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2. Event:*
4. Date and Times:*
6. Location:*
8. Address
10. City
11. State
12. Zip Code
14. Uniform & Equipment:
    Uniform of the Day with Vehicle
16. Point of Contact Name:*
18. Point of Contact Phone Number*
20. Number of Officers Requested *
22. Pay Status PER OFFICER
    Less than 3 hours, $40.00 per hour, 2 hour minimum ($80.00) 3 hours or more, $30.00 per hour House Moving detail, $100.00 first hour, $50.00 each additional hour Roadway traffic detail, (traffic direction), $40.00 per hour
24. Cancellation Policy
    Any cancellation within 24 hours of the EXTRA DUTY JOB will require a payment of 1/2 the agreed total pay.
26. Total pay offered Per Officer An Hour*
28. Name of Person Responsible for pay:*
30. Person Responsible for Pay's Phone Number *
32. For Use of the Lumpkin County Sheriff's Office
34. Deputy
35. Date & Time
37. Deputy
38. Date & Time
40. Once an Officer has placed his or her name on this document, it will not be removed except with the following expections: 1. Another officer has signed for the replacement 2. Emergency Situation approved by Captain Jeff Brown
42. Captain Jeff Brown, Court Services Division
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field