Law Enforcement

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					                                                     State of Florida
                                         Department of Environmental Protection
                                            DIVISION OF LAW ENFORCEMENT
                                        3900 Commonwealth Boulevard, M.S. 600
                                             Tallahassee, Florida 32399-3000
                                   An Equal Opportunity/Affirmative Action Employer

                     SUPPLEMENTAL APPLICATION FOR LAW ENFORCEMENT OFFICER

NAME:
PLEASE PRINT             Last                       First                    Middle or Maiden

Email Address:
                 (Indicate: Home            Work       email)

Position Applied for (Title and Position Number) or County(s) of Interest:
___________________________________________________________________________________________

IF YOU ARE A CURRENT OR FORMER STATE OF FLORIDA EMPLOYEE, PLEASE FURNISH THE FOLLOWING
INFORMATION:

Agency Name:                                             People First No.
  Currently employed                 Formerly employed; date of separation from agency

ATTENTION: this agency only accepts applications for current vacancy listings. For current vacancies,
please visit the Division of Law Enforcement’s (DLE) website at: http://www.dep.state.fl.us/law/.
Applications submitted incomplete or when no vacancy exists will not be considered.

                                   INSTRUCTIONS FOR COMPLETING APPLICATION
             Please return all requested documents to the above address or your packet will not be considered.

1. Read all instructions carefully. This application will not be considered for possible employment until ALL requested
   information is received. Any willful falsification, misrepresentation, or material omission of information on this application
   may result in your disqualification.
2. INFORMATION SHOULD BE TYPEWRITTEN OR PRINTED NEATLY IN INK. If any information is illegible, the
   application will be returned to you. If you make a mistake, please whiteout or line through neatly.
3. ANSWER ALL QUESTIONS. If one does not apply, place N/A by the number. DO NOT LEAVE ANY QUESTIONS
   BLANK.
4. The following additional items MUST accompany this application: (Please check each item included in your
   application packet)
        State of Florida Employment Application.
        Notarized Personal Inquiry Waiver / Authority for Release of Information form. (Attachment 1)
        Proof of selective service registration (if applicable). ALL males born after January 1, 1960 MUST submit proof of
        registration or will not be considered for employment. See http://www.sss.gov/ for additional information.
        Applicants claiming veteran's preference MUST submit documentation, DD-214 forms, one for each tour served, with
        application. See State of Florida Application for criteria.
        Applicants who have not served in the United States Military must complete the Certificate of Non-military Service
        (Attachment 2).
        Florida Retirement System (FRS) New Employee Certification form.
        http://www.myfrs.com/imageserver/pdf/forms/cert.pdf
        Copy of law enforcement academy graduation certificate or state certification.
        Copy of current driver's license.
        Copy of Social Security Card, with current name (as applicable).
        Copy of Birth Certificate or Certificate of Naturalization.
        Copy of name change documentation, such as marriage certificate, divorce decree, adoption papers (as applicable).
        Current photograph not larger than 2" X 3". (See page 13.)
        Copy of high school diploma and college transcript (if applicable). If transcripts are in a foreign language, it must be
        translated and notarized.
        Original driving record.
        Current credit report (within last 6 months).
                                                             1
            (Rev. 1/2010)
                                          OTHER EMPLOYMENT REQUIREMENTS

1. You must be a United States citizen. Naturalized citizens must provide a copy of Immigration and Naturalization form G-
   641.
2. You must be at least 19 years of age and have a high school diploma or its equivalent.
3. You must have 2 years public contact experience, which can be substituted by work, military or educational experience.
4. A thorough background investigation will be part of the hiring process. The information obtained is solely for the purpose of
   evaluating your qualifications for employment with the Department of Environmental Protection and shall remain the
   property of this Department.
5. You will be required to provide your fingerprints for background purposes and employment consideration.
6. You must have an overall good driving record.
7. You cannot have been convicted of any felony or of a misdemeanor involving perjury or a false statement, nor have
   received a dishonorable or undesirable discharge from any of the Armed Forces of the United States. Any person who
   pleads guilty or “nolo contendere” to or is found guilty of a felony or of a misdemeanor involving perjury or a false statement
   shall not be eligible for employment or appointment as an officer, notwithstanding suspension of sentence or withholding of
   adjudication.
8. If an offer of employment is made, that offer is contingent upon the successful completion of specific medical requirements,
   including a drug screening. Please review the agency’s minimum standards, which can be found on the Division of Law
   Enforcement’s website: (provide link).
9. You must pass a physical abilities and psychological evaluation.



HOW DID YOU LEARN ABOUT THIS JOB OPPORTUNITY?                         (Check all that apply)

        Internet. Indicate website
        Recruiting Workshop
        College Placement Center
        Job Services of Florida
        Police Academy
        DEP or DLE employee. Name _________________________________________
        Other



The Department of Environmental Protection is an Equal Employment Opportunity and Affirmative Action (EEO/AA) employer.
Equal employment opportunity is given to all applicants without discrimination as to race, sex, color, age, national origin,
religious creed, disability, political opinion or affiliation, or marital status except when such factors would constitute a bona fide
occupational qualification necessary to performing a position’s assigned tasks. Applicants with qualifying disabilities as defined
by Americans with Disabilities Act (ADA) shall not be denied employment solely because of such disability, with or without
reasonable accommodation, unless the disabling condition would prohibit performing essential functions as documented in the
position description.

The State of Florida does not tolerate violence in the workplace.

In accordance with s. 119.071(5)(a)2, F.S., your Social Security Number may be collected for the purpose of assisting with pre-
employment eligibility screening and to process your application.

If, because of a disability, you require a special accommodation to participate in the application and selection
process, please notify the hiring authority in advance.




                                                                2
             (Rev. 1/2010)
1. Mr./Ms.
                            Last Name,     First Name,   Middle or Maiden Name


2. Mailing address
                                                           Number and Street


   City                                          State                         Zip                         County


3. Physical address (if different from above)
                                                                                       Number and Street

   City                                          State                         Zip                         County


4. Home telephone (                 )                                  Business telephone                  (        )

5. Social Security #

6. Date of birth                                         7. Height                               8. Weight

9. Male            Female

10. Race (check one):       WH     (Non-Hispanic) BLK             (Non-Hispanic)     Hispanic      Native American
                            Asian or Pacific Islander            Other (Specify)

11. Do you possess a valid Driver's License?               Yes                 No      (Attach copy)
    State                   License No.                                                Expiration Date:

12. U.S. Citizen?        Yes     No             By Birth? Yes     No            By Naturalization? Yes                           No
    (If naturalized, you must submit a form G-641 from Immigration & Naturalization.)

13. Have you ever had your name legally changed? Yes                           No       (Attach documentation)

14. If you answered yes to the above question, what was:

    a.    Your previous name(s) (List all)

    b.    Date and location of change

    c.    Your reason for change

15. Have you ever applied to or been employed by another law enforcement agency? Yes                                    No

16. If yes, give name of agency(ies) and date(s) of application or employment. Use additional pages as needed.



17. Marital Status: (check one) – Single     Married        Divorced         Widowed           Separated (legally)
    Separated (living separately)        (Submit a copy of marriage certificate(s) or divorce decree(s) as applicable.)

18. Name of spouse                                                             17. Date Married:
                            Last, First, Middle/Maiden

19. Location of marriage:
                                        City                         State             Country                          County




                                                                      3
              (Rev. 1/2010)
20. List the names of your immediate family (spouse, mother, father, brother(s), sister(s) and children. Use additional
    pages as necessary.

                Name                       Relationship        Date of Birth                   Current Address




21. Chronologically list all previous places of residence for the last 10 years. (Begin with present address and work
    backwards. Use additional pages as necessary.)

    Period of residency                    Number & Street                              City                     State
  from:
  to:
  from:
  to:
  from:
  to:
  from:
  to:
  from:
  to:
  from:
  to:
  from:
  to:
  from:
  to:




                                                          4
           (Rev. 1/2010)
22. List all high schools attended.
                  Name of School                          Dates Attended                             Location
                                                       From:
                                                       To:
                                                       From:
                                                       To:
                                                       From:
                                                       To:
                                                       From:
                                                       To:

23. Higher Education: List all colleges and universities attended. (Attach a diploma or official transcript from last
    institution of higher education attended.)

                                                                 Credit Hours:        Dates Attended:
      College/University                 Location                                                               Degree/Major
                                                                Semester/Quarter          From/To

                                                                                    From:
                                                                                    To:
                                                                                    From:
                                                                                    To:
                                                                                    From:
                                                                                    To:
                                                                                    From:
                                                                                    To:

24. Other schools (trade, vocational, business, or military). Provide information requested below.

            School                        Location                    Courses Studied            Dates Attended:       Certificate
                                                                                                    From/To             Yes/no
                                                                                               From:
                                                                                               To:
                                                                                               From:
                                                                                               To:
                                                                                               From:
                                                                                               To:
                                                                                               From:
                                                                                               To:

25. If you speak a foreign language, indicate your level of fluency of each by writing “excellent,” “good,” or “minimal” in the
    proper column.

            Language                         Read                             Speak                          Understand
  Spanish

  French

  German




                                                            5
             (Rev. 1/2010)
26. Indicate type of special license, e.g. pilot, radio operator, etc., showing licensing authority, where the license was first
    issued and the date a current license expires. (Exclude driver’s license.)

                            Type                                 State of Issuance           Issue Date          Expiration Date




27. Indicate special skills that you possess, as well as machines and equipment you can use or operate, e.g. Marine VHF
    radio, computer, scientific or professional devices, heavy equipment):




28. Indicate any special qualifications not covered above, e.g. important publications (do not submit copies), patents or
    inventions, or public speaking experience.




29. List all clubs, professional or scientific societies, civic and/or fraternal organizations in which you are, or have been, a
    member.

                                            Organization                                                  Period of Membership




30. Honors, awards, scholarships, etc.




31. Hobbies:




                                                             6
            (Rev. 1/2010)
32. Do you know how to swim? Yes             No      If yes, indicate your competency level: High      Moderate      Low

33. Have you ever served in a military organization of the United States?           Yes        No

34. Branch of service _____________________________              Number_________________________

    Date of entry ________________        Discharge Date _______________________           Rank
    (If more than one branch please attach additional page(s)

35. How many periods of active military service did you serve?                      (Attach a DD-214 for each one.)

36. Are you currently in the National Guard or Military Reserve? Yes                No
    If yes, unit:
Contact Information:


37. What is the type of your discharge? (Honorable, Under Honorable Conditions, etc.)


38. Were you ever subjected to a court martial, tried on charges, or the subject of a summary court, deck court,
     captain's mast or company punishment, or any other disciplinary action while a member of the armed forces?
    Yes        No         If yes, explain:




39. List any arrests (including traffic, boating, wildlife or fishing violations) or any other violations for which you have
    been cited since you were 18 years old.

                    Charge                    Date                   Location                 Adjudication        Fine/Penalty




40. List any employee theft you have been involved in with a total amount of more than $100.00.

                                                  Items                                                       Dollar Amount




41. Have you ever unlawfully used, experimented with, tried, sold or transported any controlled substance, including illegal
    drugs?      Yes           No           If yes, explain (include type, amount, and frequency used).

                    Type                    Date last used            Amount                          Frequency Used




42. Have you ever illegally used prescribed drugs? Yes             No       If yes, explain and provide date(s) last used:


                                                             7
             (Rev. 1/2010)
43. If you have been finger-printed by a law enforcement agency, other than for arrests, give details below:

                        Agency                               Date                             Purpose




44. Has your license ever been suspended or revoked? Yes               No

                        Reason                               Date                             Location




Financial
45. List firms from which you have, or have had, charge accounts. List firms from which you have borrowed money for any
    purpose. (Use additional page(s) as necessary.)

   NAME OF FIRM                                                 Type of Business
   Street Address                                               City and State
   Date Opened                            Date Closed                              Original Loan Amount $
   Current Balance $                                            Purpose

   NAME OF FIRM                                                 Type of Business
   Street Address                                               City and State
   Date Opened                            Date Closed                              Original Loan Amount $
   Current Balance $                                            Purpose

   NAME OF FIRM                                                 Type of Business
   Street Address                                               City and State
   Date Opened                            Date Closed                              Original Loan Amount $
   Current Balance $                                            Purpose

   NAME OF FIRM                                                 Type of Business
   Street Address                                               City and State
   Date Opened                            Date Closed                              Original Loan Amount $
   Current Balance $                                            Purpose

   NAME OF FIRM                                                 Type of Business
   Street Address                                               City and State
   Date Opened                            Date Closed                              Original Loan Amount $
   Current Balance $                                            Purpose

   NAME OF FIRM                                                 Type of Business
   Street Address                                               City and State
   Date Opened                            Date Closed                              Original Loan Amount $
   Current Balance $                                            Purpose

   NAME OF FIRM                                                 Type of Business
   Street Address                                               City and State
   Date Opened                            Date Closed                              Original Loan Amount $
   Current Balance $                                            Purpose


                                                         8
            (Rev. 1/2010)
   NAME OF FIRM                                                    Type of Business
   Street Address                                                  City and State
   Date Opened                            Date Closed                                   Original Loan Amount $
   Current Balance $                                               Purpose

46. Have you ever filed for bankruptcy? Yes            No         If yes, give details, including date and court in which filed:


    a.   Have you ever had property repossessed or turned back to a finance company?                      Yes       No
         If yes, explain:
    b.   Do you now have a good credit rating, referring to paying debts when they are due? Yes                   No
         If no, explain:
    c.   Do you have other unpaid debts (private or other) not listed above? Yes               No         If yes, list them:




    d.   Have you ever been sued or to your knowledge are you about to be sued? Yes                  No         If yes, explain:




    e.   What are your total monthly payments and amounts owed on debts other than living expenses? $
    f.   Have you ever written a check that was returned unpaid to you? Yes              No               If yes, explain:


    g. Have you ever forged a check? Yes          No        If yes, explain:


Work History
47. Are you currently employed? Yes          No
48. Has your employment ever been terminated? Yes                No         If yes, explain:


49. Have you ever quit a job in lieu of being terminated?             Yes       No             If yes, explain:



50. Do you feel you have had good relationships with all former employers? Yes                  No
    If no, explain:


51. Do you know of any reason why you would not be eligible for re-employment by any previous employer, if a
    vacancy existed? Yes         No      If yes, explain


52. Did you ever make false entries on any form or document during any previous employment?
    Yes       No      If yes, explain


53. List present or most recent work experience first including part-time and summer jobs. Include military service in
    proper sequence. (Use additional page(s) as necessary.)

   Employer:                                                                                        Phone #:
   Address:
   Supervisor:                                                     Position Held
   Full time       Part time    Hours per week:                     Salary: $                   From:                  To:


                                                             9
               (Rev. 1/2010)
Duties:
Reason for leaving:


Employer:                                                           Phone #:
Address:
Supervisor:                                        Position Held
Full time       Part time   Hours per week:        Salary: $       From:       To:
Duties:
Reason for leaving:


Employer:                                                           Phone #:
Address:
Supervisor:                                        Position Held
Full time       Part time   Hours per week:        Salary: $       From:       To:
Duties:
Reason for leaving:

Employer:                                                           Phone #:
Address:
Supervisor:                                        Position Held
Full time       Part time   Hours per week:        Salary: $       From:       To:
Duties:
Reason for leaving:


Employer:                                                           Phone #:
Address:
Supervisor:                                        Position Held
Full time       Part time   Hours per week:        Salary: $       From:       To:
Duties:
Reason for leaving:

Employer:                                                           Phone #:
Address:
Supervisor:                                        Position Held
Full time       Part time   Hours per week:        Salary: $       From:       To:
Duties:
Reason for leaving:

Employer:                                                           Phone #:
Address:
Supervisor:                                        Position Held
Full time       Part time   Hours per week:        Salary: $       From:       To:
Duties:
Reason for leaving:

                                              10
            (Rev. 1/2010)
Employer:                                                               Phone #:
Address:
Supervisor:                                          Position Held
Full time       Part time   Hours per week:          Salary: $         From:       To:
Duties:
Reason for leaving:


Employer:                                                               Phone #:
Address:
Supervisor:                                          Position Held
Full time       Part time   Hours per week:          Salary: $         From:       To:
Duties:
Reason for leaving:


                                 USE ADDITIONAL PAGE(S) AS NECESSARY




                                                11
            (Rev. 1/2010)
54. Provide the names of five persons not related to you and not former employers, who have known you for at least
    five years and can attest to your character, ability, personality, and other qualities.


   Name:                                                                     Phone (     )

   Home Address:

   Years Known                   Name of Business                            Business Phone: (       )

   Business Address:



   Name:                                                                     Phone (     )

   Home Address:

   Years Known                   Name of Business                            Business Phone: (       )

   Business Address:



   Name:                                                                     Phone (     )

   Home Address:

   Years Known                   Name of Business                            Business Phone: (       )

   Business Address:



   Name:                                                                     Phone (     )

   Home Address:

   Years Known                   Name of Business                            Business Phone: (       )

   Business Address:



   Name:                                                                     Phone (     )

   Home Address:

   Years Known                   Name of Business                            Business Phone: (       )

   Business Address:


                                       REMAINDER OF PAGE LEFT BLANK




                                                      12
           (Rev. 1/2010)
I,
            Print or type full name:          (First, Middle Initial, Last)

having completed this supplemental application, hereby swear that there are no willful falsifications,

misrepresentations or material omissions in the preceding statements and answers to questions. I am aware that

should an investigation disclose such willful falsifications, misrepresentations or material omissions, my application

will be rejected and I may be disqualified from applying in the future for any position in the Division of Law

Enforcement. If, after my acceptance of employment, subsequent investigation should disclose willful falsifications,

misrepresentations or material omissions, I may be immediately dismissed. I have enclosed all requested

documents with this application.



Signature                                                                     Date




                                                  ATTACH RECENT

                                                    PHOTOGRAPH

                                                           HERE

                                               (No larger than 2" X 3")




                                                           13
      (Rev. 1/2010)
                               FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
                                          DIVISION OF LAW ENFORCEMENT
                                     3900 COMMONWEALTH BOULEVARD, MS 600
                                         TALLAHASSEE, FLORIDA 32399-3000

                                             PERSONAL INQUIRY WAIVER
                                           Authority for Release of Information

To: Concerned Person or Authorized Representative of Any Organization, Institution, or Repository of Records.

APPLICANT'S FULL NAME:

DATE OF BIRTH                                    SOCIAL SECURITY NUMBER


I authorize you to furnish the Florida Department of Environmental Protection, Division of Law Enforcement any and all
information that you may have concerning my work record, school record, military record, and reputation. This information is
to be used to assist the Department in determining my qualifications and fitness for the position I am seeking.

I am seeking a position of:       Sworn Law Enforcement                      Non-Sworn Law Enforcement

If sworn law enforcement, please include all information of a privileged nature and copies of same if requested.
I hereby release you, your staff and organization from any liability or damage that may result from furnishing the requested
information. I hereby acknowledge that I have read and fully understand this Personal Inquiry Waiver Form. I voluntarily give
my consent for the release of the described records and information.



   Applicant's Signature                                                     Date



    Address


                                                          AFFIDAVIT

STATE OF

COUNTY OF

Before me personally appeared the above named applicant,
who is personally known to me or who has exhibited to me a reliable form of identification issued within the past five (5) years,
to wit:
                                                       (exact type of identification relied upon).

Sworn to and subscribed in my presence this                         day of                          , 20
An oath was not taken.

My commission expires:
                                                                               Notary Public Signature



                                                                                Notary Seal:


                                                      ATTACHMENT 1



               (Rev. 6/2009)
                  FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
                             DIVISION OF LAW ENFORCEMENT
                        3900 COMMONWEALTH BOULEVARD, MS 600
                            TALLAHASSEE, FLORIDA 32399-3000



                                 CERTIFICATE OF NON-MILITARY SERVICE


This is to certify that I have not served in the United States military forces and therefore do not
                                    possess a DD-214 Certificate.




     Applicant’s Name (please print)                                 Social Security Number




                                            Applicant’s Signature




                                           ATTACHMENT 2




     (Rev. 6/2009)
(Rev. 6/2009)

				
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