Reserve Deputy Program

By submitting this application to participate in the Reserve Deputy Sheriff program, I authorize the Jefferson County Sheriff's Office to check my personal background and references and conduct other background checks for arrest records, convictions, and traffic citations as necessary to insure the integrity of the Reserve Deputy Sheriff Unit. I also declare and attest that the above information is correct to the best of my knowledge.

By checking the "I agree" box below, you agree and acknowledge that 1) your application and acknowledgment and consent to release information will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

I do solemnly, sincerely, and truly affirm and declare that:

I am presently an applicant for employment with the Jefferson County Sheriff's Office (the "JCSO"), which is located in Golden, Colorado.

I fully understand that the JCSO conducts a background investigation of all applicants (using this application for its beginning point), who are being considered for a position with the JCSO. This investigation includes, but is not limited to, an investigation of my past employment performance, school records, military, police, driving records, credit report and credit records, and character. Records may include all investigations of my conduct in any regard (to include internal affairs or professional standards investigations). I hereby waive any and all rights that I may have to examine, review, or inspect any documents or information of whatever kind, form or nature, obtained in the course of the background investigation.

I hereby authorize any person who is contacted by JCSO personnel to release any information to the JCSO pertaining to the background investigation including, but not limited to, records or information relating to my past employment performance, health, financial stability, credit records, reports, and information, schooling, military, police driving records and character for use by the JCSO in the consideration of my application for employment and for no other purpose.

I also understand hereby that this application and any and all papers and other exhibits submitted by me or any person, government agency, former employer, private business, or any other individual or group of individuals become, upon submission to the JCSO, the property of the JCSO and will not be returned to me under any circumstances whatsoever or disclosed to me, except as provided by the laws of the State of Colorado.

I authorize the JCSO to release any documents or information collected during the application process to any person or entity lawfully empowered to obtain such information or documents. As set forth in C.R.S. §§ 24-33.5-115(3) and 30-10-526(3), I further agree to release and hold harmless any state or local law enforcement agency or governmental agency, as well as its elected officials, officers, agents, and employees, for the release of such information to the JCSO from any liability and claims which I may have against that person or entity arising out of the release of such information.

I further agree to release and hold harmless the JCSO, Jefferson County, and their elected officials, officers, agents, and employees from all liability or claims which I may have arising out of the disclosure of such information to the JCSO for use by the JCSO in the consideration of my application for employment and for such other purposes as may be related to any subsequent employment with JCSO, and the disclosure or release of any documents or information by the JCSO or agents thereof collected during the application process to any person or entity lawfully empowered to obtain such information or documents.

This authorization for the release of information shall be valid for a six month period from the date hereof. All releases of claims and liability set forth herein shall survive the expiration of this authorization.

All statements made by me in the completion of this application are, to the best of my knowledge and recollection, accurate and true and I understand that any false answer or any fraud whatsoever, constitutes a basis for automatic rejection of this application, or if I am hired and fraud and/or deceit is subsequently discovered, such fraud and/or deceit will become grounds for my immediate dismissal from the JCSO.