Form 0055 is an IRS form that is used to report the transfer of money, securities, or other property. This form is used to report a variety of transactions, including but not limited to: the sale of property, the purchase of property, and the exchange of money or securities. The use of this form is required by law in order to properly document any such transaction. Failure to submit this form may result in fines or penalties from the IRS. For more information on Form 0055 and its uses, please visit our website. Thank you for choosing our company as your source for tax and accounting services.
| Question | Answer |
|---|---|
| Form Name | Form In 0055 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | IN 0055 Waiver of Pre employment Requirements Rev 1 13 tci waiver form tn |
STATE OF TENNESSEE
TENNESSEE CORRECTIONS INSTITUTE
WAIVER OF
T.C.A. §
Date of Request: ____________________ Department: ___________________________________________________
Applicant Name: _____________________________________________________
Social Security Number: ____________________________ Date of Birth: ________________________________
Military Service: Yes ___ No ___ Date of Discharge: ____________________ Type of Discharge: ____________________
_______________________________________ |
_____________________________________________ |
Signature of Law Enforcement Agency Head |
Print/Type Name of Agency Head |
__________________________________________________________________________________________________
The applicant has not been convicted of or pleaded guilty to or entered a plea of nolo contendere to any felony charge or to any violation of any federal or state laws or city ordinances relating to force, violence, theft, dishonesty, gambling, liquor, or controlled substances. The applicant has not been released or discharged under any other than honorable discharge from any of the armed forces of the United States.
Has the applicant ever been convicted of any criminal violation? |
Yes ___ |
No ___ |
Has the applicant ever been convicted of anything other than a traffic violation |
Yes ___ |
No ___ |
Has the applicant ever been convicted of driving under the influence? |
Yes ___ |
No ___ |
(If the answer to any of these questions is yes, attach a full explanation including date, location, charge(s), disposition, court, and the law enforcement agency having jurisdiction. If yes, and the charges have been dismissed, please attach a copy of the court document.)
The Board of Control may consider a waiver from
Any person who, with intent to deceive, makes any false statement on this document commits the offense of perjury pursuant to T.C.A.
_______________________________________ |
____________________ |
Signature of Applicant |
Date |
THE FOLLOWING DOCUMENTS MUST BE ON FILE AT THE EMPLOYING AGENCY AND READILY AVALIABLE FOR INSPECTION BY ANY BOARD OF CONTROL REPRESENTATIVE OR CORRECTIONS INSTITUTE INSPECTOR.
Copy of Application for Waiver
Original Confidential Psychological Evaluation
Copies of all Military
For TCI Use Only
RDA 2884 |