Have you ever been convicted of a felony or misdemeanor, including pleading nolo contendere (no contest) or are you currently under investigation for any such offense? All convictions must be included even if they were expunged, pardoned, first offender status, pre trial diversion, etc.)

PLEASE NOTE A FAILURE TO LIST ALL CONVICTIONS CAN RESULT IN A DENIAL OF YOUR APPLICATION

Yes      No

If the answer is "Yes", complete the information below. You must respond to this question.

If you have additional Convictions, please add them here:

**Please note: If you have a criminal arrest history all arrest, conviction status, and court documentation will be required at time of initial interview; including but not limited to the original police report of the incident and any related court documentation to include charge and/or conviction status and final disposition.

Have you ever received a traffic citation that was not dismissed in your lifetime?  Please list any and all traffic citations in your lifetime. 

A FAILURE TO LIST ALL TRAFFIC CITATIONS CAN RESULT IN A DENIAL OF YOUR APPLICATION

Yes      No

If the answer is "Yes", complete the information below. You must respond to this question.

If you have additional Traffic Violations, please add them here:

Your highest grade completed 1-12: ***Select*** 1 2 3 4 5 6 7 8 9 10 11 12

If applicable, check highest post-secondary level completed:

Freshman
Sophomore
Junior
Bachelor's Degree
Master's Degree
Specialist
Doctorate

Have you ever used any other name(s) in your lifetime?
Yes      No
If yes, list all names you have been known by in the past.

Have you ever applied for employment with any law enforcement agency?
Yes      No
If yes please list agency and dates of application.

Have you ever applied to another law enforcement academy?
Yes      No
If yes please list academy and dates of application.

Have you ever been terminated or asked to resign from any job?
Yes      No
If Yes, please explain circumstances.

Do you have a current driver's license? Yes      No
**Please note that you are ineligible for admission into the Academy without a valid Georgia driver's license.

State:
License No.:
Expiration Date:

Has your driver's license ever been suspended or revoked?
Yes      No
If Yes, please explain circumstances.

This will certify that all statements contained herein are complete and accurate. Incomplete or inaccurate information may result in denial of admission and other penalties provided in the Georgia Code regarding "making false statements" and/or "falsification of government records." By signing this application electronically, I am authorizing the release of any information, including financial and criminal records needed to properly evaluate my candidacy for admission. I also understand that applications submitted electronically, via e-mail or similar media, are not valid unless my name is entered in the field below. Such action shall constitute an electronic signature.

Electronic Signature (Please Print Full Name)