Cherokee Marshal's Office · 1 Cherokee County Marshal’s Office 2782 Marietta Hwy, Suite 100 Canton, GA 678-493-6200 APPLICATION FOR EMPLOYMENT Full Name: SS# Address:

Cherokee Marshal's Office 2782 Marietta Hwy, Suite 100

Canton, Georgia 30114

Phone: 678-493-6200 Fax: 678-493-6212 “A NATIONALLY ACCREDITED LAW ENFORCEMENT AGENCY”

Dear Applicant,

I am pleased that you have expressed interest in applying for employment with the Cherokee Marshal’s Office. The

Marshal’s Office is dedicated to providing law enforcement assistance to the citizens of Cherokee County and striving to exceed

their expectations in all areas of our work. Our employees are responsible, motivated, ethical, and meticulous, and they each strive

to achieve the highest standard of performance in their profession.

To maintain the high standards for our employees, our agency follows a comprehensive policy for employee selection. It is

our policy to use a selection process that measures each applicant’s traits and characteristics in a manner that is related to the job

applied for, allowing us to hire the best qualified individuals. Our policy assures equal opportunity to everyone regardless of race,

creed, color, national origin, sex, religion, marital status, age, gender or disability. Our agency does not discriminate against people

with disabilities and will provide reasonable accommodations to the known disabilities of qualified people where possible.

To qualify for employment within the Cherokee Marshal’s Office an applicant must meet the following minimum

qualifications: be at least 21 years of age, be a citizen of the United States, be a high school graduate or equivalent, possess an

honorable discharge from prior military service, be able to perform the job functions of the position and possess a valid driver’s

license, no tattoos/intentional scaring on ears, head, face or neck area, if on hands it must be covered by one agency approved ring.

In addition to the minimum qualifications, our hiring process includes, but is not limited, to the following: Written Competency

standard-{ you will need to provide proof of testing through one of the following exams: Accuplacer, ASSET, COMPASS, SAT,

ACT, and CPE, which are Georgia Peace Officer Standards and Training Council (POST) approved entrance exams. Applicants

for employment must achieve a satisfactory score on all sections (including the “Numerical” section) of the exam. Minimum scores

for each section of each approved exam is determined by POST and can be viewed through the following link:

https://www.gapost.org/pdf_file/ee_scores2016.pdf. If you have not already attained a minimum score on one of the above tests,

the Accuplacer is offered at most Chattahoochee Technical College campuses}, successfully passing a physical agility test, an

extensive background investigation and an oral interview. If a conditional job offer is made, the applicant must then successfully

pass a polygraph examination, medical examination, drug screen and psychological evaluation.

Applicants who are rejected for employment for lying, deceit, bad moral character or falsifying their application will not be

reconsidered for employment with the Cherokee Marshal’s Office. However, if you are rejected for any other reason, you may re-

apply during the next application period.

It is extremely important that you provide accurate information and follow all directions given during the application

process. This requirement is essential because our agency relies on the accuracy of information contained in the employment

application as well as other information obtained during the hiring process to make our selection. Please feel free to contact our office

if you have any additional questions at 678-493-6200. Again, thank you for your interest in the Cherokee Marshal’s Office.

Sincerely,

Chief Ron Hunton

https://www.gapost.org/pdf_file/ee_scores2016.pdf

1

Cherokee County Marshal’s Office 2782 Marietta Hwy, Suite 100

Canton, GA 678-493-6200

APPLICATION FOR EMPLOYMENT

Full Name: SS#

Address:

City: State: Zip Code:

Home Phone Cell: Pager:

Are you legally eligible for employment in the USA? ( )YES ( )NO

Position Applied For:

Have you ever been employed with this agency in the past? ( )YES ( )NO

If yes, give dates and details:

Date available for hire:

Are there any skills or qualifications which will be of special benefit in the job for which you

are applying? (Please do not list any information precluded by federal and or state law)

PERSONAL REFERENCES

(Not Former Employers or Relatives)

Name: Phone:

Address: City State Zip Code

Occupation:

Name: Phone:


Occupation:

Name: Phone:


Occupation:

2

EDUCATION

School Name and Address Course of Study Last Year Completed List Diploma or Degree

Elementary

High

School

College

Other

(Specify)

I hereby give permission to contact schools shown above concerning my education:

Signature: __________________________________________________________

Are you a state certified police officer? ( )YES ( )NO

If yes, date and Certification Number:

3

List below present and past employment beginning with your most recent. If more room is

needed turn over and write on back of this page.

Name and Address of

Employer

From

Month/Ye

ar

To

Month/Ye

ar

Beginning

Salary

Ending

Salary

Reason for

leaving Supervisor

Phone #

Describe the work you did:

Name and Address of

Employer

From

Month/

Year

To

Month/

Year

Beginning

Salary

Ending

Salary

Reason

for

leaving

Supervisor

Phone #

Describe the work you did:

Name and Address of

Employer

From

Month/

Year

To

Month/

Year

Beginning

Salary

Ending

Salary

Reason

for

leaving

Supervisor

Phone # Describe the work you did:

I hereby give permission to contact the employers listed above concerning my prior work

experience.

Signature: ___________________________________________________________

If there is a particular employer(s) you do not wish to be contacted, please indicate which one(s)

4

DEPARTMENTAL USE ONLY

Employment Reference Checks:

Employer #1

Employer #2

Employer #3

Employer #4

PERSONAL REFERENCE CHECK

1.

2.

3.

DEPARTMENTAL USE ONLY

Arrange Interview: ( )YES ( )NO

Remarks:

Employed: ( )YES ( )NO If yes, Hire Date:

Job Title:

5

PLEASE READ AND SIGN BELOW

The facts set forth in my application for employment are true and complete. I understand that if

employed, any false statements on this application may result in my dismissal. I further understand that

this application is not intended to be a contract for employment, not does this application obligate the

employer in any way if the employer decides to employ me. I understand and agree that my

employment is at will and can be terminated by either party with or without notice, at any time, for any

reason or no reason. No one other than the officer of the company has any authority to enter into any

agreement for employment for any specified period of time or to make any agreement contrary to the

forgoing and then only in writing signed by an officer.

Signature of Applicant: _________________________________________________________

To Applicant: READ THIS INTRODUCTION CAREFULLY BEFORE ANSWERING ANY

QUESTIONS IN THE AREA BELOW :

The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, creed,

religion, sex or national origin. Federal law also prohibits other type of discrimination such as age,

citizenship, disability, veteran status, alignment of benefits and participation in union activities. The

laws of most states and many localities also prohibit some or all types of discrimination as well as some

additional types including, but not limited to, discrimination based upon ancestry, marital status,

parental status, sexual orientation, or source of income.

The Fair Credit Reporting Act imposes restrictions with respect to credit data. DO NOT

ANSWER ANY QUESTIONS CONTAINED IN THIS BLOCKED OFF AREA UNLESS THE

EMPLOYER HAS CHECKED THE BOX NEXT TO THE QUESTION, thereby indicating that

for the position for which you are applying, the requested information is needed for a legally

permissible reason, including without limitation, national security requirements, affirmative

action, a bona fide occupational qualification of business necessity.

Are you 18 years old? ( ) Yes ( ) No If no, hire is subject to verification that you are of

minimum legal age.

Sex: ( )Male ( )Female

Are you a citizen of the USA? ( )Yes ( )No

Were you in the US Armed Forces? ( )Yes ( )No

If yes, what branch?

Did you receive any training in the Armed Forces that is relevant to the position you have applied for? (

)Yes ( )No

If yes, describe,

Are you eligible to be bonded? ( )Yes ( )No

Have you ever been convicted of a crime including misdemeanor and summary offenses, in the past

seven years which has not been annulled or expunged or sealed by a court? ( )Yes ( )No

If yes, explain:

6

CONVICTIONS OF CERTAIN CRIMES WILL NOT NECESSARILY BE CAUSE TO BAR

EMPLOYMENT.

Do you have a valid Georgia Drivers License? ( )Yes ( ) No

You have been given a written or verbal job description listing the essential job functions for the

position applied for. Please review the job description and answer the following question. Are

you able to perform each of the essential job functions listed for each position for which you

have applied? ( )Yes ( )No

If no, list the functions you are unable to perform and explain why you are unable to perform

them:

7

Cherokee County Marshal’s Office 2782 Marietta Hwy, Suite 100

Canton, GA 30114 678-493-6200

AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION

I , ________________________________________, do hereby authorize a review and full disclosure of all records concerning myself to any duly authorized agent of the Cherokee County Marshal’s Office, whether the said records are public, private, or confidential nature.

The intent of this authorization is to give my consent for full and complete disclosure of the records of educational institutions and all Georgia P.O.S.T. Records, financial or credit institutions, including records of loans, the records of commercial or retail credit agencies (including credit reports and/or ratings) and other financial statements and records wherever filed, employment records, including background checks, efficiency ratings, complaints, or grievances filed by or against me and the records and recollections of attorneys at law or of other counsel, where representing me or another person in any case, whether criminal or civil, in which I presently have or have had an interest.

I understand that any information obtained by a personal history background investigation, which is developed directly or indirectly, in whole or in part upon this release. Authorization will be considered in determining my suitability for employment with the Cherokee County Marshal’s Office. I also certify that any person(s) who may furnish such information concerning me shall not be held accountable for giving this information, and I do hereby release said person(s) from any and all liability which may be incurred as a result of furnishing such information also agree to pay any and all charges or fees concerning this request and can be billed for such charges at the below listed address.

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.

Witness: ___________________________ Signature: _______________________

(Include Maiden Name)

Address: ___________________________ City: ______________ State ________

Home Phone: _______________ Cell: _______________ Pager: ______________

DOB: ____________________________ SSN# ___________________________

THIS APPLICATION MUST BE NOTARIZED OR IT WILL BE VOID

Notary: ________________________________________

8

Cherokee County Marshal’s Office

INFORMATION CHANGE/REPORTING AGREEMENT

I ACKNOWLEDGE HAVING SUBMITTED INFORMATION TO THE CHEROKEE COUNTY MARSHAL’S OFFICE. This has been done in a verbal and/or written manner. I realize this information is being used to determine if I meet the hiring standards and criteria of the agency and the job task that I have applied form.

By signing below I do hereby agree to notify and duly authorized agent of the Cherokee

County Marshal’s Office of any changes regarding information I have provided. This notification would include but not limited to: arrest, traffic citations, job termination, bankruptcies, financial responsibilities assigned to collections, civil and criminal litigation, drug use, or other information of pertinence to any employment background investigation. I realize failure to report such information to the hiring agency could affect my status as an applicant. Additionally, if hired, failure to disclose pertinent information during the hiring process could result in termination of my employment. The reporting of such information can be done in person, via telephone, or in writing.

THIS FORM MUST BE NOTIRIZED OR IT WILL BE VOID

This _______________ day of _______________________, _____________ (year) Applicants Signature: _________________________________________________ Notary Public: _________________________ Date: ________________________

9

BACKGROUND INVESTIGATION REQUEST CONFIDENTIAL

This background investigation is not an offer of employment or a contract for employment. The booklet, whether completed or not, remains the property of the Cherokee County Marshal’s Office. All information will be kept strictly confidential. Only the persons who have a need to know will have access to the information. The information within this booklet is needed to facilitate a background investigation. The background investigation report itself will be released to your prospective employer, upon your request.

INSTRUCTIONS

1. Print all information in black ink only in your own handwriting. 2. Complete all areas, answering all questions. Give explanation where requested. 3. If a particular question or area does not apply to you, enter “N/A”. 4. If more writing space is needed in any given section, use the reverse side of the applicable

page. Do not staple, tape or otherwise attach pages to this booklet.

IMPORTANT

Truthful and complete responses to the question in this booklet are a necessity. The entry of false or misleading information is in violation of law. All information placed in this booklet will be subject to confirm by background investigators. Any false or misleading information will terminate the background investigation and will be reported to the requested.

AFFIRMATION

I understand if I choose not to answer a question in this booklet, the background investigation which I have requested will not be conducted. All information which is recorded in this booklet will be used to determine my integrity, trustworthiness, and suitability. _____________________________________ _________________________________ S igna ture Date

10

PERSONAL HISTORY STATEMENT

First Name Middle Name Last Name

Give any other names that you have used or have been known by including names associated with marriages, or name changes. Attach court documents and explanations of

why you used another name.

PERSONAL Height Weight Hair

Eyes Sex Race

ADDRESS Number Street

City State Zip Code

With whom do you reside?

Home Phone Number Work Phone Number Other Number(s) where you can be reached?

BIRTH RECORDS

Date of Birth (M/D/Y) City of Birth County of Birth

State of Birth Country or Birth

Are you a citizen of the United States?

( )Yes ( )No

Are you?

( ) Natural Born ( ) Naturalized ( ) Resident Alien Social Security

- -

Other identification number Source

MARITAL STATUS

( ) Single ( ) Married ( ) Separated ( ) Divorced

Spouse First Name Spouse Middle Name Spouse Last Name

Spouse’s complete physical address

Home Phone Work Phone Spouse Employer

DEPENDENT INFORMATION

Name DOB Relation Resides

11

FAMILY HISTORY

List all living members of your family including parents, sisters, brothers (blood or half) and parent –in-law

Name Relationship

Address

DOB Phone Occupation

Name Relationship

Address


Name Relationship

Address


Name Relationship

Address


Name Relationship

Address


Name Relationship

Address


RESIDENCES

List all of your addresses for the past 10 years. Start with your present address at the top and include any addresses you had while in the military. If more space is needed, use reverse.

From (mo/yr) To (mo/yr) Address City / State

12

EDUCATION

Circle the highest year completed:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

If you graduated from an accredited high school, provide the following.

School Complete Address Year Obtained

List any colleges, universities, vocational/technical schools or graduate schools that you attended:

School Complete Address From – TO

Major course of study Did you Graduate?





If you have any technical skills, not necessarily acquired through formal education, list them below:

13

EMPLOYMENT HI STORY

What is your present occupation?

Have you ever been declined employment? ( ) Yes ( ) No

If so, explain:

Do you have any experience with shift work? ( ) Yes ( ) No

Have you ever been engaged in any business as an owner, as a partner or as a corporate member? ( ) Yes ( ) No

If so, explain:

Have you ever worked for a family member? ( ) Yes ( ) No

If so, explain:

Have you ever had work arguments concerning job duties or working conditions with an employer? ( ) Yes ( ) No

If so, explain:

Has a supervisor ever reprimanded you for being late or for being absent? ( ) Yes ( ) No

If so, explain:

Has a supervisor ever reprimanded you for misconduct or for not performing your job properly? ( ) Yes ( ) No

If so, explain:

Circle the times that you have been asked to resign or have been fired from a job in the past ten years:

10 9 8 7 6 5 4 3 2 1

Circle the number of times in the past ten years that you have resigned after being told that your employer intended to fire you or take any form of disciplinary action against you:

10 9 8 7 6 5 4 3 2 1

14

FINANCIAL

Your savings account #

Bank

Your checking account #

Bank

Do you have any investments (stock, bonds, etc)? ( ) Yes ( ) No

Do you hold active/silent interest in any company? ( ) Yes ( ) No

List any source of income other than your salary you currently have

What is the approximate total of your monthly income (including your spouse’s income)?

Do you have a vehicle ( ) Yes ( ) No

Make

Model

Year

Paid for? ( ) Yes ( ) No Tag

State

Do you own or are you buying your own home? ( ) Yes ( ) No

Amount invested?

Bank or company

How much rent/mortgage do you pay monthly?

Circle the weekly/monthly time payments you have: if none, so state.

Alimony Delinquents Taxes Insurance Premiums

Appliances Dentist Bills Jewelry Stores

Auto Repairs Department Stores Owe Money (family, friends)

Bank Loans Doctor Bills Television

Child Support Finance Co. Loans Student Loans

Clothing Bills Furniture Furniture Rental

Club Dues Home Improvements Others

Court Judgments Hospital Bills

Do you owe money to any employers, employees or Credit Unions?

If yes, please explain:

What is your total indebtedness at the present time? $

What are your total assets? $

Do you have any bills that are overdue? ( ) Yes ( ) No

If yes, explain,

Are any of your creditors pressing you for payment? ( ) Yes ( ) No

List information concerning all your current liabilities include mortgage loans, auto loans, personal loans, credit cards, etc.

15

Firm name

Present Balance

Address Account #

Firm name

Present Balance

Address Account #

Firm name

Present Balance

Address Account #

Firm name

Present Balance

Address Account #

Firm name

Present Balance

Address Account #

Firm name

Present Balance

Address Account #

Firm name

Present Balance

Address Account #

Have you ever had anything repossessed? ( ) Yes ( ) No


Have you ever declared bankruptcy? ( ) Yes ( ) No

Have you ever had wage garnishments? ( ) Yes ( ) No

Have you ever fraudulently misused a credit card or forged a check? ( ) Yes ( ) No

If so, please explain:

Have you ever been involved in any kind of lawsuit (criminal, civil or divorce)?


16

MILITARY

Have you ever attempted to join any branch of the armed forces? ( ) Yes ( ) No


Have you ever served active duty in any branch of the armed forces? ( ) Yes ( ) No

If yes, what branch :

What is your service number?

List date and location of entrance of active duly:

List your type of discharge (Honorable, dishonorable, general, entry level separation, etc.) and be exact:

What was your highest rank held?

List periods of active military service:

From:

To: Rank:

From:

To: Rank:

From:

To: Rank:

From:

To: Rank:

List all medals and decorations awarded to you as a member of the armed forces:

Have you ever been an active or inactive member of any branch of the United States Reserve Forces? ( ) Yes ( ) No

If yes, what branch?

From To

Where you active or inactive?

Rank Held

If active, list location:

Have you ever been a member of the National Guard? ( ) Yes ( ) No

If yes, what state?

From:

To:

Location:

Rank held: Type Discharge:

Have you ever been court-martialed, tried on charges, or the subject of an Article 15, Company punishment of any other disciplinary action while a member of any of the armed forces (including active duty, reserves or National Guard)? ( ) Yes ( ) No

If yes, explain below:

Are you registered for the Draft? ( ) Yes ( ) No

17

ALCOHOL ABUSE

This section deals with alcohol use and abuse. Answer each question truthfully. If you once had a drinking problem, but the problem no longer exists, you should not be unduly concern.

Do you drink alcoholic beverages? ( ) Yes ( ) No

If yes, to what extent?

When were you last intoxicated? (month/year)

Circle the approximate number of times during the last five years you have used alcohol during working hours (this includes during lunch or coffee breaks, as well as while actually working.

500 400 300 200 100 75 50 25 15 10 5 0

Have you ever held a job where the use of alcohol on the job was a common practice by most employees? ? ( ) Yes ( ) No

If yes, explain:

Have you ever been fired, lost a job, been penalized or counseled or counseled by an employer due to drinking? ? ( ) Yes ( ) No

If yes, explain:

What alcoholic beverage do you usually drink?

Do you sometimes become intoxicated while alone? ( ) Yes ( ) No

Has anyone ever told you that you drink too much? ( ) Yes ( ) No

Have you ever had any trouble with your spouse or family due to drinking? ( ) Yes ( ) No

If yes, explain:

Have you ever been arrested due to drinking? ? ( ) Yes ( ) No

If yes, explain where, charge and date:

Have you ever been treated for alcohol dependency? ( ) Yes ( ) No

18

DRUG USE

This section deals with the use of illegal drugs and the abuse of legal drugs. Answer every line on this page truthfully. In the space provided below, indicate when you first tried the drugs listed, when you last used them and the approximate number of times you used them. Be truthful.

DRUG AGE FIRST USED AGE LAST USED TIMES USED

Marijuana

Hashish

Angel Dust

Cocaine

Crack Cocaine

Crank

Crystal

Heroin

LSD

Magic Mushroom (PCP)

Mescaline (Cactus)

Opium

Psilocybin

Quaalude

Speed (Specify)

STP

THC

Steroids

Prescription Drugs Not prescribed to you (Specify)

Any Other Illegal Drugs

Have you ever been treated for an overdose of drugs? ( ) Yes ( ) No

If yes, explain:

Circle the approximate number of times during the last 10 years you have used marijuana or any other illegal drugs during working hours (this includes lunch and coffee breaks, as well as while actually working): Marijuana 500 400 300 200 100 50 25 10 0 Other Illegal Drugs 500 400 300 200 100 50 25 10 0 Figure out how many dollars worth of marijuana or other illegal drugs you have sold, even to friends or relatives at no profit to yourself, and circle the amount below which comes closest to the total amount you have sold: $10,000 $5,000 $1,000 $500 $250 $100 $50 $25 $0 Is your name listed on any law enforcement agency’s suspect file as a drug user or dealer? ( ) Yes ( ) No If yes, explain:

19

GRATUITIES

This section deals with gratuities (tips, gifts, reward, bonuses, etc.). Some companies have strict rules about accepting gratuities and other companies have little or no guidelines. In some jobs, regular gratuities are a way of life. In such companies, refusing a gratuity may alienate a valuable business contact. Answer the questions below:

Circle the approximate value of all gratuities you have received during the last five years:

$25,000 $20,000 $15,000 $10,000 $5,000 $2,500 $1,000 $750 $500 $250 $100 $50 $25 $0

Have you ever knowingly violated an employer’s rule regarding gratuities? ( ) Yes ( ) No

If yes, explain:

Have you ever been offered money or other gifts to do a special favor for someone, which was considered improper? ( ) Yes ( ) No

If yes, explain:

SOCIAL NETWORKS

Are you currently a member of any social networks? ( ) Yes ( ) No

If yes, list the social network and account information:

20

CRIMINAL ACTIVITY

It is important that you answer each of the following questions truthfully, if you would like to write any explanations. There is space to do so. The polygraphist will take time to listen to anything else you have to say in this area.

Indicate Yes or No if you have ever committed any of the following: (Whether you were arrested or not).

Yes No Burglary of: Yes No

School Unlawful Sexual Act

Residence Incest

Cabin Other

Warehouse Felony Theft

Business Petty Theft

Car (Vehicle) Shoplifting

Boat Mail Theft

Trailer Purse Snatch

Storage Shed Auto Theft

Other: Joy Riding

Armed Robbery Car Stripping

Strong Arm Vandalism

Assault with Weapon Buying Stolen Property

Murder Selling Stolen Property

Manslaughter Forged Identification

Attempted Suicide Forgery

Kidnapping Credit Card Fraud

Rape Bad Checks

Indecent Exposure Insufficient Fund Checks

Terrorist Threats Arson

Child Molestation Bombing

Extortion

Have you ever been convicted of an offense not listed? ( ) Yes ( ) No

If yes, explain:

Have you ever been reported as a missing person or as a runaway? ( ) Yes ( ) No

If yes, give details, including jurisdiction, dates and outcome:

Have you ever been fingerprinted? ( ) Yes ( ) No

If yes, give details below: Fingerprinted by

Agency

Date Purpose

Agency

Date Purpose

Agency

Date Purpose

21

ARREST AND UNDETECTED CRIMES

Are you a fugitive from justice? ( ) Yes ( ) No

Are you now or have you ever been a member of any foreign or domestic organization, association, movement, group or combination of persons which is Totalitarian, Fascist, Communist, or Subversive, or which has adopted or shows a policy of advocating or approving the commission of acts of force or violence to deny other persons their rights under the Constitution of the United States by unconstitutional means? ( ) Yes ( ) No

If yes, explain:

Have you ever been arrested or detained by the police? (Include juvenile) ( ) Yes ( ) No

If yes, give details below:

Crime Charged:

Police Agency:

Date: Disposition:

Crime Charged:

Police Agency:

Date: Disposition:

Crime Charged:

Police Agency:

Date: Disposition:

If more space is needed, use the reverse side of this page.

Did you ever commit a serious undetected crime? ( ) Yes ( ) No

If yes, explain:

Did you ever perjure yourself in a court of law? ( ) Yes ( ) No

If yes, explain:

Are you involved in any lawsuits? ( ) Yes ( ) No

If yes, explain:

Have you ever bounced a check, which turned into a warrant for your arrest? (Regardless if you were arrested or not) ( ) Yes ( ) No

If yes, explain:

22

DRIVING RECORD

Your current driver’s license # State:

Expiration Date: Any Restrictions:

Have you ever possessed a driver’s license issued by any other State? ( ) Yes ( ) No

If yes, list States and license numbers (if known):

Have you ever been refused a driver’s license by any State? ( ) Yes ( ) No

If yes, give details:

Have you ever obtained a driver’s license under an assumed name? ( ) Yes ( ) No


Have you ever had your driver’s license suspended or revoked? ( ) Yes ( ) No

If yes, give details (include what State, dates and reason and whether it was a suspension or revocation):

List below all traffic citations (except for parking) that you have received in your entire lifetime:

Location (City)

Approximate Date Nature of Violation Penalty Disposition

Do you have any pending traffic citations? ( ) Yes ( ) No


23

DRIVING RECORD (cont inued)

Do you currently have liability insurance? ( ) Yes ( ) No

Have you ever been denied auto insurance? ( ) Yes ( ) No

If yes, explain:

Has your insurance ever been cancelled? ( ) Yes ( ) No

If yes, explain:

List details below for every motor vehicle accident that you have been involved in during your lifetime:

Date: Was a Police Report made? ( ) Yes ( ) No

Incident location

Cause of Accident:

Circle: Injury Non-injury Who was citation issued to?


Incident location

Cause of Accident:



Incident location

Cause of Accident:


Use reverse of this page if needed.

List any accidents you have had that have not been reported?

Have you ever had any hit and run accident? ( ) Yes ( ) No

If yes, explain:

Have you ever left the scene of a traffic related accident? ( ) Yes ( ) No

If yes, explain:

Have you ever had any traffic related lawsuits? ( ) Yes ( ) No


Have you ever been charged with driving under the influence?


CONSENT FORM

Requested by:

Date: Received by: Date:

Date to GCIC Officer: Date Returned: Returned to:

Criminal History to SID Number FBI Number (If none stamp no record) Driver’s History:

Purpose of Request: Information Requested:

Private/Public employment Drivers History

Criminal Justice Employment Criminal History

Alcoholic Beverage License Employment History

I hereby authorize Cherokee County Marshal (Agency) to receive any Criminal/Driver’s History

Record Information pertaining to me that may be in the files of any Local, State, or Federal

jurisdiction. I understand the information will be used to assist the Agency in determining my

eligibility and fitness for the position I am seeking with the Agency. I herby release you; your

organization, and/or others from liability which may result from furnishing the information. I

understand a PHOTOCOPY of this release form is valid as an original thereof, even though the

photocopy does not contain an original writing of my signature.

Please print or type the following information: Last Name First Name Middle Name Maiden Name or A.K.A.

Number and Street Address Apt # City

State Zip Code

Telephone Number: Home Telephone Number: Work

Social Security Number

Date of Birth Place of Birth

Drivers License Number State Expires Have you ever been licensed to drive in any

other state? __________. If yes, what state?

___________________________________

Race Sex Height

Ft _____ in _____

Weight Eyes Hair

_________________________________ ___________________ Signature Date

Notary: ____________________________________ ________________________

(Official Seal and Stamp) Date

Form 04-004

6

POLYGRAPH EXAMINATION

Prior to being employed with the Cherokee County Marshal’s Office, you will be required to pass an extensive

background investigation. Part of this investigation will include a polygraph examination, a criminal

background check, driver’s history check, employment history check, a references check, verification of

diplomas and/or certificates, a psychological examination, a medical examination, and interviews of known

associates and neighbors.

Following an interview with the background investigators, you may be asked to take a polygraph examination.

Polygraph questions may come from any of the following areas of the application:

1. Criminal History

2. Drug Use

3. Driver’s History

4. Work History

5. Alcohol Use

6. Gambling

7. Honesty in filling out the application for employment

8. Honesty in completing the background investigation’s booklet

The preceding information was provided in compliance with in accordance with CALEA standard 32.2.4.

Documents

Cherokee Marshal's Office · 1 Cherokee County Marshal’s Office 2782 Marietta Hwy, Suite 100 Canton, GA 678-493-6200 APPLICATION FOR EMPLOYMENT Full Name: SS# Address: