COUNTY/STATE EMPLOYEES
NAME OF
APPLICANT_________________________________________________
LAST FIRST
M.I.
DATE OF BIRTH__________________
COMPANY
NAME_______________________________PHONE#_______________
BUSINESS
ADDRESS___________________________________________________
Requirement at Time of
Application
1)
Completed
Application
I understand this I.D. badge cannot be loaned to another individual. I
will not allow a person without a badge to accompany me through the card swipe entrances or carry unauthorized items into the courthouse. I
further understand it is my duty to secure this badge, and agree to contact
Security immediately at 318-6774 if lost or stolen. I understand this is a
privilege, which can be rescinded in the sound discretion of the issuing
authority.
Signature of
Applicant Date
COST: THERE WILL BE NO CHARGE FOR COUNTY OR
STATE
EMPLOYEE’S FOR THEIR initial CARD.
HOWEVER
THERE WILL BE A $25.00 FEE FOR A
DUPLICAte
CARD IF LOST OR STOLEN.