Security Clearance Form - Casa Of Los Angeles
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CASA
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
SECURITY CLEARANCE
PRINT NAME: (Last)
(First)
(M.I.)
Other Names Used: (Last)
(First)
(M.I.)
Address:
City:
State:
Zip:
Driver's License No.:
Expiration:
DOB:
CA I.D. No.:
Expiration:
SSN:
Proper conduct by Court employees inspires public confidence and trust in the Court and
conveys the values of impartiality, equality, and fairness that brings integrity to the Court's
work. Court employees are expected to demonstrate, through both words and actions, the
in all professional and personal dealings.
highest level of personal integrity and honesty
Employees are also to refrain from any perceived or actual impropriety including violating the
law.
The Court conducts criminal background checks on candidates to whom it makes offers of
employment. Existence of a criminal record is not an automatic bar to employment. In
evaluating an applicant's suitabi
lity for Court employment, the Court will consider such
factors as the nature and recency of the offense(s), the number of offenses and any
mitigating circumstances.
Full and complete responses to the questions below are required and will be carefully
evaluated and verified. Employees' fingerprints are sent to State and Federal agencies for a
check of criminal record history. Any false statement or omission of a material fact will
cause forfeiture of all rights to employment.
ARREST AND CONVICTION INFORMATION
Pursuant to California Labor Code section 432.7, the Court, as a criminal justice
agency, may inquire about arrests including those that did not result in convictions.
Have you ever been convicted of an offense(s) in any criminal or military court or has a
1.
juvenile court petition(s) ever been filed against you and found true? Please mark the
"Yes", please explain in the chart below. Note: Exclude
appropriate box below and, if
any offense(s) which resulted in the successful completion of a deferred entry of
any offense(s) where court record has
judgment program(s) (pre-trial diversion) or
been sealed.
YES
NO
Security Clearance (Revised April 2007)
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