Certified Process Server Application Form - Judicial Council Of Georgia
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5Form 1
Judicial Council of Georgia
C
P
S
A
ERTIFIED
ROCESS
ERVER
PPLICATION
1. Name ________________________________________________________________________________
(Last Name)
(First Name)
(Middle Initial)
2. Address ______________________________________________________________________________
City _____________________________ State _________
ZIP
_________________
3. Work Telephone (
) _________________
4. Alternate Telephone (
) _______________________
5. Date of Birth ________________
6. Race ________________
7. Gender _______________
8. Email Address _______________________________________________
9. Are you now, or have you even been, licensed to carry a firearm in this or any other state? Yes No
10. If yes to Question 9, for each indicate the state, the corresponding license number, and the issuance date
(attach additional sheets as necessary):
__________________________________________________________________________________________
11. Have you been disciplined by any state, national, or federal licensing agency or authority which regulates any
profession? Yes No (If yes, please attached an explanation)
12. Have you ever been convicted of, or have entered a plea of nolo contendere to, or been granted first offender
treatment upon being charged with (1) any criminal offense other than a traffic violation or (2) any traffic
violation that involved driving under the influence of alcohol or drugs, homicide or feticide by vehicle, fleeing
the scene of an accident, attempting to elude a police officer, or impersonating a law enforcement officer?
Yes No (If yes, please attached an explanation)
I hereby swear that all information I have provided on this application and any attached explanations and accompanying
forms are true, complete, and correct. I understand that any information provided by me that the certifying sheriff or
Georgia Sheriffs’ Association finds to be false, incomplete, or misrepresented in any respect are grounds for denial of a
certificate and, if discovered after certification, are grounds for disciplinary actions, up to and including prosecution and
revocation of my certificate.
Signature ____________________________________________________Date _____________________
Submission Checklist:
o Completed Certified Process Server Application
o Two passport photos
o Proof of completion of a fingerprint based criminal background check
o Certificate of completion of 12 hour pre-certification training
o Certificate of successful completion of certification exam
o Copy of Commercial surety bond
o $80 application fee
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