ࡱ> FHE`  bjbj .2%8 4?"88"ZZZ555!!!!!!!$"h]%v!55!ZZ!!!!pZZ!!!!!!Z, eC`!!"0?"!% d%!%! 5|!_dO555!!F!X555?"! ORANGE BEACH POLICE DEPARTMENT ORDINANCE NUMBER 295 INVESTIGATION FORM COVER SHEET EXPLANATION: Applicants for a license under Ordinance #134 shall file with the Chief of Police this form outlining personal data, education, experience, civil and criminal background and other such data as may be required by him to enable him to conduct a proper background investigation of the applicant. If the applicant is an agency then all officer, directors and parties with any proprietary interest in such agency must provide the information requested. INSTRUCTIONS: Read every question carefully and answer every question. If a question does not pertain to you, indicate by marking N/A within the appropriate space. LEAVE NO BLANK SPACES. An applicant may be rejected who has made a false statement of a material fact, omitted information or practiced, or attempted to practice any deception or fraud on this form. All entries, except the signature, must be typed or printed in block letters in black or blue ink. If space for answering any question in this form is insufficient, continue on the back of the appropriate page. ORANGE BEACH POLICE DEPARTMENT ORDINANCE NUMBER 295 INVESTIGATION FORM PERSONAL HISTORY: NAME:_________________________________________________________________ Last First Middle (Maiden) ADDRESS: _____________________________________________________________ street/city/state/zip HOME PHONE:______________________ BUSINESS PHONE:________________ DATE OF BIRTH:____/____/____ PLACE OF BIRTH:_______________________ HEIGHT:_______ WEIGHT:______ COLOR EYES:_____ COLOR HAIR:_____ SEX:_____ AGE:______ SOCIAL SECURITY NUMBER:_______/_______/_____ DRIVERS LICENSE NUMBER:________________________ STATE:___________ SINGLE:________ MARRIED:_______ (IF MARRIED LIST MAIDEN NAME OF WIFE) NAME OF SPOUSE: _____________________________________________________ Last (Maiden) first middle SPOUSE DATE OF BIRTH:______/______/______ SPOUSE SOCIAL SECURITY NUMBER:_______/_______/_______ HAVE YOU EVER BEEN A LAW ENFORCEMENT OFFICER OR HELD A SIMILAR POSITION? YES ___ NO ___ IF YES, WHERE?___________________ DATES EMPLOYED: FROM______________ TO _______________ REASON FOR LEAVING:________________________________________________ ________________________________________________________________________ HAVE YOU EVER OWNED, OR HELD A POSITION IN ANY OTHER PRIVATE SECURITY BUSINESS? YES ____ NO ____ IF YES, WHERE?_______________________________________________________ DATES EMPLOYED: FROM______________ TO _______________ REASON FOR LEAVING:________________________________________________ ________________________________________________________________________ ORANGE BEACH POLICE DEPARTMENT ORDINANCE NUMBER 295 INVESTIGATION FORM PERSONAL HISTORY: HAVE YOU EVER BEEN ARRESTED FOR A FELONY, CRIME OF VIOLENCE, OR A CRIME OF MORAL TURPITUDE? YES ___ NO___ IF YES, LIST ALL ARRESTS, CHARGES AND DISPOSITIONS OF EACH CASE> TYPE OF CHARGE POLICE DEPT. DATE DISPOSITION ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ARE THERE ANY WARRANTS OR INDICTMENTS NOW PENDING AGAINST YOU? YES ___ NO___ IF YES, EXPLAIN:__________________________________ ________________________________________________________________________ DO YOU NOW, OR HAVE YOU EVER USED OR EXPERIMENTED WITH ANY NARCOTIC OR BARBITURATES? YES ___ NO ___ IF YES, GIVE DETAILS: ________________________________________________________________________ HAVE YOU EVER SERVED IN ANY MILITARY ORGANIZATION? YES __ NO___ IF YES, WHAT BRANCH________________ FROM ____ TO____ WHAT TYPE DISCHARGE DID YOU RECEIVE? (HONORABLE, DISHONORABLE, HONORABLE CONDITIONS, ETC.) OF OTHER THAN HONORABLE, EXPLAIN FULLY: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ WERE YOU EVER COURT-MARSHALED, TRIED ON CHARGES, OR WEE YOU THE OBJECT OF A SUMMARY COURT, CAPTAINS MAST, COMPANY PUNISHMENT OR ANY OTHER DISCIPLINARY ACTION WHILE IN ARMED FORCES? YES ____ NO____ IF YES, EXPLAIN FULLY:___________________ ________________________________________________________________________ ________________________________________________________________________ ORANGE BEACH POLICE DEPARTMENT P. O. BOX 1039 ORANGE BEACH, ALABAMA 36561 PERSONAL INQUIRY WAIVER AUTHORITY FOR RELEASE OF INFORMATION TO WHOM IT MAY CONCERN: I respectfully request and authorize you to furnish the Orange Beach Police Department any/and all information, including that of a confidential or privileged nature you may have concerning me. This includes police records, civil and criminal court records, school records, military records, medical and mental records, and other information requested. This information will be used to assist in determining my qualifications and fitness for the position or authority I am seeking, that requires approval by the City of Orange Beach, Alabama. Intending to be legally bound, I hereby release you, your organization and others contacted, from any liability or damage which may result from furnishing the information requested. NOTE: A photocopy reproduction of this request shall be for all intents and purposes, as valid as the original. You may retain this form in your files. _________________________________________ _____________________ Applicants Signature Date _________________________________________ _______________________ Witness Date SUBSCRIBED AND SWORN TO BEFORE ME ON THE _________DAY OF ______________________________, 20____. _____________________________________ Notary Public     PAGE  PAGE 1 HT 2PQXy      ˺h0JmHnHu hd0Jjhd0JUjhdUhd5CJ\hd hd5\hd5CJ\ hdCJ%GHTUVcd% & 4 5 l m n o p q r s t u v w $a$$a$ w x y z { | } ~  ! I J BC$a$WX%&ghIJ $a$ 23b=QRJ[*stuuvwxy?@:$a$:MNOPQ   h]h&`#$,1h/ =!"#$% @@@ NormalCJ_HaJmH sH tH :@: Heading 1$@&5\@@@ Heading 2$$@&a$5\DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List 2>@2 Title$a$5\4 @4 Footer  !.)@. 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