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Security Clearance Form - Superior Court Of California, County Of Los Angeles - 2009 Page 2

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

highest level of personal integrity and honesty in all professional and personal dealings.

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 suitability 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

juvenile court petition(s) ever been filed against you and found true? Please mark the

appropriate box below and, if “Yes”, please explain in the chart below. Note: Exclude

any offense(s) which resulted in the successful completion of a deferred entry of

judgment program(s) (pre-trial diversion) or any offense(s) where court record has

been sealed.

YES

Security Clearance (Revised October 2009)

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Security Clearance Form - Superior Court Of California, County Of Los Angeles - 2009 Page 2

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