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THANK YOU for your interest in becoming a Volunteer Firefighter with the Bulloch County Fire Department! Onthe following pages, you can find the application. It is fillable on a computer, or you can print it out andcomplete.Once you’ve completed the application, please email it to the Recruitment Coordinator, Mrs. Pat Lanier Jones,at [email protected] you’ve printed it out and completed it by hand, you can drop it off at the firestation in Brooklet or at theEmergency Operations Center in Statesboro.Address for the Brooklet station: 16841 Hwy 80 East, Brooklet Ga 30415Address for Emergency Operations Center: 17245 Hwy 301 North, Statesboro Ga 30458Questions?Pat Lanier JonesVolunteer Fire CoordinatorBulloch County Fire Department17245 Hwy 301 NorthStatesboro, GA [email protected]
BULLOCH COUNTY SHERIFF’S OFFICECRIMINAL HISTORY RECORD INFORMATION CONSENT/INQUIRY FORMI hereby authorize ETTA DIEMERT, AGENT FOR BULLOCH COUNTY FIRE DEPARTMENT to conduct aninquiry for the purpose(s) listed below and receive and Georgia and/or national criminal history record informationas authorized by state and federal law.FULL NAME(print)ADDRESSSEXRACEDATE OF BIRTHSOCIAL SECURITY NUMBERXThis authorization is valid for 30 days from date of signature.SignatureAttorney for Individual (Pur E and U only)Bar NumberTELEPHONEDateDateSHERIFF’S OFFICE PERSONNEL ONLYDate of Inquiry Time of Inquiry Operator’s InitialsXNON-CRIMINAL JUSTICE PURPOSESE - EmploymentM - Working with Mentally DisabledN - Working with ElderlyW - Working with ChildrenP – Public Records (no consent required)F – Probate Court / Weapons Carry LicensePERSONAL REQUEST (INDIVIDUAL OR THEIR ATTORNEY)U – Personal CopyCRIMINAL JUSTICE EMPLOYEMENTJ - Civilian Criminal Justice Employment (State & III Info Received)Z – Sworn Criminal Justice Employment (State & III Info Received)The inquiry resulted in the following (check all that apply)No Criminal Record AvailableCriminal Record (Attached/Released)No NCIC/GCIC WarrantPossible NCIC/GCIC Warrant (List Wanting Agency Below)Wanting Agency NameWanting Agency TelephoneAgency Designee Signature and TitleDateMUST ATTACH A COPY OF VALID DRIVER’S LICENSE OR STATE ISSUED PHOTO I.D.RECEIVED BY:DATE:REVISED MARCH 2022
Bulloch County Fire Department 17245 Hwy 301 North Statesboro, GA 30458 [email protected] 912.842-2200. BULLOCH COUNTY SHERIFF'S OFFICE CRIMINAL HISTORY RECORD INFORMATION CONSENT/INQUIRY FORM . SEX RACE DATE OF BIRTH SOCIAL SECURITY NUMBER TELEPHONE
