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Oceanside Police Department

3855 Mission Avenue, Oceanside, CA 90258-1882

760-435-4650

Oceanside Police Department

 

Cardroom Permit Application

Organization - Please select one

Applicant Information

Sex

Current Home Address (No PO Boxes Allowed)

    Criminal History

    List all arrests resulting in convictions (other than infractions for traffic violations).

    If additional space is needed, attach additional sheets to the application.  Please note any false statements, misleading statements, or omissions on this application shall be grounds for disqualification.

    Arrest Date

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    Arrest Date

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    Arrest Date

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    Arrest Date

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    Arrest Date

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    Previous addresses for the past five (5) years and dates of residence at each

    Dates of Residence


    Dates of Residence


    Dates of Residence


    Dates of Residence


    Dates of Residence


    Dates of Residence


    Dates of Residence

    Employment History for the past five years. List most recent first.

    Employer Address

    Dates of Employment


    Employer Address

    Dates of Employment


    Employer Address

    Dates of Employment

    Background Investigation Release

    I agree to provide any information requested or deemed necessary by the State of California Department of Justice and the Federal Bureau Investigation, or any other law enforcement agency or third-party consultant authorized by the City Manager or Chief of Police.

    I understand this will serve to disclose any record of arrests to which I have been the subject that resulted in conviction. I further agree to hold harmless and to defend and indemnify the City of Oceanside, its officers, agents, and employees, from any action(s), or damages whatsoever or at all, arising or resulting from the taking of such fingerprints or forwarding them to the appropriate law enforcement agency for a record’s check obtaining access to any other documentation which pertains to meeting the qualification for a Cardroom Employee Permit, or relying upon said documentation in making any decision relating to this application.

    By signing this form, I acknowledge and agree to comply with all the conditions and terms of this application. I also understand that falsifying and/or omitting any information on this application may be grounds for denial of a Permit or is grounds for termination of employment per the Oceanside Ordinance.

    Statement of Perjury

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    Choose how to sign

    Date

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