Online Application

Describe your complete work history BEGINNING WITH YOUR CURRENT OR MOST RECENT JOB. Include military, volunteer experience, and periods of unemployment. Failure to give complete information regarding each job held will result in your disqualification. Complete addresses with zip code and phone numbers for all employers are necessary. A resume may be attached only as additional information and will not be accepted in lieu of completing this application.

I hereby authorize the Stephens County Sheriff’s Office to receive a copy of my Georgia Driver’s History information as part of my Application for Criminal Justice Employment or for use relative to the performance of my official duties with this Agency. Also, I hereby authorize the Stephens County Sheriff’s Office to receive any Georgia Criminal History record information pertaining to me which may be in the files of any State or Local Criminal Justice Agency in Georgia.

I hereby authorize a review of and full disclosure of all records concerning me to any duly authorized agent of the Stephens County Sheriff’s Office, whether said records are of a public, private, or confidential nature. The intent of this authorization is to give my consent for full and complete disclosure of all records including, but not limited to, records of educational institutions, driving history records, GCIC and/or NCIC criminal history records, financial or credit institutions including records of loans, records of commercial or retail credit agencies including credit reports or ratings, and other financial statements and records wherever filed, employment and pre-employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me, and the record and recollections of attorneys or other counsel whether representing me or another party in any case either criminal or civil in which I presently have had an interest. I understand that any information obtained in a personal history background investigation arising in whole or in part, directly or indirectly, from this waiver and authorization will be considered in determining my suitability for employment with the Stephens County Sheriff’s Office. I certify that any person furnishing information concerning me shall not be held accountable for such information, and I hereby release said person from any and all liability, be it civil or criminal in nature, which may be incurred as a result of furnishing such information. I understand that the 1974 Privacy Act affords me the right to expect certain types of information not to be disseminated by persons who have access to such information. For the purpose of a personal history background investigation to determine my suitability for employment with the Stephens County Sheriff’s Office, I hereby waive said rights. I understand that, by my signature below, I am authorizing the Stephens County Sheriff’s Office to release any and all information regarding or relating to my employment with the Stephens County Sheriff’s Office to future or prospective employers seeking information regarding my employment and/or performance while employed by the Stephens County Sheriff’s Office. A copy of this release form shall be valid as an original thereof even though said photocopy does not bear an original of my signature. Also, I hereby authorize your organization to release any and all information of a confident and privileged nature from your files to the Stephens County Sheriff’s Office. I understand that in order to process my application for employment with the Stephens County Sheriff’s Office that my CREDIT HISTORY will be obtained by a consumer reporting agency. I understand that the Stephens County Sheriff’s Office intends to obtain such a report and that I have a right to request that the consumer reporting agency disclose to me, its results. In authorizing this CREDIT CHECK, I hereby release any agencies from ALL LIABILITY for any damages whatsoever for issuing this information. A photographic copy of this authorization shall be viewed as valid as the original. I hereby request your cooperation with the Stephens County Sheriff’s Office or their acting agent in obtaining any information as stated above. It is understood that the information provided will be held in strict confidence by the Stephens County Sheriff’s Office. I understand that this information will be used to determine my qualifications for the position for which I have applied and/or for my continued employment. I further understand and also realize that the information so released be held in the strictest of confidence and may prove unfavorable to my being selected for the position or have an adverse effect on my present employment with the Stephens County Sheriff’s Office. This release will be in effect for the pre-employment consideration and shall continue to be in effect as long as I am employed by the Stephens County Sheriff’s Office.

As an applicant who is the subject of a Georgia only or a Georgia and Federal Bureau of Investigation (FBI) national fingerprint/biometric-based criminal history check for a non-criminal justice purpose (such as an application for criminal justice or non-criminal justice employment or a license, an immigration or naturalization matter, security clearance, or adoption), you have certain rights which are discussed below. All notices must be provided to you in writing. These obligations are pursuant to the Privacy Act of 1974, Title 5, United States Code (U.S.C.) Section 552a, and Title 28 Code of Federal Regulation (CFR), 50.12, among other authorities. • You must be provided written notification that your fingerprints/biometrics will be used to check the criminal history records maintained by the Georgia Crime Information Center (GCIC) and the FBI, when a federal record check is so authorized. • You must be provided an adequate written FBI Privacy Act Statement (dated 2013 or later) when you submit your fingerprints and associated personal information. This Privacy Act Statement must explain the authority for collecting your fingerprints and associated information and whether your fingerprints and associated information will be searched, shared, or explained. • You must be advised in writing of the procedures for obtaining a change, correction, or update of your criminal history record as set forth at 28 CFR 16.34. • You must be provided the opportunity to complete or challenge the accuracy of the information in your criminal history record (if you have such a record). • If you have a criminal history record, you should be afforded a reasonable amount of time to correct or complete the record (or decline to do so) before the officials deny you the employment, license, or other benefit based on the information in the criminal history record. • If agency policy permits, the officials may provide you with a copy of your criminal history record for review and possible challenge. If agency policy does not permit it to provide you a copy of the record, you may find information regarding how to obtain a copy of your Georgia criminal history record at the GBI website: https://gbi.georgia.gov/services/obtaining-criminal-history-recordinformation-frequently-asked-questions Information regarding how to obtain a copy of your FBI criminal history record is located at the FBI website: https://www.edo.cjis.gov • If you decide to challenge the accuracy or completeness of your criminal history record, you should contact and send your challenge to the agency that contributed the questioned information. If the disputed arrest occurred in the State of Georgia, you may send your challenge directly to the GCIC. Contact information for the GCIC can be found at https://gbi.georgia.gov/services/obtainingcriminal-history-record-information-frequently-asked-questions Alternatively, you may send your challenge directly to the FBI by submitting a request via https://www.edo.cjis.gov. The FBI will then forward your challenge to the agency that contributed the questioned information and request the agency to verify or correct the challenge entry. Upon receipt of an official communication from that agency, the FBI will make any necessary changes/corrections to your record in accordance with the information supplied by that agency. (See 28 CFR 16.30 through 16.34.) • You have the right to expect that officials receiving the results of the criminal history record check will use it only for the authorized purposes and will not retain or disseminate it in violation of federal statute, regulation or executive order, or rule, procedure or standard established by the National Crime Prevention and Privacy Compact Council. Privacy Act Statement This privacy act statement is located on the back of the (blue) FD-258 fingerprint card. Authority: The FBI’s acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub. L. 92-544, Presidential Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application. Principle Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI’s Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI’s Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, and other suitability determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety. Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal history records of the FBI. You have the opportunity to complete or challenge the accuracy of the information contained in the FBI identification record. The procedure of obtaining a change, correction or updating an FBI identification record is set forth in Title 28, Code of Federal Regulations (CFR), 16.34. Procedures for obtaining a copy of the FBI criminal history record are set forth in 28 CFR 16.30 through 16.33 or review the FBI website.

List five people whom you know well and who live in the United States. They should be a good friend, peer, colleague or college roommate, whose combined association with you covers as much as possible of the last 10 years. DO NOT list your spouse, former spouse, or other relatives. DO NOT list anyone who is listed elsewhere in this application.

The information you provide in this questionnaire will be used as a part of your background investigation to assist the Stephens County Sheriff’s Office, and the community, in which it serves, in determining your suitability as a employee. Completion of this questionnaire is necessary if you wish to continue in the selection process. Stephens County has a right to expect, and in fact demand, truthfulness from the men and women who are to serve as sheriff’s office employees. Honesty is expected and required from the very onset of this processing. Your background investigator WILL NOT distinguish between lies, big or small. Any perceived or deliberate inaccuracies, incomplete statements, untruthfulness or omissions will not be tolerated and may be grounds for disqualification. Please print (legibly) all responses. If you need more space to answer a question, turn the sheet over, identify the question numeral and write your response on the back of the page. Leave no question blank or unanswered. Write “None” if this is an appropriate answer. If a question does not apply to you, print “N/A” (not applicable). No question is intended as a medical inquiry. The American with Disabilities Act prohibits employers from making medically related inquiries prior to a conditional offer of employment. Therefore, if you are completing this questionnaire before you have received a conditional offer of employment, DO NOT; divulge information concerning physical or medical conditions, either past of current. Remember, your responses may be confirmed by an in-depth polygraph examination and background investigation.

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 disqualification from further consideration.