, one or more steps may be excluded, depending on the vacancy to be filled. Completing the hiring process and outfitting an officer is both time consuming and costly. For these

reasons, should a candidate accept the position and then VOLUNTARILY leave Sheriff's Office within 12 months of the hire date, they will be expected to repay all hiring and associated costs. After the first twelve months, the candidate would be responsible for a reduced amount of the hiring and associated costs. The amounts and details will be disclosed at the final employment interview (see step 12 above).

This is a lengthy process, which usually takes several weeks to get through. We typically have 50 or more candidates to consider at any given time and candidates may be eliminated from consideration at any point. Candidates are not always notified when eliminations occur or when the job has been filled. If you have questions, please call (770) 920-4968 or (678) 486-1313.


PHYSICAL ABILITY TEST

Another change coming from POST on January 1, 2021, is the Physical Ability Test (PAT) that will be required for each candidate enrolled in a basic law enforcement course attending any law enforcement academy in the state. POST worked hand-in-hand with the Georgia Public Safety Training Center (GPSTC), and other agencies, to develop this test.

POST executive director Mike Ayers, along with members of the staff from GPSTC, travelled to the South Carolina Criminal Justice Academy in Columbia, SC, to view their test and to watch several students run the course. The PAT has been validated and approved by the Federal Law Enforcement Training Center and is now the POST approved PAT for all basic law enforcement candidates.

The test is basically a timed obstacle course. See the map below. The course is just a few feet larger than half of a basketball court and must be completed in 2 minutes, six seconds or less.

The candidate starts with 1 3/4 laps around the outside of the course and then enters, following the pattern shown on the map. They must jump two small hurdles, climb a flight of stairs, descend the flight of stairs, go around a cone and continue back up and down the stairs again. The candidate jumps over more hurdles and must go under a bar that is 2 ½ feet high. If they fail to negotiate the low crawl correctly, there is a two-second time penalty. More running and a leap across a simulated 6-foot gap representing a large ditch. If either foot hits the tape, there is another two second time penalty. The candidate can opt to skip the jump and take the two second time penalty as well.

Running back across the floor, the candidate must negotiate a 4-foot-high chain link fence panel, round the cone and run back across the floor. Now the candidate must climb through a standard sized window, which is four feet high, and, once safely through it, drag a 150-pound dummy a distance of 20 feet until the dummy is across the designated line. Now, one more lap around the outside of the course and they are finished.

SEE MAP OF COURSE ON NEXT PAGE

Douglas County Sher i f f ’ s Off ice 8470 Ear l D. Lee Blvd Douglasv i l le , GA 30134 employment@sher if f .douglas .ga.us

Douglas County Sher if f ’ s Of f ice 8470 Ear l D . Lee Blvd

Douglasv i l le, GA 30134 employment@sheri f f .douglas .ga.us

DOUGLAS COUNTY SHERIFF'S OFFICE BACKGROUND QUESTIONNAIRE APPLICATION

NOTE: DOUGLAS COUNTY GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER. THE PERSONAL DATA REQUESTED BELOW IS USED ONLY TO CREATE AN APPLICANT DATABASE AND IS NOT USED AS A SCREENING TOOL.

LAST FIRST MIDDLE NAME DATE OF BIRTH

RACE SEX WEIGHT HEIGHT EYE COLOR HAIR COLOR

SOCIAL SECURITY NUMBER

ADDRESS (INCLUDE STREET NUMBERS, STREET/ROAD, CITY, STATE, AND ZIP CODE)

(AREA CODE) HOME PHONE (AREA CODE) WORK PHONE (AREA CODE) CELL PHONE

EMAIL ADDRESS

mailto:[email protected]

elizabeth.reeder

Underline



SHERIFF'S OFFICE APPLICANT

Douglas County Sheriff’s Office maintains strict hiring guidelines that all applicants must satisfactorily meet or surpass in order to be considered for positions within Law Enforcement or Corrections.

The following questions address several of the areas covered in the hiring guidelines. Your responses will be verified during the background investigation process and pre-employment polygraph examinations. Completed and honest responses are required. Any negative information contained within the information provided in the questionnaire will be evaluated to determine compliance with the Department's hiring guidelines. Any false or misleading information identified during the background investigation process will result in immediate disqualification of your employment application. Therefore, it is imperative that you answer all of these questions truthfully and to the best of your ability.

1. Applicants for Jailer, Communications Officer, or any civilian position must be 18 years of age.

Applicants for Deputies must be 21 years of age. Your age: 18yoa 21yoa

2. Position applied for Date:

3. Are you a citizen of the United States of America? Y N

This is a requirement for sworn positions (deputy sheriff and corrections officer).

4. Did you graduate from high school or do you have a G.E.D.? Y N

This is a requirement.

5. Have you ever applied for a position with Douglas County? Y N

If yes, please provide:

Position applied for:

Year you made the application:

6. Do you have any tattoos that would be visible when wearing a short-sleeved shirt? Y N

If yes, briefly describe:

Location and content:




7. List all traffic citations received within the last ten (10) years:

Date Charge Location Disposition

8. In the past ten (10) years, have you been involved as a driver in a motor vehicle accident?

Y N

If yes, please provide the following information:

Date Charge Location Driver at Fault

9. Do you presently hold a valid Driver's License? Y N

If no, explain


State: License class:

Expiration date: Driver's License #

10. Has your Driver's License ever been suspended and/or revoked for any reason? Y N


Date of suspension: Date reinstated

Reason for suspension




11. Have you ever been convicted of or pled nolo to D.U.I.? Y N

If yes, please explain:

Provide:

Date Location Disposition

12. Have you ever been convicted or pled nolo to a misdemeanor offense? Y N



13. Do you have any summons outstanding against you? Y N

If yes, please explain

14. Have you ever been convicted or pled nolo to a felony offense? Y N



15. Have you ever been arrested? Y N


Charge:

Location:




16. Have you ever enlisted or attempted to enlist in the military? Y N

If yes, which branch?

Number of years served: Type of discharge:

While serving in the military were you ever the subject of any court martial, Article 15, companypunishment or disciplinary action? Y N

If yes, please explain

17. Have you ever been suspended, terminated or forced to resign from any place of employment?

Y N


Employer's name

Reason for termination/forced resignation/dismissal

18. Have you ever been disciplined for any reason by your present or past employer? Y N


19. Do you have commitments that would not allow you to work on various shifts, weekends, holidays orother periods? Y N


20. Have you ever committed any undetected crimes (crimes that you have not been arrested for)?

Y N


21. If you had to place a dollar amount on the property that you have taken throughout your lifetime,what would that amount be? . This amount should include any theft from an employer,including but not limited to pens, paper, and other office supplies.Please describe the items taken:




22. Over the past three years, how would you describe your credit standing?

23. Have you ever used an illegal drug, including but not limited to: marijuana, cocaine, heroin, angeldust/PCP, LSD/Acid or other hallucinogenic drugs, crack, opium, Quaaludes, speed, crank, mushrooms,peyote, ecstasy/MDMA, ice, hashish, steroids, crystal, methadone, morphine, valium, etc.?

Y N

If yes, please explain below:

Drug(s) Used Date First Used Date Last Used Number of Times Used

24. Have you ever been involved in the sale, distribution or manufacture of any illegal drugs?

Y N


25. Have you ever consumed any drugs prescribed for another person? Y N

If yes, please explain below:

Drug(s) Used Date First Used Date Last Used Number of Times Used

26. Have you ever consumed any alcoholic beverage or used any type of illegal drug while working?

Y N

If yes please explain

27. Have you ever had a name change including adoptions, all marriages? Y N


Previous name:

Date and location of change

Reason for change




28. List all previous places of residence for the last twenty (20) years and dates resided there:

Address Dates

29. Do you belong to any organizations such as:

Bloods, Crips Y N Folks Y N Neo Nazi Group Y N

Black Panthers Y N Ku Klux Klan Y N Aryan Nations Y N

Latin Kings Y N Lafaza Y N Sur 13 Y N

Other, specify

30. Have you been a party to a repossession, garnishment, or bankruptcy? Y N

If yes, explain

31. Have you been the subject of or a witness in an internal affairs professional standards investigation?

Y N





Educational Background

32. List all schools that you have attended. Be prepared to provide transcripts or certificates from anyschools attended.

To/End Date School Location Graduate (Yes/No)

Have you ever been suspended, expelled or placed on probation? Y N

What subjects were your favorites:

What subjects were most difficult for you:

What is the most significant accomplishment derived from your education?

33. List any club, society, civic, or fraternal organization to which you are a member or have been a member:

Organization Name Dates of Membership

34. If it became necessary in the course of your law enforcement duties to lawfully take a human life,would you have any reluctance to do so because of religious or other beliefs? Y N

Explain your answer in the space provided:

35. Is there anything that you would like to tell us about yourself that you have not addressed tothis point? Y N





36. Do you currently have any pending criminal charges against you, including but not limited to, trafficcitations or domestic violence? Y N


37. Are you currently under subpoena or involved in any criminal or civil litigation either as a plaintiff ordefendant? Y N

Are you currently serving probation for any offense? Y N

If yes to either question, please explain:

38. The duties and responsibilities of a position can change. This may arise from technological changes orchanges in department policies and procedures. Are you willing to accept changes in the duties andresponsibilities for the position for which you have applied?

Y N




Employment

39. Do you object to your present employer being contacted by us? Y N

40. When will you be able to report for work?

41. If employed by Douglas County Sheriff’s Office, do you anticipate any income other than your salary?

Y N

42. Are you now on any eligibility list for employment? Y N


Name of company or agency

For what position?

43. List every job you have ever had including full-time, part-time and temporary services. Beginning withpresent employer. Be specific about dates and use employer’s complete mailing address with zip codes.

Start Date

End Date

Company Name

Supervisor’s Name

Employer Address

Employer Phone Number

Position or Duties

Reason for Leaving

Start Date

End Date

Company Name

Supervisor’s Name

Employer Address


Position or Duties

Reason for Leaving




Start Date

End Date

Company Name

Supervisor’s Name

Employer Address


Position or Duties

Reason for Leaving

Start Date

End Date

Company Name

Supervisor’s Name

Employer Address


Position or Duties

Reason for Leaving

Start Date

End Date

Company Name

Supervisor’s Name

Employer Address


Position or Duties

Reason for Leaving


Douglas County Sher i f f ’ s Off ice 8470 Ear l D. Lee Blvd

Douglasvi l le , GA 30134 employment@sheri f f .douglas.ga.us

References 44. List below the names of three (3) persons not related to you, whom you have known for at least three

(3) years. All persons (i.e., teacher, employers, neighbors) to whom you refer may be asked to appraiseyour character, ability, experience, personality and other qualities. Include the individual’s full name,complete mailing address with zip code, phone number, occupation, length of acquaintance, and theiremail address.

Full Name:

Address:

Occupation

Telephone

Years known

Email address

Full Name:

Address:

Occupation

Telephone

Years known

Email address

Full Name:

Address:

Occupation

Telephone

Years known

Email address




46. Have you been completely honest with us when completing your application for employment and thisquestionnaire? Y N

If no, please explain

Signature of Applicant Date

Answering “yes” to any of the aforementioned questions will not necessarily result in your disqualification from the hiring process. Any intentional omissions or dishonesty in any documents submitted as part of your application or any other part of the hiring process will be cause for immediate removal from further consideration.

As a Deputy Sheriff or Jailer: Oath of Office:

I swear that I am not the holder of any public monies due this or any other State or political subdivision unaccounted for:





CHARACTER-BASED HIRING

Applicant Interview Form

Last Name First Name Middle Initial Social Security #

1. Would your previous supervisors say you are consistently on time? Y N

Why or why not?

2. How would your previous supervisors rate your attendance?

☐ Excellent ☐Good ☐Fair ☐Poor

Please explain

3. Would your past supervisors say that you are orderly? Y N

What does "being orderly" mean to you?

4. Would those who know you best say your word can be trusted? Y N

Why or why not?

5. What responsibilities do you have or did you have that prepared you for your responsibilities at this job?

6. If you know a fellow employee who is involved in immoral or illegal activity, what is your responsibilityto the employer?

7. What are some legitimate reasons to miss work?




8. Would your previous supervisor say that you were good at following instructions? Y N

Why or why not?

9. How often would your past supervisors say you get angry?

☐Never ☐Rarely ☐Sometimes ☐Often

10. What causes you to get upset on the job?

11. Have you ever experienced a loss for doing what is right?

12. What methods do you use to remember instructions?

13. What outward signs should you watch for to ensure that a customer's needs are being met?

14. What do you think you owe to your employer?

15. What does your employer owe you?




16. Please choose three (3) areas in which you are weakest:

☐ Contentment ☐ Diligence ☐ Dependability ☐ Gratefulness ☐ Loyalty

☐Meekness ☐ Forgiveness ☐ Orderliness ☐ Punctuality ☐ Truthfulness

☐ Obedience ☐ Self-control

17. Please choose three (3) area in which you are strongest:

☐ Contentment ☐ Diligence ☐ Dependability ☐ Gratefulness ☐ Loyalty

☐Meekness ☐ Forgiveness ☐ Orderliness ☐ Punctuality ☐ Truthfulness

☐ Obedience ☐ Self-control

18. What distinguishes your time from company time?

19. What are your goals?

20. How will this job help you achieve your goals?

Signature Date

BASED ON THE INFORMATION PROVIDED IN THIS QUESTIONNAIRE, THIS APPLICANT APPEARS TO BE

☐ ACCEPTABLE ☐UNACCEPTABLE




COMMUNICATIONS OFFICER 1

NAME:

SOCIAL SECURITY #

Thank you for applying for employment with Douglas County Government. The following questionnaire provides you with information relative to the requirements, duties and demands of the above referenced classification. Read each statement carefully and then truly assess yourself to determine your suitability for employment in this classification. ANSWER THESE QUESTIONS HONESTLY. All of the tasks mentioned are required of you should you be selected for employment.

You may provide additional information not specifically requested on the questionnaire that you believe will assist the Personnel Officer in evaluating your application. Please attach additional pages if desired. However, the information requested will form the primary basis of your evaluation.

THIS AFFIRMATION MUST BE COMPLETED

I confirm that the statements made on this questionnaire are true under the penalties of perjury.





DOUGLAS COUNTY SHERIFF’S OFFICE COMMUNICATIONS OFFICER 1

SUPPLEMENTARY QUESTIONNAIRE

NOTE:

The backgrounds of all Sheriff’s Office employees are checked through the Georgia Crime Information Center and the National Crime Information Center in addition to checks with previous employers. Previous arrests, traffic citations and/or convictions will be evaluated on an individual basis and do not automatically disqualify you from consideration for employment.

1. The Communication Center operates on a 12 hour, three and four-day work week schedule.

There are two (2) work shifts per day: 6:00 a.m. – 6:00 p.m. and 6:00 p.m. – 6:00 a.m.

While off days and works shifts are changed periodically, on a rotating basis, it is necessary that allcommunications personnel are available to work both shifts.

Are you able and willing to work on either of the two shifts described above? Y N

2. No smoking is allowed in the Communications Center.

Are you willing to work under these conditions? Y N

3. Generally, a meal break and one coffee/smoke break are offered during each shift. Sometimes, because ofheavy call volume due to bad weather or other major incidents, these breaks are not available.


4. The Communications Center, because of the criticality of its function, operates under very strict andvery narrow guidelines Because the mishandling of a call may cause harm and/or death to a citizen,police officer or firefighter, strict adherence to these guidelines is required and a strict disciplinarypolicy exists.


5. How much time have you spent on a computer terminal? (months/years)

Describe the activities (entry, retrieval, etc.) and types of information:




6. Very often, calls dealt with in the Communications Center are regarding life or death situations andrequire instant decisions on the part of the Communications Officer to save the life of a citizen orofficer. Handling of such a call in these cases must be in seconds instead of minutes and the decisionsmade must be correct and precise.


7. The Communications Center is open 24 hours a day, 7 days a week.

Are you willing and ABLE to work weekends and holidays? Y N





Social Networking Sites

Please provide the addresses of sites you visit. (example: http//www.facebook.com/home.php#!/profilephp?id=00000000) Do not provide password

How do you access these sites?




Emergency Contact Information

In case of accident or emergency, notify:

Name:

Relationship:

Phone:

Address:

City: State: Zip

Place of Employment:

Phone:

Address:

City: State: Zip

Name:

Relationship:

Phone:

Address:

City: State: Zip

Place of Employment:

Phone:

Address:

City: State: Zip




Background Investigation

You are hereby informed that a complete investigation of your background and character will be made a part of your application for employment with the Douglas County Sheriff's Office. Any intentional falsification or omission of information on your part will automatically disqualify you from consideration of employment with this office.

Are you willing to take a polygraph examination to verify all information supplied in this application and all other information supplied by you to this department? Y N

If no, please state your reasons:

Signature Current Date




CRIMINAL HISTORY RECORD INFORMATION CONSENT FORM

Law Enforcement Officers -Purpose Code J

Revisions to the Federal Omnibus Consolidation Appropriations Act of 1977 and amendments to the Gun Control Act of 1868 makes it unlawful for any person convicted of a misdemeanor crime of domestic violence to ship, transport, possess, or receive firearms or ammunition. There are no provisions in this law for exceptions.

I hereby, voluntarily, authorize Douglas County Sheriff's Office, 8470 Earl D. Lee Blvd., Douglasville, GA 30134, to receive any criminal and driver's history record information pertaining to me which may be in the files of any state or local criminal justice agency. I acknowledge that refusal to give this consent may have an adverse effect on my continued employment as a law enforcement officer.

Current full name printed

Previous Name(s) (including maiden)

Street Address

City: State: Zip

Sex Race Date of Birth Social Security Number

Signature Date




Georgia Bureau of Investigation Georgia Crime Information Center

Consent Form

I hereby give my consent for the Douglas County Sheriff’s Office, 8470 Earl D. Lee Blvd., Douglasville, Georgia 30134, to receive any Georgia or III criminal history record information pertaining to me, as authorized under state and federal law for individuals seeking employment with a criminal justice agency.

Full Name

Street Address

City State Zip

Sex Race Date of Birth Social Security Number

Previous Name(s) (including maiden)

Signature Date

One of the following must be checked:

☐ This authorization is valid for 90/180/ days from date of signature.

☐ I, give consent to the above named to perform periodic criminal history background checks for the duration of my employment with this agency.

Please do not write below this line.

Employment with criminal justice agency – civilian (Purpose code “J”)

Employment with criminal justice agency – P.O.S.T. certified (Purpose code “Z”)




Polygraph or Voice Stress Examination Agreement

The undersigned applicant, for a position with the Douglas County Sheriff's Office, understands and agrees to voluntarily submit to an examination by a professional polygraphist prior to being accepted for employment with the Douglas County Sheriff's Office. The undersigned applicant also understands and agrees that he/she will voluntarily submit to examination by a professional polygraphist pursuant to an administrative investigation at any time during their employment with the Douglas County Sheriff's Office.

The undersigned person also understands and agrees that the results of any polygraph examination given them will be considered for administrative or departmental purposes relating to their employment by Douglas County Sheriff's Office. The undersigned person further agrees and understands, to release, absolve and forever hold harmless the Douglas County Board of Commissioners, the Douglas County Personnel Review Board and the Douglas County Sheriff's Office. This includes its officers, agents and employees from any and all liability which the undersigned, his or her successors, assigns, heirs, executors or administrators have now or may ever have resulting directly, indirectly or remotely from the undersigned person having taken such polygraph.

SIGNATURES OF APPLICANT AND WITNESS WILL BE OBTAINED DURING INTERVIEW

Signature Date Time

Witness Date Time




Personal Inquiry Waiver

TO:

I respectfully request and authorize you to furnish the Douglas County Sheriff’s Office any and all information that you may have concerning me, my work record, school record, my reputation, my financial/credit status. Please include any and all medical, physical, mental health and psychological records or reports. This release includes any confidential, privileged or protected matters under federal, state or local laws, rules and regulations, and includes personal identifiable information and photostats of the same, if required. This information is to be used to assist the Douglas County Sheriff's Office in determining my qualification and fitness for the position I am seeking with this office.

I hereby release you, your organization, or others from liability or damage which may result from furnishing the information requested above. (If under 18 years of age, a parent or guardian must sign)

SIGNATURES OF APPLICANT AND NOTARY WILL BE OBTAINED DURING INTERVIEW

An Affidavit of Acknowledgement

State of Georgia County of Douglas

Known all men by these present that on the day of , 20 , personally appeared before me the undersigned authority and upon being duly sworn, did acknowledge that he/she had voluntarily executed the above instrument for the purpose therein expressed.

Applicant’s Signature

Sworn to and subscribed before me this day of , 20 .

Notary Public




Waiver of Liability and Agreement to Hold Harmless

The undersigned person as an applicant for employment with the Douglas County Sheriff's Office hereby agrees to participate freely and voluntarily in any physical agility test. The undersigned understands that this test may consist of exercises such as jumping fences, crawling, carrying weights of at least 100 pounds for 50 yards, a designated run and any other event applicable to determine my physical ability to perform law enforcement or detention activities. The undersigned agrees to release, absolve and forever hold harmless the Douglas County Sheriff's Office, its officers, agents, and employees from any liability resulting in any injury or damage during and after completion of this test.

This also applies to any and all suits, actions, or causes of actions at law, claim, demand or liability which the undersigned, his or her successors, assigns, heirs, executors, or administrators have now or may have resulting directly, indirectly, or remotely from the undersigned person having taken such test.

The application process may also include a tour of the Douglas County Jail and a supervised contact with inmates. The undersigned acknowledges the risk inherent to such a tour and voluntarily agrees to accept such risk and hold harmless Douglas County and the Douglas County Sheriff's Office for any claims of damage or injuries received as a result of the tour or contact with inmates.


Signature Date Time

Witness Date Time




Waiver of Doctor/Client Privileges

I hereby authorize any information, reports, examinations, test, records, and any results of the information, reports, examinations, and test regarding the examination and treatment of myself, to be turned over to the Personnel Director of the Douglas County Sheriff’s Office. Furthermore, I waive any and all rights that are expressed or implied under doctor/client privilege in regards to my examination and treatment.


Signature Date Time

Witness Date Time




Georgia Crime Information Center Awareness Statement

Access to Criminal Justice Information, as defined in GCIC Council Rule 140-1-02 (amended), and dissemination of such information are governed by state and federal laws and GCIC Council Rules. Criminal Justice Information cannot be accessed or disseminated by any employee except as directed by superiors and as authorized by approved standard operating procedures which are based on controlling state and federal laws, relevant federal laws, relevant federal regulations, and the Rules of the GCIC Council.

O.C.G.A. §35-3-38 establishes criminal penalties for specific offenses involving obtaining, using ordisseminating criminal history record information except as permitted by law. The same statute establishescriminal penalties for disclosing or attempting to disclose techniques or methods employed to ensure thesecurity and privacy of information systems.

The Georgia Computer Systems Protection Act (O.C.G.A. §16-9-90 et seq) provides for the protection of public and private sector computer systems, including communications links to such computer systems. The Act establishes four (4) criminal offenses, all major felonies, for violations of the Act: Computer Theft, Computer Trespass, Computer Invasion of Privacy, and Computer Forgery. The criminal penalties for each offense carries maximum sentences of fifteen (15) years in prison and/or fines up to $50,000, as well as possible civil ramifications The Act also establishes Computer Password Disclosure as a criminal offense with penalties of one (1) year in prison and/or a $5,000.00 fine.

The Georgia Criminal Justice Information System Network is operated by the Georgia Crime Information Center in compliance with O.C.G.A. §35-3-31. All data bases accessible via CJIS Network terminals are protected by the Computer Systems Protection Act. Similar communications and computer systems operated by municipal/county governments are also protected by the Act.

By my signature below, I acknowledge that I have read and understand this Awareness Statement.


Printed Name:

Signature: Date:

Witness: Date:



WAIVER AND RELEASE OF LIABILITY

1. I, _____________________________ desire to participate in a physical agility test in conjunction with the Peace Officer Training Standards physical agility pre-test examination for basic law enforcement class. I understand that my execution of this Waiver and Release is a prerequisite for my participation in the physical agility test.

2. I understand there will be risk involved and I agree to assume all risk involved in my participation of the physical agility test.

3. I hereby agree to release, indemnify, defend, and hold harmless the Douglas County Board of Commissioners, the Douglas County Sheriff’s office, any elected officials, officers, directors, agents or employees from any and all damages, losses, liabilities, claims, illnesses, demands, bodily injury or personal injury, including death, that may be sustained by me by participating in the physical agility test. This provision shall include all reasonable attorneys’ fees, costs, expenses, and damages, if any.

4. I understand and agree that this Waiver and Release is binding on my heirs, assigns, and legal representatives.

5. I have carefully read this Waiver and Release and fully understand its contents and consent to its terms. I am aware that this is a RELEASE OF LIABILITY.

This _________ day of ________________, 20_______.

_____________________________________

Participant’s Printed Name

_____________________________________

Participant’s Signature



DOCUMENTS REQUIRED FOR THE DOUGLAS COUNTY SHERIFF'S OFFICE

APPLICATION

Required Attachments:

Birth Certificate Y N N/A Naturalization Certificate Y N N/A

High School Diploma Y N N/A GED Certificate Y N N/A

College Diploma(s) Y N N/A DD214 (Long Form) Y N N/A

Driver’s License Y N N/A Social Security Card Y N N/A

Certified Officers Must Submit:

Certification Y N N/A Training Certificates Y N N/A


APPLICATION FOR EMPLOYMENT

Documents

Transcript of APPLICATION FOR EMPLOYMENT