Visitor Security Clearance Request Form.pdf

San Diego County

SHERIFF’S OFFICE

VISITOR SECURITY CLEARANCE REQUEST

Legal Name: Alias or Maiden:

Date of Birth: Gender:

Social Security No.: Driver's License/ID: State:

Full Home Address:

(Street, Apt. No.)

Personal Phone:

(City) (State) (Zip Code)

Work Phone:

Personal Email: Work Email:

Emergency Contact: Phone:

Organization/Agency: Supervisor: Phone:

What is the purpose of your clearance? Case Management Religious Service Class Instruction Other

Please explain other:

1. Do you currently have any family members or acquaintances in Sheriff's Custody? Yes No If yes, who? (Not disqualifying, but it must be disclosed)

2. Have you ever been convicted of a crime? Yes No

3. Have you ever been arrested or detained by Law Enforcement? Yes No

If yes, what was the result? Incarceration Probation/Parole Home Detention

No

Diversion Fines, etc.

4. Have you ever been denied access to a Sheriff's facility? Yes

5. Incarceration History (Check all relevant) County Jail/Local State Prison Federal Other N/A

* * *Application will not be processed without a clear copy of your valid picture identification* * *

SHERIFF STAFF USE ONLY BELOW THIS LINE

Contact: Requested by: Facility/Division Phone:

This request is for: Temporary – Dates(s) Continuous (Annual) Pro-Visit (Annual)

Request entry into: EMRF GBDF

Volunteer

LCDRF

Pro-Visit

RMDF SBDF SDCJ

Clergy

VDF

Visit Type: Contracted Provider Religious Volunteer

Renewal: Yes No Pin#:

Investigating Deputy: ARJIS#: Date:

J-23 (Rev 09/24)

I hereby authorize the San Diego County Sheriff's Department to conduct a background and security check on myself, as a condition of my acceptance to enter the San Diego County Jail facilities as a visitor/volunteer/contractor. I understand that any false statement, verbal or written, will cause my clearance request to be denied or be cause for dismissal if an approval was made. I also understand that if any of the above information changes, I shall notify my Agency Supervisor and the Sheriff's Department immediately.

Applicant's Signature: Date: