Sheriff’s NET application

First Name (required):

Middle Initial (required):

Last Name (required):

Birth Date (required):

Age (required):

Sex (required):

Home Address (required):

City (required):

Zip Code (required):

State:

Home Phone (required):

Email (required):

Drivers License #(required):

Occupation (required):

Current Employer / Retired From (required):

Do you know anyone employed by the Clay County Sheriff's Office? (required):

Yes No

If yes, who? (required - if none, write none):

Have you ever been convicted of a crime (excluding traffic violations)? (required):

Yes No

If yes, please explain? (required - if none, write none):

What is your motivation for wanting to become a member of Sheriff's NET? (required):

CCSO