Security Clearance Application

Please read instruction letter completely before filling out application.

Anyone requesting a Security Clearance must submit to a record check. Many applications are often denied because of an individual failing to disclose information. Applications are not processed until all forms are completed and all required documents have been received. The following information must be provided with all security clearance requests:

Official Visitors: (i.e. Doctors, Psychiatrists, Private Investigators, Paralegals, Interpreters, Legal Runners, Notaries and Interviewers).

Clergy or religious members can apply for security clearance through the Community Volunteer Program at (949) 855-2629.

Completed and signed Security Clearance Application, Security Clearance Information/Release of Liability, and Background

Questionnaire.

Letter of Introduction from employer stating purpose of requested visit. If self-employed, a letter of introduction stating purpose for security clearance.

A clear copy of Driver’s License or I.D. Card.

A clear copy of Social Security Card or Passport.

Copy of current Official Identification (Investigator License, Psychologist License, Notary Certificate & Stamp, etc.)

Contractors:

Contractor applications should be submitted through the appropriate Project Manager with all clearance requests for the specific project. This shall include a coversheet listing the project name, individuals applying for the clearance, and a brief description of the project and location.

Completed and signed Security Clearance Application, Security Clearance Information/Release of Liability, and Background

Questionnaire.

A clear copy of Driver’s License or I.D. Card.

A clear copy of Social Security Card or Passport.

All approved Security Clearance applications will be placed on an approved list that is maintained for a period of one year. It is the applicant’s responsibility to renew the application. The background clearance process can take up to 4 to 6 weeks to complete. In certain circumstances it may take longer depending on the completeness of the information provided by the applicant and staff resources.

Application Submission Options:

1. Email all required documents in PDF Format to: CJXAdmin@ocsd.org

2. Mail completed packet Attn: Admin Deputy to:

Central Jail Complex 550 N. Flower Street, Santa Ana, CA 92703

Theo Lacy Facility, 501 The City Drive, Orange, CA 92868 (for TLF Clearances)

Security Clearance questions can be answered by emailing CJXAdmin@ocsd.org. Per Department Policy and California Law, we will not disclose background information, reason for Security Clearance denial, or qualification criteria. An individual can request their criminal history through the California Department of Justice.

cottova Text Box Exhibit C (For Reference Only)

ORANGE COUNTY

SHERIFF-CORONER DEPARTMENT

SECURITY CLEARANCE APPLICATION

Please read and answer all questions. Information you provide will be verified and a criminal background check will be conducted. Any omissions, falsifications or misstatements on this application will result in your application being denied.

Return completed application with a copy of you DMV issued Driver’s License and a copy of your Social Security card or U.S. Passport.

PRINT ALL INFORMATION - Contractor ☐ Volunteer ☐ Notary ☐ Paralegal ☐ Other_____

Full Name ____________________________________________________________________________________________

Residence Address _________________________________City ________________________________ Zip __________

Res. Phone _____________________ Soc. Sec. # _____________________ Drivers. Lic. #________________State _______

Cell Phone ______________________ E-Mail Address ___________________________________

Age ____________ DOB_____________HT. ______________WT_______________ Eyes ____________Hair_____________

Employer ___________________________________________________ Phone _____________________

Immediate Supervisor’s Name ________________________________ Phone ____________________

Employer’s Address ________________________________ City _____________________________ Zip _________

Emergency Contact Information

Name: ______________________________ Telephone: Day__________________ Evening___________________

Address________________________________ City____________________________ Zip_______________________

Relationship_____________________________

I hereby certify that the above information is true and correct. I acknowledge that this Security Clearance form is the property of the Orange County Sheriff’s Department.

As a condition of my request to enter the Orange County Jail or Court system I hereby authorize the Orange County Sheriff’s Department to conduct a criminal background investigation.

Signature of Applicant: _______________________________________ Date: _______________ cottova

Background Questionnaire

Have you ever been arrested as an adult or a juvenile (excluding traffic citation) Yes ☐ No ☐

If YES, write the name(s) you were arrested under, the date(s) and explain your arrest(s) (charges, disposition) List all arrests:

Are you currently on Parole or Probation (including informal probation)? Yes ☐ No ☐

Do you have any relatives or friends incarcerated within the Orange County Jail system? Yes ☐ No ☐ If YES, provide name(s) of relative(s) or friend(s) who are incarcerated:

Have you ever been in or currently involved with a gang(s)? Yes ☐ No ☐ If “Yes” explain below:

Do you currently have family members or friends in or involved with any gang(s)? Yes ☐ No ☐ If Yes, please explain:

I (Print name) _____________________________________ certify all information on this questionnaire is true and correct. I understand that the Orange County Sheriff’s Department will verify the information prior to approving my application. I also understand that any misstatements, falsifications or omissions will result in my application being denied.

Signature: _____________________________________________________ Date: __________________

Revised 3-29-16

SECURITY INFORMATION

1. Security clearance will be required of all persons entering the facility.

2. Upon entering the Orange County Jail, a Government form of identification bearing my picture will be required. I will pick up a visitor I.D. card to be worn in a conspicuous place at all times. I will return it to main control any time I leave the facility.

3. I may be required to submit to a search of my person and possessions at any time while inside the Orange County Jail facilities or prior to entry.

4. All equipment and/or tools will be accounted for at the end of each day, and discrepancies shall be reported immediately to security staff.

5. The giving to, or accepting items from any inmate is prohibited.

6. Personal contact with any inmate while in the Orange County Jail is prohibited.

7. Personal attire should be conservative and non-provocative to the inmates.

8. Work or programs may be immediately terminated should a security threat or dangerous situation exist within the jail facility.

9. Objects that could be used as a weapon against members of the jail staff or other persons may be prohibited from this facility.

10. Narcotics, controlled substances or alcoholic beverages of any kind cannot be brought into the facility. Any person found in violation of the California Penal Code 4573 through 4573.9 is guilty of a felony.

ORANGE COUNTY JAIL RELEASE OF LIABILITY

I, (Print Name) , understand I am entering into a facility of the Orange County Jail System. I recognize that this facility houses inmates who are charged with or convicted of criminal offenses, some of whom have the potential to be violent and may pose a threat to my safety and wellbeing. ( ) Initials

I understand further that the Orange County Sheriff’s Jail System has a “No Negotiations for Hostage” policy, and that the Sheriff- Coroner will not negotiate with inmates for the release of hostages. ( ) Initials

I, on behalf of myself, my heirs, executors, administrators, and assigns, and in consideration of permission for my entry into the Orange County Jail System, hereby fully release the County of Orange, their officers, agents, and employees from any and all claims, causes of action, and liability for damage or injury of any type or nature, including death, that may be sustained as a result of or in connection with my entering, remaining in, or participating in any event within the Jail System. ( ) Initials

NOTICE REGARDING PROHIBITED ITEMS AND SUBSTANCES

You are about to enter a County Jail facility. It is a crime to bring into the Jail, or to have in your possession in the Jail, any of the items or substances listed below:

1) Firearms of any sort

2) Deadly weapons

3) Explosives or explosive substances

4) Tear gas or tear gas weapons, including pepper spray

5) Instruments or weapons commonly known as blackjacks, slingshots, billies, sand clubs, metal knuckles, mini batons, etc.

6) Fixed ammunition

7) Knives, dirks, daggers, or any sharp instrument

8) Drugs of any type, including controlled and uncontrolled substances

9) Hypodermic needles and any other devices, contrivances, instruments, or paraphernalia used for injecting or consuming any type of drug or narcotic.

10) Cell phone

11) No Electronic Devices

I have read and fully understand the security information listed above.

Signature: ___________________________________________________ Date: ________________

Background investigation completed by: ______________________________________

Date of investigation: _________

Criminal Record: Yes ☐ No ☐

Approved ☐ Denied ☐

Additional Information:

Facility Commander: ___________________________ Date: _____

Approved ☐ Denied ☐

FOR OFFICAL USE ONLY – DO NOT WRITE BELOW THIS LINE