SHERIFF’S OFFICE Application

NEWTON COUNTY SHERIFF"S OFFICE

APPLICATION FOR EMPLOYMENT
Ezell Brown, Sheriff

COMMITTED TO EXCELLENCE
INSTRUCTION SHEET
To be considered for employment, applicants must meet the following minimum qualifications: Applicants must be at least 21 years of age for Deputy Sheriff positions, 18 years of age for Detention Officer and civilian positions, possess a high school diploma or equivalent, possess a valid driver’s license, honorable discharge (if prior military), be a US citizen, have no adverse driving record nor felony or family violence convictions, and be of good moral character.Return the completed application and required supporting documents to the following address: Newton County Sheriff's Office 15151 Alcovy Road Covington, GA 30014**NOTE: Some pages require Notary.Applicant(s) must complete ALL pages accurately, legibly and completely. DO NOT LEAVE ANY BLANK SPACES. If a question does not apply to you write “N/A” in the space. PRINT ANSWERS to questions with a BLACK INK PEN ONLY. Applicant(s) should be absolutely truthful, a false statement or the omission of requested information is grounds for automatic rejection including termination of the application/recruitment process and/or termination of employment. If you answer “yes” to a question, you must provide the complete details explaining the circumstances. Do not omit an explanation because you think the incident was minor and of no importance. If the space provided is insufficient to complete your answers, please attach additional pages.Upon submission, your application and supporting documents will be reviewed for completeness. If your application is incomplete, it will be returned to you. Applications that are complete and meet the minimum requirements will be forwarded to the Newton County Sheriff’s Office, Office of Professional Standards for processing. The hiring process includes but is not limited to the following: an oral board interview, an intensive background investigation, voice stress analysis, and, following a conditional job offer, medical examination, drug screen and psychological examination.If you have any questions concerning this process please contact the Newton County Sheriff’s Office at (678) 625-1403.The Equal Opportunity Employer and does not discriminate on the basis of race, color, National origin, sex, religion, or disability in employment or provision of services.
The following documents are required to begin the application/recruitment process and must be submitted with the application:The Equal Opportunity Employer and does not discriminate on the basis of race, color, National origin, sex, religion, or disability in employment or provision of services.•Copy of high school diploma or equivalent •Copy of birth certificate •Photo copy of current driver’s license •Current 7-yr driver's history report •Copy of test scores (e.g. SAT, ACT, ASSET, COMPASS or ACCUPLACER) The following documents are required if they are applicable to you and must be mailed in with the application: •Copy of DD214 (long form), showing an Honorable Discharge and a letter of good standing. • Certified copy of College Transcripts (sealed) •Copy of official name change documents •Copy of citizenship papers • Copy of Bankruptcy discharge papers
APPLICATION FOR EMPLOYMENT
Position Applied For

Deputy SheriffDetention OfficerAdministrativeReserve Deputy
PERSONAL INFORMATION
Name (Last, First, Middle)
Date of Birth

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
SSN
Home Address (Street Number/Name, City, State, Zip Code)
How long have you lived at your current address?
Contact Telephone Number
Email Address
example@example.com
Are you a citizen of the United States?

YesNo
If no, are you a permanent resident?

YesNo
Place of Birth (City, County, State/Country)
Have you ever used another name or had your name changed?

YesNo
If Yes, Put Name here

This includes Maiden Names, Former Married Names, Adopted Names, Nicknames, etc If you answered yes, please provide the following information:

	Previous Name	Date of Change	Location of Change	Reason for Change

List your residence in the past 10 years. If not able to fill out the remaining sections put N/A.
EDUCATION
Name of High School
Dates Attended

MonthDayYear
Date
Address (Street Number/Name, City, State, Zip Code)
High School Diploma / GED?
YesNo
Date Graduated

MonthDayYear
Date
Address (Street Number/Name, City, State, Zip Code)
Name of School/Local Board of Education
Address (Street Number/Name, City, State, Zip Code)

List all colleges, universities, business/technical schools or graduate schools you have attended:

	School Name	Address	Start Date	End Date	Major/Minor	Degree Earned

LAW ENFORCEMENT EXPERIENCE
Are you currently a Georgia P.O.S.T. Certified Peace Officer

YesNo
Georgia P.O.S.T. PBLE number
Have you been awarded any Georgia P.O.S.T. certification or certification from another state?

YesNo

If yes, please provide:

	State of Issuance	Type of Certification	Certification Number

How many years and months experience do you have as a certified law enforcement officer?
Is your Law Enforcement, Correction, Jailer, Probation, or Parole Officer Certification under investigation by any state or federal Law Enforcement Training Council?

YesNO
If yes, please attach a narrative on a separate sheet of paper explaining in detail the cause for the investigation.
Has your Law Enforcement, Correction, Jailer, Probation, or Parole Officer certification ever been revoke or placed on probation by any state or federal Law Enforcement Training Council?

YesNo
If yes, please attach a narrative on a separate sheet of paper explaining in detail the cause for the revocation or probation.
Criminal History Consent Form

I hereby authorize, Newton County Law Enforcement Center to receive any and all criminal history record information pertaining to me which may be in the files of any local or national criminal justice agency. This name based criminal history will be completed using the Georgia Criminal Information Center (GCIC) system and the NCIC System.Please print the following:
Name

First NameLast Name
Maiden Name
SSN
xxx-xx-xxxx
Dates of Birth

MonthDayYear
Date
Race
Sex
Address (Street Number/Name, City, State, Zip Code)
Phone Number
Check if this Applies to you

Criminal History for mandated position (PC “Z”)Criminal History for civilian position (PC “J)
Signature

Clear
Date Requested

MonthDayYear
Date
Signature of operator completing history request:

Clear
Date

MonthDayYear
Date
**************************** This authorization is valid for 90 DAYS from date requestor signs************************* *********************************Release will not be processed if submitted incomplete*****************************
NEWTON COUNTY SHERIFF’S OFFICE CONSENT WAIVER
, do hereby authorize a review of and full disclosure of all records concerning
Your Name
myself to any duly authorized agent of the Newton County Sheriff’s Office, or to any authorized agent of a criminal justice agency or any private agency upon request of the Newton County Sheriff’s Office, whether the 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 the records of military service records, “authority to release law enforcement or criminal records or information from a law enforcement agency;” educational institutions; financial or credit institutions, including records of loans, the records of commercial or retail credit agencies (including credit reports and/or rating) and financial statements and records wherever filed; medical and psychiatric treatment and/or consultation including hospitals, clinics, private practitioners, and the U.S. Veterans Administration; employment and pre-employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me and the records and recollections of attorneys at law, or of the other counsel whether representing me or another person in any case, either 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 by the Newton County Sheriff’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 hereby release said person(s) from any and all liability, which may be incurred as a result of furnishing such information.

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.
Applicant Signature

Clear
Date

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
Social Security
Notary
Date

MonthDayYear
Date
THIS FORM MUST BE COMPLETED AND NOTRIZED
APPLICANT RELEASE AND HOLD HARMLESS AGREEMENT
I,
Your Name
, hereby acknowledge that I am a Peace Officer applicant, or a candidate for appointment or

certification to a position as a Peace Officer in the State of Georgia, or for attendance at a basic training course required for such appointment and certification.

1. I hereby request that my former employers release to any law enforcement agency requesting employment related information as defined in O.C.G.A. § 35-8-8(c1) the following:

All written information contained in a prior employer’s records or personnel files that relates to an applicant’s, candidate’s, or peace officer’s performance or behavior while employed by such prior employer, including performance evaluations, records of disciplinary actions, and eligibility for rehire. Such term shall not include information prohibited from disclosure by federal law or any document not in the possession of the employer at the time a request for such information is received.

2. In consideration of your providing such information to my prospective Law Enforcement employer, I hereby forever release and agree to hold harmless and to defend from all liability for any claims, causes of action or suits or charges by every former employer who provides such complete and accurate information about my employment to the requesting law enforcement agency in accord with O.C.G.A. § 35-8-8(c2

3. I understand that O.C.G.A. § 35-8-8(c5) provides as follows:

Before taking final action on an application for employment based, in whole or in part, on any unfavorable employment related information received from a previous employer, a law enforcement agency shall inform the applicant, candidate, or peace officer that it has received such employment related information, and that the applicant, candidate, or peace officer may inspect and respond in writing to such information. Upon the applicant’s, candidate’s, or peace officer’s request, the law enforcement agency shall allow him or her to inspect the employment related information and to submit a written response to such information. The request for inspection shall be made within five business days from the date that the applicant, candidate, or peace officer is notified of the law enforcement agency’s receipt of such employment related information. The inspection shall occur not later than ten business days after said notification. Any response to the employment related information shall be made by the applicant, candidate, or peace officer not later than three business days after his or her inspection.
Applicant Signature

Clear
Print Name
Date

MonthDayYear
Date
Notary
Notary Signature

Clear
My commission expires
THIS FORM MUST BE COMPLETED AND NOTRIZED
NEWTON COUNTY HUMAN RESOURCES

1124 Clark Street Covington, Georgia 30014 Tel: (678) 625-1212
AUTHORIZATION TO RELEASE INFORMATION
I have applied to Newton County, Georgia, for employment. Part of the employment process is an investigation and verification of information I provide or will provide on my application for employment and in occasional reports during my employment with Newton County, Georgia.

I do hereby authorize a review of and full disclosure of all records concerning me to Newton County. The intent of this authorization is to give my consent for full and complete disclosure of the records of educational institutions; employment records; financial statements and records wherever files; medical and psychiatric treatment and/or consultation including hospitals, clinics and private practitioners, and employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me whether representing me or another person in any case either criminal or civil, in which I presently have or have not had an interest; criminal history record information which may be in the files of the State of Georgia or local criminal justice agency and/or any other information contained in your files relevant to my employment with Newton County, Georgia.

I hereby fully and finally release and discharge Newton County, Georgia, and its officials, employees and agents from any and all liability for acts and ommissions taken pursuant to this authorization. I similarly release all persons, corporations, and other entities who release any information or documents pursuant to this authorization. I represent and warrant that I will not, directly or indirectly, seek disclosure of information obtained pursuant to this authorization either to me or to anyone else. I also understand that this executed document may be used in any process of promotion, transfer or demotion to a position for which I have applied.

I have carefully read and fully understand the contents of this authorization and I execute it voluntarily as my own free act and deed.
Full Name (printed or typed)
Date

MonthDayYear
Date
Street Address (City, State, Zip)
Social Security Number
Signature

Clear
Notary Public (must be notarized)
Date of Birth

MonthDayYear
Date
Race
Sex
Purpose Code
NEWTON COUNTY HUMAN RESOURCES

1124 Clark Street Covington, Georgia 30014 Tel: (678) 625-1212
NOTICE TO JOB APPLICANTS NEWTON COUNTY’S DRUG SCREENING POLICY
Newton County has a strong commitment to its employees to provide a safe work environment and to promote high standards of employee health. The county also has a strong commitment to provide high quality public service. Consistent with the spirit and intent of these commitments, the Board of County Commissioners has determined that there is a compelling need for a county policy on drug use, which includes chemical testing for recent use of controlled substances.

Upon an offer of employment by the county and prior to final appointment, job applicants will be asked to consent to a controlled substance screening test. If the initial screening test indicates that the applicant has recently used controlled substances, the applicant will be notified of the test results.

Before a test is administered, applicants will be asked to sign a consent form authorizing the test and permitting release of test results to those county officials with a need to know.

If an applicant refuses to consent to a test, or if testing indicates use of controlled substances, the offer of employment will be retracted, and the applicant will be denied employment with the county. Applicants will be informed if they are rejected on the basis of test results.

All information from an applicant’s drug evaluation is confidential and only those with a need to know are to be informed of test results. Disclosure of such information to any other person, agency, or organization is prohibited unless written authorization is obtained from the applicant.
IX. APPLICANT QUESTIONNAIRE

If you answer YES to questions 4-29, you must explain in full detail on the explanation sheet(s) provided with this questionnaire. Be sure to indicate the question number that you are addressing.
1. Are you available to work any hour of the day, day of the week, including holidays and be available during unusual occurrences for call-outs?

YesNo
2. Will you consent to a thorough background investigation of your character?

YesNo
3. Will you consent to a medical examination by a physician and a psychological evaluation upon a conditional offer of employment?

YesNo
4. Have you ever been rejected for employment, for any reason, by any law enforcement agency?

YesNo
If yes, what agency and why?
5. Have you ever been terminated by any law enforcement agency?

YesNo
If yes, give the agency, date of termination, and reason.
6. Have you ever been terminated or asked to resign from any job?

YesNo
If yes, list the name of the employer(s), dates of employment, and reason for termination or resignation under pressure.
7. Have you ever been physically arrested or given a copy of charges for violation of any city, municipal, state, or federal law?

YesNo
8. Have you ever appeared in any court (including juvenile) as a defendant to answer any city, municipal, state, or federal criminal charge?

YesNo
If so, give the court in which you appeared and the disposition of the case (i.e. conviction, First Offenders, charges dismissed, etc).
9. Have you ever been detained by any law enforcement representative, been the subject of any criminal investigation, or been named as the accused on a warrant? If yes, explain in detail.

YesNo
If yes, explain in detail.
10. Have you ever received any tickets for traffic violations (excluding parking tickets) on any license that you have held since you began driving?

YesNo
If yes, list type of violation, date received, jurisdiction, and disposition (i.e. fine, suspension, charges dismissed).
11. Have you ever used, tried, ingested, or experimented with marijuana (including as a juvenile or even one experimental use)?

YesNo
If yes, write the number of times used, the first date used, and the date of last use.
12. Have you ever used, tried, ingested, or experimented with any other type of illegal narcotics or dangerous drugs (i.e. heroin, cocaine, hashish, speed, LSD, anabolic steroids, etc.)?

YesNo
If yes, indicate what type of drug and when you used it?
13. Have you ever sold any type of illegal drug, delivered illegal drugs, shared drugs with another person, or directed another person where to buy drugs?

YesNo
If yes, indicate what type of drug and when.
14. Have you ever used, tried, ingested, or experimented with any drug legally prescribed to another person? If yes, indicate what type of drug and when.

YesNo
15. Have you ever filed or declared bankruptcy, had any judgments, repossessions, foreclosures, or collections?

YesNo
16. Do you know of anything that might prevent you from obtaining this position?

YesNo
17. Have you ever been sued?

YesNo
18. Have you ever had your wages garnished?

YesNo
19. Are there any unpaid judgments against you?

YesNo
20. Are you delinquent in property taxes or other taxes?

YesNo
21. Have you ever had a charge, complaint, or lawsuit filed against you alleging the use of excessive force?

YesNo
22. Have you ever had a charge, complaint, or lawsuit filed against you alleging false arrest?

YesNo
24. Do you have any visible tattoos and/or brands? Visible is defined as the area that is exposed to public view in short sleeves or the areas that are exposed in shorts. If yes, provide location and meaning of each one on the explanation sheet.

YesNo
25. Are you now or have you ever been, engaged in any business as an owner, partner, or corporate member?

YesNo
26. Have you received written reprimands from supervisors or employers for not doing your job correctly or conduct violations?

YesNo
27. Have you been counseled or received warning for being late or absent from work?

YesNo
28. Have you ever been suspended from a job for a period of time with or without pay?

YesNo
29. Have you purposely omitted any information from your employment application?

YesNo
X. EXPLANATION TO APPLICANT QUESTIONNAIRE

Please make sure that all explanations are detailed, accurate, and true. Be sure to list the number to the question that you are explaining. Attach additional sheets if necessary.
Type Explanation
XI. APPLICANT SWORN STATEMENT

I certify that I have read and understand all questions and instructions in this application, and that my answers are true and complete. I understand that this application is not an offer of employment or a contract for employment.I understand that any untrue statement in this application may result in my dismissal at any time during my employment with the Newton County Sheriff’s Office. I understand that any intentional false statement will result in my disqualification from the hiring process and may result in criminal prosecution under O.C.G.A. 16-10-20 and 16-10-71.
Name

First NameLast Name
Date

MonthDayYear
Date
Signature

Clear
Date

MonthDayYear
Date
Notary Public

First NameLast Name
Date

MonthDayYear
Date
XII. EMPLOYEE REIMBURSEMENT AGREEMENT

The Official Code of Georgia Annotated Title 35 Chapter 8 Section 22 (O.C.G.A. 35-8-22) states the following:35-8-22. Reimbursement for Peace Officer’s Mandated or Formalized Training
Employee Reimbursement Agreement

(a) Unless otherwise provided by an employment contract to the contrary, if the State of Georgia or any county or municipality thereof employs a peace officer and said peace officer is hired by another agency within 15 months after completing mandated or formalized training requirements, then the total expense of training, including salary paid during training, shall be reimbursed by the hiring agency to the State of Georgia or any county or municipality thereof which initially paid for such training. If said officer is hired by another agency during a period of 15 to 24 months after mandated or formalized training requirements are completed, then one-half of the total expense of training, including salary paid during training, shall be reimbursed by the hiring agency to the State of Georgia or any county or municipality thereof which initially paid for such training. The council shall set standards for reimbursement by hiring agencies based upon actual expenses incurred in mandated or formalized training by individual departments.(b) The State of Georgia or any county or municipality thereof which initially paid for the training of a peace officer shall submit an itemized, sworn statement to the new employer of the peace officer and shall demand payment thereof and may enforce collection of such obligation through civil remedies and procedures.(c) Effective July1, 2003, in order for the State of Georgia or any county or municipality thereof to demand reimbursement, the demanding governmental unit must be able to document that the peace officer in question signed an acknowledgment of the terms of this Code section or an employment contract specifying the provisions of this Code section prior to such peace officers employment with the demanding governmental unit. Otherwise, this Code section shall not apply to such demand for reimbursement.
First Name Last Name (Applicant), have read in full and do agree to abide by the provisions of O.C.G.A 35-8-22 Reimbursement for Peace Officer’s Mandated or Formalized Training.
Signature

Clear
Date

MonthDayYear
Date
Notary Public

First NameLast Name
Date

MonthDayYear
Date
XVI. ACKNOWLEDGEMENT OF AT-WILL EMPLOYMENT

I hereby acknowledge that if hired, my employment relationship with Newton County is strictly on an "at-will employment" basis. I understand that I may end the employment relationship at any time and for any reason not prohibited by law, and my employer may do the same. I understand that my at-will employment status may not be changed except by express written contract approved by the Board of Commissioners.
Employee/ Applicant Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

NEWTON COUNTY SHERIFF"S OFFICE

Ezell Brown, Sheriff

INSTRUCTION SHEET

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EDUCATION

LAW ENFORCEMENT EXPERIENCE

Criminal History Consent Form

**************************** This authorization is valid for 90 DAYS from date requestor signs************************* *********************************Release will not be processed if submitted incomplete*****************************

NEWTON COUNTY SHERIFF’S OFFICE CONSENT WAIVER

THIS FORM MUST BE COMPLETED AND NOTRIZED

APPLICANT RELEASE AND HOLD HARMLESS AGREEMENT

THIS FORM MUST BE COMPLETED AND NOTRIZED

NEWTON COUNTY HUMAN RESOURCES

AUTHORIZATION TO RELEASE INFORMATION

NEWTON COUNTY HUMAN RESOURCES

NOTICE TO JOB APPLICANTS NEWTON COUNTY’S DRUG SCREENING POLICY

IX. APPLICANT QUESTIONNAIRE

X. EXPLANATION TO APPLICANT QUESTIONNAIRE

XI. APPLICANT SWORN STATEMENT

XII. EMPLOYEE REIMBURSEMENT AGREEMENT

Employee Reimbursement Agreement

XVI. ACKNOWLEDGEMENT OF AT-WILL EMPLOYMENT

**************** This authorization is valid for 90 DAYS from date requestor signs* *Release will not be processed if submitted incomplete*********