City of Social Circle
An Equal Opportunity Employer and Drug Free Workplace
Public Safety Police and Fire Employment Application
Attach additional sheets if needed to completely answer every item.
AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION
I, (enter your full name here) ___________________________________________________________________________
do hereby authorize a review and full disclosure of all records concerning myself to any duly authorized officer or agent of the Social
Circle Police Department, or their designee, such as the Georgia Bureau of Investigation, whether such 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 of my driver's history, criminal
history, educational background, military personnel records, records of military service, records of financial or credit institutions
(including records of loans), records of commercial or retail credit agencies (including credit reports and/or rating), records of the
Georgia Department of Revenue, and any other financial statements and records wherever filed, as well as U.S. Veterans
Administration records, and employment and pre-employment records (including background reports, polygraph reports and
charts, efficiency ratings, complaints or grievances filed by or against me).
I understand that any information obtained by a personal history background investigation that is developed directly or indirectly, in
completely or in part, upon this release authorization will be used in determining my suitability for employment with or for the Social
Circle Police Department or appointment to a governmental position of trust. I authorize the disclosure of the aforementioned
personal information to any person(s) deemed by the Social Circle Police Department to be a participant in the determination
process of such suitability. 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.
A photocopy of this release form will be as valid as the original form, even though the photocopy does not contain my original
I have read and fully understand the contents of this Authorization for Release of Personal Information document.
Signature (including maiden name)
Mailing Address (if different from Street Address)