RANDOLPH COUNTY SHERIFF’S OFFICE
SHERIFF GREGORY J. SEABOLT
727 McDowell Road
Asheboro, North Carolina 27205
Phone: 336.318.6699 Fax: 336.318.6618
Full Legal Name: _______________________________________________________________________
(First) (Full Middle Name – No Initials) (Last)
Maiden or Other Name(s): __________________________________________________________
Current Address: ________________________________ City: _____________________ Zip: ________
Previous Address: _______________________________ City: _____________________ State: ______
Birth Date: _________________
Male Female Height: ________ Weight: ________
*Social Security #: _____________________________ Driver’s License/ID Number: ________________
Place of Birth: __________________________________
Are you a US citizen: Yes No
If you are not a citizen, please provide your alien registration number or I-94 number: _______________
Phone: Home ______________________ Cell _____________________ Work ____________________
E-mail Address: _____________________________________________
Occupation/Employer: ______________________________________________________
Church or Organization: _____________________________________________________
Prior Volunteer Experience: ______________________________________________________________
Which program(s) would you be interested in volunteering with? ________________________________
_____________________________________________________________________________________
*Disclosure of your Social Security number is optional. However, choosing to omit this number may result in the return of
multiple criminal records for individuals who share similar identifying information as you. The information may or may not be
part of your criminal record and therefore, could delay the processing of your application and require you to submit fingerprints
in order for determination to be made. Social Security numbers are only used for identification purposes and are not shared
with anyone outside the Sheriff’s Office.
Do you have a special skill, work experience, certification, training or job skill to offer as a volunteer?
Yes No If yes, please explain: _____________________________________________________
____________________________________________________________________________________
PLEASE READ AND SIGN THE BACKGROUND CHECK CONSENT FORM
