Important Halloween
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shared with anyone not directly involved in the hiring process. The Hamilton Police Department will also not share the information with me, except in response to a court order. I understand that my failure to cooperate fully in all facets of the background investigation will result in my immediate disqualification from further consideration for the position of Police Officer for the Hamilton Police Department. Signature of Applicant ____________________________________ Date _______________ Subscribed and Sworn to before me this _______ day of ____________, ______. Notary Public in and for said County of ________________, State of ___________________ Notary Public Signature _______________________________________________________ plication Packet Page: 32 CHILD SUPPORT Please mark the appropriate response. Failure to mark one of the three statements will result in the denial of your application. _____ I am not subject to a court order for the support of a child. _____ I am subject to a court order for the support of one or more children and I am in compliance with the order; or I am in compliance with a plan approved by the County Attorney (or other public agency) enforcing the order for the repayment of the amount owed, pursuant to the order. _____ I am subject to a court order for the support of one or more children and I am NOT in compliance with the order or plan approved by the County Attorney (or other public agency), enforcing the order for the repayment of the amount owed, pursuant to the order. Applicant's Social Security Number: ___________________________ Signature of Applicant _______________________________ Date ____________________ Subscribed and Sworn to before me this ______ day of ________________, ______. Notary Public for said County of ___________________, State of _____________________ Notary Public Signature_______________________________________________________ pplication Packet Page: 33 AUTHORIZATION TO RELEASE INFORMATION Name of Applicant ________________________________________________________ Date of Birth _________________________________________________________ Social Security Number______________________________________________________ As an applicant for the position of Police Officer with the Hamilton Police Department I am required to undergo a background investigation for use in determining my qualifications and suitability to be a police officer. I realize that this Department will NOT release the information provided to them to any person, including myself. The information submitted to this Department is confidential and will be used only for investigation of my suitability for law enforcement employment. Toward this end, I authorize release to the Hamilton Police Department of any and all information that you may have concerning me, including information of a confidential or privileged nature. I hereby authorize all my previous employers, physicians, and professionals who may have examined or treated me, friends, acquaintances, credit reporting services, public agencies, and all others to furnish the Hamilton Police Department any and all information they may have concerning me. I hereby release you, your organization, or others, from liability or damage, which may result from furnishing the information requested. You may be contacted by mail, by a background investigator with the Hamilton Police Department, or both. I further authorize that a photocopy of this Authorization to Release Information form shall be for all intents and purposes, as valid as the original. I authorize you to retain a copy of this form for your files. This release is valid for a period of one (1) year of the date of my signature. Signature of Applicant________________________________ Date_______________ Subscribed and Sworn to before me this ___________ day of __________________, _____ Notary Public in and for said County of _______________, State of ___________________ Notary Public Signature ______________________________________________________

posted by Isaac Hobart at 10:38 AM

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