Atlanta Police Department

Code Enforcement Agent Application

(Type or print in capital letters using blue or black ink in white areas only.)

Name
First	Middle	Last
Photo
Social Security Number	Sex	M F
Place of Birth
Date of Birth
Age
Month	Day	Year
Race
Height
Weight
Feet	Inches
Eye Color
Natural Hair Color

Home Address

City	State	Zip Code

Telephone Number
How long have you lived here?

Employer

Assignment
How long have you worked at this assignment?
Job Duties:

Address of Employment

City	State	Zip Code

Have you been convicted for violation of any law?
Foreign Country	Yes	No
State Law	Yes	No
Federal	Yes	No
City Ordinance	Yes	No

If so, for what?

when?

where?

Prior addresses for the past five years (Most recent address first)

Address
City	State	Zip Code

Address
City	State	Zip Code

Address
City	State	Zip Code

Address
City	State	Zip Code

Address
City	State	Zip Code

Names and addresses of your previous employers for the past three years. (List most recent employment first)

From	To	Your Job Title
Name of Employer
Address
City	State	Zip Code

From	To	Your Job Title
Name of Employer
Address
City	State	Zip Code

From	To	Your Job Title
Name of Employer
Address
City	State	Zip Code

Married?	Yes	No	Spouse’s full name

Name and address of immediate family members

I hereby authorize the Atlanta Police Department/Identification Unit to receive any criminal history record information pertaining to me, which may be in the files of any state or local criminal justice agency in Georgia.

I certify that the above information is true and complete.
Applicant’s signature
Date

OFFICIAL USE ONLY

Approved for code enforcement agent status by the applicant’s immediate supervisor:

Name	(print or type)

Signature
Date

This employee is morally, physically, and mentally qualified to be a Code Enforcement Agent.

Name of title and department head	(print or type)

Signature
Date

Send the completed form to the Identification Unit, Atlanta Police Department.

Solicitor’s Office reports successful completion of code enforcement training	Yes	No
Criminal history checked and found to be	Satisfactory	Unsatisfactory

Signature
Date

Fingerprint Right Index Finger
I authorize deny Code Enforcement Agent status for this individual
Signed
Date
CID Commander
I have notified the applicant’s department head of the CID Commander’s decision and, if approved have issued the Code Enforcement Agent identification card. Numbered_________.
Signed
Date
Fingerprint by
License and Permits Unit Commander

Form APD 744 Revised 7/24/07 Admin

Atlanta Police Department

VLivsey

2007-07-24

cid