OVIEDO POLICE DEPARTMENT WAIVER OF LIABILITY AND CONSENT FORM

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OVIEDO POLICE DEPARTMENT WAIVER OF LIABILITY AND CONSENT FORM Powered By Docstoc
					                         OVIEDO POLICE DEPARTMENT

                 WAIVER OF LIABILITY AND CONSENT FORM
                        PHYSICAL ABILITIES TEST


The undersigned hereby waives all liability, rights, claims and causes of action
against the City of Oviedo, its officers, employees, agents and representatives,
and their successors and assigns in the event that I am disabled or injured,
temporarily or permanently, while participating in the Physical Abilities Test (Test)
conducted by the Oviedo Police Department as part of the testing process for
employment by the Oviedo Police Department.

I have agreed to participate in the Test as part of my quest in seeking
employment with the Oviedo Police Department. I acknowledge that I have
tendered to the Oviedo Police Department a clearance form from a medical
doctor and that I personally am not aware of any medical condition or disorder
which would preclude me from participation in the Test. Furthermore, I have
inspected the Test course and have been given ample time/opportunity to ask
and have my questions answered as they relate to the Test and its procedures.

I also voluntarily waive all liability, rights, claims and causes of action against the
Central Florida Regional Airport Authority, owner of the property on which the
Test will be conducted.




_____________________________________ ______________________
     Participant’s Name (PRINT)              Date of Birth


_____________________________________ ______________________
       Participants Signature                  Witness


_____________________________________ ______________________
   Person to contact in case of emergency  Phone Number


_____________________________________
             Date
                      The Physical Abilities (Fitness) Test

The Test consists of several sections, which are run in a continuing time.

Timing begins with the individual seated in a vehicle, seat belt on, with hands at
the 3 and 9 o’clock positions on the steering wheel. The individual is wearing a
leather belt with two handcuff cases (containing handcuffs) around his or her
waist. The handcuff cases are located on the belt in a manner so that each case
is centered over the back pockets. The trunk key is in the glove compartment that
is closed. A standard issue flashlight is in the trunk.

On the command “Go”, the individual unfastens the seatbelt, removes the key
from the glove compartment, gets out of the car and goes to the trunk where he
or she places the key in the trunk lock. He or she then removes the handcuffs in
the following manner: (a) use right hand to open the handcuff case and remove
the handcuffs from the case on the left hip and (b) use left hand to open the
handcuff case and remove the handcuffs from the case on the right hip. After
opening the trunk, remove a handgun and places it on the stool placed near the
trunk of the vehicle. Then remove the flashlight and begins the 220-yard run
carrying the flashlight.

After the run, the individual enters the obstacle course. The first obstacle is a
window 40 inches off the ground followed by three hurdles of 24, 18 ad 12
inches. After the hurdles is a 50-foot serpentine run followed by a low crawl
through a 27-inch high, 8-foot long area.

If the individual knocks over any of the crossbars, he or she must replace the
crossbar and return to the course at the point of infraction. The time will continue
running until the individual completed the course successfully.

After completing the obstacle course, the individual drops the flashlight and
climbs a 6-foot chain link fence. After climbing the fence, the individual recovers
the flashlight and goes back through the obstacle course beginning with the low
crawl and ending with the window. This is followed by another 220-yard run.

Upon returning to the vehicle after the run, the individual opens the trunk and
places the flashlight inside and then removes the handgun from the stool and
dry-fires six times with each hand. After dry firing, the handgun is returned to the
trunk, the key is removed from the trunk lock and the individual re-enters the car.
He or she will replace the key in the glove compartment, put on his or her
seatbelt and place his or her hands on the steering wheel at the 3 and 9 o’clock
position.

At this point the Test ends and the timing stops.
                  PHYSICIAN’S CLEARANCE TO TEST FORM

AGENCY NAME:         __Oviedo Police Department_____________________

NAME OF
APPLICANT:___________________________________________________

Dear Physician:

The purpose of this communication is to inform you of the above-named
individual’s intentions with regards to participation in the pre-employment
Physical Abilities Test for the Oviedo Police Department. The Oviedo Police
Department is aware of the fact that strenuous physical activity may be
inadvisable for some individuals. As such, the Oviedo Police Department
requests that you indicate whether the above-named applicant has any medical
condition or disorder that would preclude participating in the Test. It must be
emphasized that the Oviedo Police Department is not asking you to assume
responsibility for the applicant while participating in the Test. Rather, the Oviedo
Police Department wants to have as much information as possible when making
decisions concerning appropriates of the Test.

The Test will consist of a series of the following:

Timing begins with the individual seated in a vehicle, seat belt on, with hands at
the 3 and 9 o’clock positions on the steering wheel. The individual is wearing a
leather belt with two handcuff cases (containing handcuffs) around his or her
waist. The handcuff cases are located on the belt in a manner so that each case
is centered over the back pockets. The trunk key is in the glove compartment that
is closed. A standard issue flashlight is in the trunk.

On the command “Go”, the individual unfastens the seatbelt, removes the key
from the glove compartment, gets out of the car and goes to the trunk where he
or she places the key in the trunk lock. He or she then removes the handcuffs in
the following manner: (a) use right hand to open the handcuff case and remove
the handcuffs from the case on the left hip and (b) use left hand to open the
handcuff case and remove the handcuffs from the case on the right hip. After
opening the trunk, remove a handgun and places it on the stool placed near the
trunk of the vehicle. Then remove the flashlight and begins the 220-yard run
carrying the flashlight.

After the run, the individual enters the obstacle course. The first obstacle is a
window 40 inches off the ground followed by three hurdles of 24, 18 ad 12
inches. After the hurdles is a 50-foot serpentine run followed by a low crawl
through a 27-inch high, 8-foot long area.
If the individual knocks over any of the crossbars, he or she must replace the
crossbar and return to the course at the point of infraction. The time will continue
running until the individual completed the course successfully.

After completing the obstacle course, the individual drops the flashlight and
climbs a 6-foot chain link fence. After climbing the fence, the individual recovers
the flashlight and goes back through the obstacle course beginning with the low
crawl and ending with the window. This is followed by another 220-yard run.

Upon returning to the vehicle after the run, the individual opens the trunk and
places the flashlight inside and then removes the handgun from the stool and
dry-fires six times with each hand. After dry firing, the handgun is returned to the
trunk, the key is removed from the trunk lock and the individual re-enters the car.
He or she will replace the key in the glove compartment, put on his or her
seatbelt and place his or her hands on the steering wheel at the 3 and 9 o’clock
position.

At this point the Test ends and the timing stops.

The primary goal of the Test is to determine whether the applicant is capable of
performing minimum standards appropriate to the Oviedo Police Department.
Should you have any questions, please call the City’s Human resources
Department at 407-971-5520.

I have examined this applicant and his/her medical history, and based upon my
evaluation I recommend that:

       □ Participation in the Test is not advisable at the present time. If you
         advise against participation, please do not disclose the applicant’s
         medical condition on this form.
       □ Within a reasonable degree of probability, no medical condition or
         disorder exists which precludes this applicant from participation in the
         Test as described.



_________________________________                ________________________
     Signature of Physician                                 Date



_________________________________                ________________________
     Physician’s Name                                 Physician’s Address