The personal declaration was designed for our police academy and law enforcement clients. The personal declaration is processed as part of your completed background investigation at no cost as a value added service.
PERSONAL DECLARATION
(Please type or print in black ink)
1.
Have you used marijuana during
the last 3 years?
Yes
No
If yes, please list the dates of use (be sure to include first use and last use) and circumstances of use:
______________________________________________________________________________
Have you used marijuana more
than 15 times?
Yes
No
If yes, please list the dates of use (be sure to include first use and last use) and circumstances of use:
______________________________________________________________________________
Have you used an illegal drug or combination
of illegal drugs, other than marijuana,
more than 5 times?
Yes
No
If yes, please list the illegal drug(s) you have used, dates of use and circumstances of use
______________________________________________________________________________
Have you used an illegal
drug or combination of illegal drugs, other
than marijuana, during the last 10 years?
Yes
No
If yes, please list the illegal drug(s) you have used, dates of use and circumstances of use
______________________________________________________________________________
Have you used an illegal
drug while employed in a law enforcement
or prosecutorial position?
Yes
No
If yes, please list the illegal drug(s) you have used, dates of use and circumstances of use
______________________________________________________________________________
Have you ever sold illegal
drugs?
Yes
No
If yes, please list the illegal drug(s) you have sold, along with the period of time in which you sold them.
______________________________________________________________________________
Are you now
or have you been a member of a foreign or
domestic organization, association, movement,
group, or combination of persons that is
totalitarian, fascist, communist, or subversive
or that has adopted or shows a policy of
advocating or approving acts of force or
violence to deprive other persons of their
rights under the Constitution of the United
States or that seeks to alter the form of
Government of the United States or any state
in the United States?
Yes
No
If yes, provide details.
______________________________________________________________________________
Have you ever been a member
of a foreign intelligence organization,
or have you supported or had any connection
with its activities?
Yes
No
If yes, provide details.
______________________________________________________________________________
Have you ever submitted an application to a police academy in Georgia, or any other State, other than the one you are currently applying to?
Yes
No
If yes, provide name, address, telephone number, and date of application submission
______________________________________________________________________________
Have you ever served in the military?
Yes
No
If yes, which branch and component (if multiple, please list all):
______________________________________________________________________________
If you answered yes to question 10, please provide all dates of enlistment:
______________________________________________________________________________
If you answered yes to question 10, please provide Character of Service/Discharge listed on DD 214 (please submit a copy of your DD 214 via e-mail to Email or via fax to 706-235-6452):
Honorable
General under Honorable Conditions
Uncharacterized
Dishonorable
Other type of discharge (give type): ______________________________________________________
13.
If the answer to question 12 is anything other than an Honorable discharge please provide an explanation (please submit documentation regarding the discharge via e-mail to Email or via fax to 706-235-6452)
______________________________________________________________________________
Have you ever been arrested for a crime of violence?
Yes
No
If yes, please provide your relationship with the victim and the circumstances of the crime:
______________________________________________________________________________
Have you ever been involved in a crime against a police officer?
Yes
No
If yes, please provide specific details:
______________________________________________________________________________
