Application Packet

Transcription

Application Packet

Criminal Justice Selection Center
Law Enforcement
Application Packet
Revised August 2015
Criminal Justice | Emergency Medical Services | Aviation Science | Fire Science
3737 N.E. 39th Avenue • Gainesville, FL 32609
Office 352.271.2945 • Fax 352.271.2938
www.policecareers.org
www.sfcollege.edu
Notice of Equal Access/Equal Opportunity and
Nondiscrimination
Santa Fe College is committed to an environment that embraces diversity, respects the rights of all
individuals, is open and accessible, and is free of harassment and discrimination based on, but not
limited to, ethnicity, race, creed, color, religion, age, disability, sex, marital status, national origin,
political opinions or affiliations, veteran status, and genetic information. The College does not
discriminate in its programs and activities, including employment and admissions.
In particular, Title IX of the Education Amendments of 1972 (20 U.S.C. § 1681) is an all-encompassing
federal law that prohibits discrimination based on the sex of students, employees, and third parties when
appropriate, of educational institutions which receive federal financial assistance. Sexual harassment of
students, which includes acts of sexual violence, is a form of sex discrimination prohibited by Title IX.
Santa Fe College complies with all aspects of this and other federal and state laws regarding nondiscrimination.
Title II of the Genetic Information Nondiscrimination Act of 2008 protects applicants and employees from
discrimination based on genetic information in hiring, promotion, discharge, pay, fringe benefits, job
training, classification, referral, and other aspects of employment. GINA also restricts employers'
acquisition of genetic information and strictly limits disclosure of genetic information. Genetic information
includes information about genetic tests of applicants, employees, or their family members; the
manifestation of diseases or disorders in family members (family medical history); and requests for or
receipt of genetic services by applicants, employees, or their family members.
Anyone with questions about compliance or a complaint regarding harassment or discrimination,
including sexual harassment and sexual violence as a violation of Title IX, should contact the College's
Equal Access/Equal Opportunity Coordinator using the following contact information:
Lela Frye, Equal Access/Equal Opportunity Coordinator
3000 NW 83rd Street, R-Annex, Room 105, Gainesville, Florida 32606
(352) 395-5420
[email protected]
Santa Fe College's Board Rule 2.8 and procedure 2.8P define its policy prohibiting discrimination and
harassment and its grievance procedures for such complaints.
BRC Program Awareness Survey
Please let us know how you heard about the Police Academy. You may
check more than one.
Radio Station
Country 103.7 - The Gator - WRUF-FM
WKTK-FM 98.5
KISS 105.3 FM
Magic 101 - WTMG FM
The Buzz - WHHZ FM 100.5
________________________
Other
College Advisor
Already aware of the program
Friends/Co-Workers
Web/Internet searches
Gainesville Health & Fitness Center
Career fair _____________________________________________
Agency
_____________________________________________
Other
_____________________________________________
12122014A
Santa Fe College Admission Process MUST be complete in
order to submit your application to the Law Enforcement
Academy.
Step 1
Obtain your Santa Fe ID by starting your application
process http://www.sfcollege.edu/admissions/
Step 2
Once you have your Santa Fe ID continue your
Admission Process through
eSantaFe. https://ss2.sfcollege.edu/eSantaFe.
o Law Enforcement Program Code – VC7702
o Corrections Program Code – VC7705
Step 3
Print your eSantaFe notification that shows you may
now register for classes.
Step 4
Download and complete your application
online, www.policecareers.org, print the application
and bring it in person together with all the required
documents.
INCOMPLETE AND HAND WRITTEN APPLICATIONS WILL
NOT BE ACCEPTED.
Required Documents Check List
All documents are required at the time of the submission of application.
Incomplete applications will not be accepted
Complete and submit application in person. Application can be downloaded
from www.policecareers.org
HAND WRITTEN APPLICATION WILL NOT BE ACCEPTED.
Santa Fe ID #
A RECENT 2” x 2” full-color, head and shoulders photo (for background
purposes only).
Copy of Official birth certificate (issued by the Bureau of Vital Statistics)
Photocopy of high school diploma, OR GED Certificate and Scores (if
applicable)
A certified high school transcript must be sent from the school directly to
Santa Fe College, Institute of Public Safety, Criminal Justice Selection Center,
3737 NE 39th Avenue, Gainesville FL 32609
Photocopy of your college diploma (if applicable) AND a certified copy of
college transcripts for any courses taken. The transcript must be sent from the
school directly to the Criminal Justice Selection Center
Photocopy of your Florida driver’s license
Photocopy of your social security card
Naturalization Documents (if applicable). Do not copy; bring originals for the
Selection Center to copy
Photocopy of any name change documents (if applicable), i.e. Marriage
License, Dissolution of Marriage, Legal name Change, Adoption Papers
Photocopy of your Military Discharge Papers (DD 214 long form) for each tour
of duty or Attestation of Non-Service
Documentation of Court Disposition of Charges must be submitted with
application
NOTE: Law Enforcement Program Code – VC7702
Corrections Program Code – VC7705
Dear Candidate:
The Criminal Justice Selection Center is responsible for screening applicants to determine qualification
into law enforcement positions and entrance into the Law Enforcement or Corrections Academy.
Please read this cover letter and go over your packet carefully and thoroughly. Be sure to read the
enclosed list of Basic Qualifications very carefully.
Please type all information, making sure that all answers are legible. Your application cannot be
completely processed if the information is not legible. Please ensure that all questions on your
application are completely and accurately answered. You should be aware that when submitting this
application, local area law enforcement and correctional agencies have access to your application.
These agencies include, but may not be limited to, the Alachua County Sheriff’s Office, the Gainesville
Police Department and the Santa Fe College Police Department.
Make sure to complete all areas of the application. If a section does not apply to you, mark it “N/A”. In
the sections of Residence/Landlord Information and Employment History make sure that all listed
information is included. It is not our responsibility to look up this information – if you do not include
the necessary information we will return your application to you for completion.
Arrest and Drug History Sections – it is especially important that you complete these portions
completely and truthfully. Any problems that you may have in your background can be discussed with
our background investigator. Omissions, or dishonesty, will potentially disqualify you from the academy
or from employment as a law enforcement officer in the State of Florida.
The information provided in this application is essentially the same as that required by agencies for
employment. WE STRONGLY SUGGEST THAT YOU MAKE A COPY OF THIS APPLICATION FOR YOUR
RECORDS. Many agencies will request a copy of our application after you’ve applied to their agency.
Your Application along with the notarized documents and the application fee should be returned, in
person, to be considered for the next scheduled academy. In accordance with Section 943.14, F.S., “a
complete set of fingerprints must be taken by an employee of the Criminal Justice Selection Center.”
For fingerprint purposes, bring your photo ID with you when submitting your application. Applications
are accepted from 8:30 – 11:00 am, and from 1:00-3:30 pm. Plan on being at our office for
approximately thirty minutes to complete the process. When you return your application, you will be
given the dates for the next scheduled testing process.
Candidate positions in the Law Enforcement and Corrections Academy will be based on screening
process results. All applications must be submitted on or before the deadline.
Candidates that are not accepted can re-submit an application for a future academy and will be
subjected to the current application fee.
3737 N.E. 39th Avenue • Gainesville, FL 32609
Office 352.271.2945 • Fax 352.271.2938 •
www.sfcollege.edu
Fees are non-refundable and are due with your Application, either by cashier’s check or money order
made payable to Santa Fe College (no personal checks or cash will be accepted). Please write your name
and SF College student identification number or social security number on your cashier’s check or
money order. We also accept AmEx, Discover, MC and Visa.
Fee Schedule:
Application Fee
Out of State
$125
$225
Background Investigation: A thorough background investigation will be conducted to include drug use,
previous employment, military history, fingerprint check and criminal and driver’s license histories.
Failure to answer all questions on your application may delay entrance into the Institute of Public Safety.
Submission of your signed and notarized Applicant Authorization, Applicant Certification and the CJSTC
Form 58 enables us to begin your background investigation.
We feel it is necessary to inform you that SEALED OR EXPUNGED RECORDS (refer to Florida State
Statute Section 943.059(4)(a) and Section 943.0585(4)(a) ), may or may not be reported to us
during your background check. These records will, however, be reported to hiring agencies. You
must reveal any information of this nature to us. This could restrict your ability to be hired on by
an agency, even if you complete the academy. It is possible that a student who has a sealed or
expunged record they have not disclosed to the training school may complete the training and
may not be eligible for employment or appointment as a criminal justice officer.
Medical Clearance: You will need to have your physician submit a signed FDLE CJSTC 75B-Physicians
Form and Physical Training Program Plan attesting that no medical condition exists which would
preclude you from participating in the Physical Training (PT) and Defensive Tactics (DT) that are required
of academy candidates. No one will be permitted to participate in Testing without this form on file with
the Selection Center. Any costs incurred in order to obtain medical clearance are the sole
responsibility of the applicant and are not covered by the processing fee.
Standard Form 180 - Please complete all of Section I and write the year(s) of separation on the first line
of Section II on your SF180, Request Pertaining to Military Records (if applicable) and return it with your
application. If you have not served in the military, please complete the enclosed Affidavit of No Military
Service, have it notarized, and return it with your application. You must complete, sign, and return
either the Request Pertaining to Military Records or the Affidavit of No Military Service.
Please be aware that the candidate evaluation process is time consuming. If your selection process is
interrupted for any reason, i.e., test results, background discrepancies, untimely submission of
paperwork, we will notify you as soon as possible. Therefore, IT IS IMPERATIVE THAT YOU KEEP US
INFORMED OF ANY CHANGES TO YOUR APPLICATION, SUCH AS ADDRESS, TELEPHONE NUMBERS,
AND/OR E-MAIL. You will be contacted regarding your acceptance/non-acceptance into the academy
approximately three weeks prior to the starting date.
Page 2 of 4
What Comes Next?
You will be provided a Schedule of Dates. In order to be considered for the next scheduled Law
Enforcement Officer Academy you must comply with these requirements.
Keep the Schedule of Dates in a place where you will be able to refer to it.
1. FBAT (Cognitive Testing): You will be required to take an examination to determine your cognitive
skills, as well as reading skills.
FBAT (Florida Basic Abilities Test)
This is a multiple choice, written exam which tests the abilities identified as important for the successful
performance of the entry-level law enforcement officer. These abilities include:
Verbal Comprehension: Understanding the meaning of words or ideas.
Associative Memory: Such as memorizing information from wanted posters that requires later recall
and the information does not necessarily have a logical relationship.
Memory for Relationships: Such as step by step instructions and operating procedures used in filling
out an incident report.
Memory for Ideas: Such as reading and understanding the main ideas and themes from police academy
training materials.
Semantic Ordering: For example, an officer, when arriving at a crime scene, is required to make
decisions on what order he/she should set about to accomplish the necessary tasks.
Identifying Themes and Ideas: Reading material and making inferences and inducing certain
issues/hypotheses from that information typically required of an officer in attempting to solve a
crime.
Problem Sensitivity: For example, officers are constantly required to make decisions on what action to
take (i.e., choosing between backing up another officer or stopping a traffic violator).
Observational Judgment: Such as when observing an accident scene, an officer is required to “sift”
through the information, visually and verbally, in order to determine what is relevant and important.
Spatial Orientation: For example, an officer is required to draw sketches of traffic accidents and in
doing so must be able to visualize the placement of cars and directions in order to accurately depict
the accident.
Spatial Scanning: Such as finding one’s way through a paper maze, requiring quick scanning of the field
for openings, following paths with the eye, and quickly rejecting false leads such as determining the
quickest route to take to get to a crime scene.
Visualization: For example, an officer may not have a recent picture of a wanted felon but must be able
to visualize this felon with possible physical changes.
Page 3 of 4
2. Drug Testing: When you return your application, you will be given the Drug Screen Referral Form
and information on where and when to report for your drug screen.
Before Going to the Collection Site
Taking a drug test is part of many hiring/application processes. Being asked to take a drug test does not
mean you are suspected of being on drugs. Drug testing is done to insure that the workplace remains drug
free.
The Criminal Justice Selection Center will arrange for you to go to a Diagnostic Lab and give a urine
specimen. Personnel at the clinic are thoroughly trained in collecting urine for drug testing.
You should go to the clinic ONLY during the time period you are scheduled. You will be asked to show a
photo ID.
Please inform the clinic personnel that you are there to drug test for Santa Fe College Police Academy,
and provide them the referral form that was given to you.
It is very important that each part of your screening be done by the specified
deadline.
Page 4 of 4
Law Enforcement Program – VC7702
Corrections Program – VC7705
Type of Award
PSAV - Post Secondary Adult Vocational Certificate
Program Website
http://www.sfcollege.edu/centers/kirkpatrick/
Program
Description
The Law Enforcement Academy is a limited access program governed by the Florida Criminal Justice
Standards and Training Commission and the Florida Department of Law Enforcement.
The Law Enforcement Basic Recruit Training prepares students as entry-level law enforcement officers in
the State of Florida. Practical skills and simulated activities complement the classroom instruction. Upon
successful completion, students are eligible to take the Florida Department of Law Enforcement State
Certification Examination (SOCE). This minimum standards class is regulated by Florida statutes and is a
highly structured and disciplined program with special rules, policies and procedures.
Program Length
LE - Total program hours: 770
Employment
Opportunities
The Law Enforcement Officer Program provides eligibility for certification as a Florida law enforcement
officer.
Application
Qualifications
In order to comply with the provisions of Section 943.13, Florida Statutes, the following qualifications
are required for the position of law enforcement officer:
 You must be at least 19 years of age.
 You must be a citizen of the United States.
 You must have earned a high school diploma or equivalent (GED) as the commission has defined
the term by rule. Certified transcripts required.
 You must not have been convicted of any felony, or misdemeanor involving perjury or false
statement, nor have received a dishonorable or undesirable discharge from any of the Armed Forces
of the United States.
 Any person who, after July 1, 1981, pleads guilty or nolo contendere to or is found guilty of a felony
or of a misdemeanor involving perjury or false statement shall not be eligible for employment or
appointment as an officer, notwithstanding suspension of sentence or withholding of adjudication.
Notwithstanding this subsection, any person who has pled nolo contendere to a misdemeanor
involving a false statement, prior to December 1, 1985, and has had such record sealed or expunged
shall not be deemed ineligible for employment or appointment as an officer.
 Federal Law prohibits any individual who has been convicted of a domestic violence charge (felony
or misdemeanor) from carrying a firearm. This law prohibits an individual with such a conviction
from becoming a law enforcement officer.
 Documentation of Court Disposition of Charges must be submitted with application
 A thorough background investigation will be part of the process. You must be of good moral
character, if you are unsure of what constitutes a moral character violation, please call our office,
352-271-2939 or 271-2945.
 Must possess a valid Florida Driver’s license. Candidates with valid out of state licenses must obtain
a Florida driver’s license before the start of the academy.
 Your submission of this application carries the understanding that you are authorizing the Criminal
Justice Selection Center at Santa Fe College to contact any and all available sources for the purpose
of obtaining information as to your qualifications.
 Must Complete the Criminal Justice Selection Center Testing or be sponsored by a law enforcement
agency.
 Must Complete basic recruit training.
 Must Pass the State Licensure exam.
Completion
Requirements
Statewide Examination and Failure
At the completion of academic training, the applicant must file with CJSTC to take the statewide
certification examination (SOCE). The test will be developed and administered by CJSTC. A total of three
attempts will be permitted. Failure of the third re-test will necessitate repeating the complete academy
training program.
Location
Kirkpatrick Criminal Justice Training Center, 3737 NE 39th Ave., Gainesville, FL 32609
Financial Aid
http://www.sfcollege.edu/financialaid/
Advising
Louis Kalivoda, [email protected], 352-271-2925
For More
Information
Criminal Justice Selection Center 352-271-2945
APPLICANT AUTHORIZATION
I, ___________________________________, SFC ID# ______________, do hereby authorize Santa Fe College to
release copies of any and all student records held by the College to any of my past, present or future employing or
sponsoring agencies and to the Criminal Justice Standards and Training Commission. Student records include but
are not limited to information related to grades, transcripts, disciplinary actions, attendance, participation or
performance in training or educational programs, evidence of misconduct or safety violations, and any other
information maintained by the College that pertains to me.
I HEREBY AUTHORIZE the Criminal Justice Selection Center at Santa Fe College to conduct a thorough investigation
of my character, reputation, past employment, and medical history. Accordingly, I authorize these parties having
knowledge of my past (including financial and credit records) to cooperate in this procedure by releasing
information as requested. I respectfully request that former employers furnish the necessary information
concerning my employment with their organization, and I hereby release them from any and all liability for
damages for providing the information requested.
I do authorize the Criminal Justice Selection Center at Santa Fe College to release all portions of my assessment file
(including background information) to any law enforcement or corrections agency for the purpose of prospective
employment. I do acknowledge and accept that under Florida law any information, with the exception of medical,
criminal history, and test results, will become public record upon receipt by the Criminal Justice Selection Center,
pursuant to Chapter 119, Florida statutes; and I hereby waive any rights or claims I may have, whether presently
fully developed or not, against Santa Fe College, the Criminal Justice Institute of Public Safety and the Criminal
Justice Selection Center at Santa Fe College, the County of Alachua, the City of Gainesville, the Alachua County
Sheriff’s Office, Gainesville Police Department, or any of the above agents or employees, arising out of, or resulting
from the release, authorized or unauthorized, of the information received pursuant to or in connection with the
Selection Center’s handling, processing, investigation, etc. of my application for employment. I also acknowledge
and accept that I will NOT be privy to the information retained by the Criminal Justice Selection Center in the
background investigation section of my file.
Applicant Signature
Date
Applicant’s Printed Name
State of
County of
The foregoing instrument was acknowledged before me this
, who is personally known to me or has produced
as identification.
Notary Signature
th
3737 N.E. 39 Avenue • Gainesville, FL 32609
Office 352.271.2945 • Fax 352.271.2938
www.sfcollege.edu
(date) by
APPLICANT CERTIFICATION
I understand that by executing this document I am attesting that I meet the qualifications as specified. I
HEREBY CERTIFY that I have read my application, and it is true and correct, and all other information I
will furnish in conjunction with my application, is true and correct.
I HEREBY SWEAR OR AFFIRM that this application contains no misrepresentations or falsifications,
omissions, or concealment of material fact, and that information given by me is true and complete to
the best of my knowledge and belief. I am aware that statements made by me on this application are
subject to later investigation. I am further aware that should any investigation disclose any such
misrepresentation, falsification, omission, or concealment of material fact, my application may be
rejected and my name removed from any eligibility list; and if already selected, I may be dismissed from
the screening process and/or the academy class. I also understand that failure to comply with or
complete any portion of the testing, examination, or other application process may result in my
application being rejected or suspended, and my name removed from any eligibility list; and if already in
the academy class, I may be dismissed. I further understand that nothing in this application constitutes a
promise of commitment, nor has any other promise or commitment been made to me by the Criminal
Justice Selection Center at Santa Fe College as to a time when hiring will take place, when a decision on
hiring will take place or whether I will, in fact, be hired.
NOTICE TO APPLICANTS: This document shall constitute an official statement within the purview of
Section 837.06, Florida Statutes, and is subject to verification by the employing agency and/or Criminal
Justice Standards and Training Commission. Any intentional omission when submitting this application
or false execution of this affidavit shall constitute a misdemeanor of the second degree and may
disqualify you from employment as a law enforcement officer in the State of Florida.
Applicant Signature
Date
Applicant’s Printed Name
State of
County of
(date) by
, who is personally known to me or has produced
as identification.
Notary Signature
th
Office 352.271.2945 • Fax 352.271.2938
www.sfcollege.edu
AFFIDAVIT
NO MILITARY SERVICE
I,
, do hereby swear (or affirm) that I have never served in
any branch of the Armed Forces of the United States of America.
Signature
STATE OF
COUNTY OF
_______
of
,
, ____ by
personally known to me or who has produced
identification.
Notary's Signature
Notary's Name (printed or typed)
Seal:
who
as
day
is
✔
Certified DD214 with RE codes, SPN codes, and explanation, Article 15's and Court Martial records.
✔
✔
Robert Dolan, Associate Director
Institute of Public Safety - 3737 NE 39th Avenue
Gainesville
FL
32609
PHYSICAL FITNESS ASSESSMENT
1.
Applicant’s Name:
2.
Applicant’s Address:
3.
Enter Last Four Digits of Social Security Number:
4.
Training School: Sana Fe College Institute of Public Safety
5.
The Applicant Is Requesting Admission Into a Basic Recruit Training Program for One of the Following Disciplines:
Last
Law Enforcement
6.
CJSTC
75B
Incorporated by Reference in Rule 11B-35.001(10)(d)14., F.A.C.
Florida Department of
Law Enforcement
First
Correctional
MI
Correctional Probation
Student Participation in Basic Recruit Training Program Activities. A student enrolled in a basic recruit training program (BRTP) is required to participate in the following
activities:
A.
Defensive tactics and firearms high-liability training is a component of the curriculum mandated by the Criminal Justice Standards and Training Commission. Firearms
training requires firing a handgun and long gun creating exposure to lead. Defensive tactics training requires sustained physical exertion and chemical agent contamination
to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS).
B.
Physical Fitness Conditioning and Physical Fitness Testing: A BRTP student shall participate in physical fitness conditioning and a fitness test and includes the
following measures:
 Vertical Jump
C.
 One Minute Sit Ups
 300 Meter Run
 Maximum Push Ups
 1.5 Mile Run/Walk
The training center director has attached the training schools physical fitness conditioning program: Yes ✔
**********TO BE COMPLETED BY THE APPLICANT*********
7.
Medical Conditions Regarding OC/CS Contamination. A BRTP student should be aware of the following personal considerations that may restrict participation in the chemical
agent contamination of the BRTP and could possibly be aggravated to a severe degree during the contamination: Recent eye surgery, heart problems, panic disorder or stress,
respiratory disorder, emphysema (loss of elasticity/thinning of lung tissues), bronchial asthma, x-ray evidence of pneumoconiosis (black lung), evidence of reduced pulmonary
(lung) function, chronic obstructive pulmonary disease, coronary (heart) artery disease, cerebral (brain) blood vessel disease, severe or progressive hypertension (high blood
pressure), epilepsy, grand mal or petite mal (seizures), pernicious anemia (severe reduction in red blood cells), diabetes (any form), pueumomediastinum gap (air in the sac
surrounding lungs), history of skin allergies, or any condition for which the student is presently taking medication.
8.
BRTP Student Certification. I certify that I have reviewed the above information and
I do or
participating in the basic recruit training program activities outlined in item numbers 6, 6A, and 6B above.
9.
Student’s Printed Name:
10.
Student’s Signature:
11.
Prior Exposure to OC or CS. For a student who has had prior chemical agent exposure that includes chemical agent contamination and working through the effects of chemical
agent contamination in a training environment, please attach the supporting documentation of prior exposure and check one of the following boxes:
I certify that I have
OR I have not
been exposed to oleo-resin capsicum (OC) and/or orthochlorobenzal-malononitrile (CS) in the manner described in item
number 11 above.
do not have any medical restrictions that would prevent me from
Date:
**********TO BE COMPLETED BY THE EXAMINING PHYSICIAN*********
12.
Physician Attestment. The above applicant is seeking entry into a law enforcement, correctional, or correctional probation basic recruit training program.
Rule 11B-35.001(14)(b), F.A.C., requires a complete physical examination at a level of specificity sufficient to determine whether there are any medical or physiological restrictions
that would prevent the applicant from performing the required activities described in items 6, 6A, and 6B above. Disabilities, impairment, or limitations identified by the examination
that would prevent the applicant from performing the required activities should be reported to the training school indicated in item number 4 above.
I hereby attest that I have examined the above named applicant and find him or her CAPABLE of participating in the basic recruit training program activities indicated in item
numbers 6, 6A, and 6B above.
I hereby attest that I have examined the above named applicant and find him or her NOT CAPABLE of participating in the basic recruit training program activities indicated in
item numbers 6, 6A, and 6B above.
13.
Physician, Certified Advanced Registered
Nurse Practitioner, or Physician Assistant’s Signature
14.
15.
Printed Name
Examination Date
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s License Number
Licensing State
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s Professional Address
**********TO BE COMPLETED BY THE TRAINING CENTER DIRECTOR OR DESIGNEE*********
16.
Training Center Director or Designee’s Printed Name: Robert Dolan - Training Center Director
Training Center Director or Designee’s Signature:
Created 11/8/2007
Training School: Original
Date:
Agency: Copy
1 of 2
Applicant: Copy
Commission-Approved: 11/6/2014
Form Effective Date: 7/2015
Applicant’s Name: _________________________________________________
Basic Recruit Physical Training Program Plan
Recruits are required to perform certain physical training tasks to increase their physical fitness and
cardiovascular health. These physical fitness tasks are designed to help the recruit perform on the CJSTC Physical
Fitness Course Performance test. This test is given at the beginning and the end of the physical fitness course.
Physical fitness sessions are performed in 2-hour blocks and are designed to increase the recruits’ total physical
fitness level in the following areas:
A. Muscular endurance / strength
B. Flexibility
C. Cardio-respiratory endurance
Calisthenics are used to increase the recruits muscular endurance and strength, to include the following:
A. Push-ups
B. Sit-ups
C. Leg lifts
D. Lunges
E. Circuit Training
F. Pull-ups
Stretching is done before and after physical training to increase the recruits’ flexibility and to help prevent injury.
The following aerobic activities are used to increase the recruits’ cardio-respiratory endurance:
A. Running:
a. Starting with 1 mile increasing to 2 or 3 miles.
b. Interval training
c. Sprints
B. Basketball
C. Volleyball – also used to increase vertical leap and muscular endurance
D. Physical Agility Course
In addition the testing by CJSTC Rule includes:
A. Measuring vertical jump
B. Number of sit-ups in one minute
C. 300 meter sprint
D. Number of push-ups in one minute
E. 1.5 mile run / walk
Recruits should be in a level of physical condition that allows them to take part in the above listed activities.
Print Doctor’s Name
Doctor’s Signature
th
Office 352.271.2945 • Fax 352.271.2938
www.sfcollege.edu
Date
INSTRUCTIONS FOR COMPLETING FORM CJSTC-75B
A basic recruit student approved to enter a basic recruit training program (BRTP) shall review and complete form CJSTC-75B to indicate the presence of any medical conditions that may
prevent participation in the Physical Fitness Program and Chemical Agent Contamination of the BRTP. A copy of the Physical Fitness Program for law enforcement, correctional, or
correctional probation discipline shall be attached to this form for the student to review.
1.
Applicant’s Name. Enter the applicant’s last name, first name, and middle initial.
2.
Applicant’s Address. Enter the applicant’s current address, city, state, and zip code.
3.
Applicant’s Social Security Number. Enter the last four digits of the applicant’s social security number as in this example: 000-00-1234.
4.
Training School Name. Enter the name of the Commission-certified criminal justice training school where the applicant is enrolled.
5.
Basic Recruit Training Program Discipline. Place a check mark in one of the box(es) for the law enforcement, correctional, or correctional probation discipline for which the
applicant is requesting admission.
6.
Student Participation in Basic Recruit Training Program Activities. Defensive Tactics (includes chemical agent contamination), Firearms, and Physical Fitness
Conditioning and Physical Fitness Testing: High-liability training in defensive tactics, firearms, and chemical agent contamination is a component of the curriculum mandated
by the Criminal Justice Standards and Training Commission and participation in the activities is a requirement for successfully completing a BRTP. There is no pass or fail at this
time. The test results for each of the five required tests will be recorded on the Academy Physical Fitness Standards Report, form CJSTC-67A as “I” if the student did not perform
the test component or “D” if the student was dismissed from the basic recruit training program.
A.
Defensive Tactics and Firearms Training. Firearms training requires firing a handgun and long gun creating exposure to lead. Defensive tactics training requires
sustained physical exertion and chemical agent contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS).
B.
Physical Fitness Conditioning and Physical Fitness Testing. The Physical Fitness Test includes the following measures and are defined as follows:
C.

Vertical Jump. This measures leg power by measuring how high a person jumps.

One Minute Sit Ups. This measures abdominal, or trunk, muscular endurance. While lying on his or her back, the student will be given one minute to do as many
bent-leg sit ups as possible.

300 Meter Run. This measures anaerobic power, or the ability to make an intense burst of effort for a short time period or distance. This component consists of
sprinting 300 meters as fast as possible.

Maximum Push Ups. This measures the muscular endurance of the upper body. This component consists of doing as many push ups as possible until muscular
failure. Males are required to perform the standard push-up and females have the option to perform the standard or modified push-up.

1.5 Mile Run/Walk. This measures aerobic power or cardiovascular endurance (stamina over time). To complete this component, the student runs or walks a distance
of 1.5 miles as fast as possible.
A physical fitness conditioning program developed by the training school shall be attached to form CJSTC-75B prior to the student’s examination by a physician,
certified advanced registered nurse practitioner, or the physician’s assistant.
7.
Medical Conditions Regarding Chemical Agent Contamination. The student shall review the listed medical conditions and list other conditions that may restrict him or her from
participating in Chemical Agent Contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS).
8.
Basic Recruit Training Program Activities Certification. The student shall check the appropriate box to indicate if he or she does or does not have a medical condition that
would restrict participation in the BRTP activities indicated in item numbers 6, 6A, and 6B of this form.
9.
Student’s Printed Name. The student shall print his or her first name, last name, and middle initial.
10.
Student’s Signature and Date. The student shall provide a signature and date to verify the information provided by the student is true and correct.
11.
Prior Exposure to Chemical Agent Contamination. The student shall Indicate in the appropriate box if he or she has been previously exposed to chemical agent contamination
to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS), and shall attach supporting documentation of such contamination.
12.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s Attestment. The physician shall check the appropriate box to indicate if the student is
capable or not capable of participating in the BRTP activities indicated in item numbers 6, 6A, and 6B of this form.
13.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s Signature, Printed Name, and Examination Date. The physician shall complete this
item to verify his or her attestment to item number 12 of this form.
14.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s License Number and Licensing State. The physician shall complete this item to
verify his or her valid license number and licensing state.
15.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s Professional Address. The physician shall print his or her complete professional
address.
16.
Training Center Director or Designee’s Printed Name, Signature and Date. The training center director or designee who signs this form shall print his or her legal first and last
name. The training center director or designee shall sign and date this form.
FORM CJSTC-75B
Page 2 of 2
For official Use Only
Date Received:
Reviewed by:
Please ensure that all questions are answered completely, accurately, and truthfully. If any item does not
pertain to you, please answer "N/A" (not applicable). Keep in mind that all information will be checked and
verified. Misstatements, falsifications or omissions may delay/suspend entrance into the Institute of
Public Safety.
Date:
SF Student #:
PERSONAL HISTORY:
The questions below will not be used to determine eligibility for admission to the academy. The information
given will only be used to conduct a background/criminal history investigation.
Full legal name:
___________________________________________________________________________________________
Last Name
First
Date of Birth:
Middle
Maiden
Social Security Number:
mm/dd/yyyy
Sex:
Race: White Black Hispanic Asian Other __ ___ Height ____ _ Weight ______ Eyes _____ Hair ______
Do you have a valid driver’s license?
If yes, provide the following information:
Current Driver’s License Number
Class
___________________
YES
NO
_______________________________
State _____________________
Expiration Date _________________
mm/dd/yyyy
E-mail: _________________________________________
Applicant's Current Street Address:
___________________________________________________________________________________________
Address
___________________________________________________________________________________________
City
County
State
Zip Code
___________________________________________________________________________________________
Home Telephone
Cell Telephone
Mailing Address (If different from above):
___________________________________________________________________________________________
Address
Apt. #
___________________________________________________________________________________________
City
County
State
Zip Code
Have you previously submitted an application to any other law enforcement agency or LE academy?
YES
NO
If yes, when and where?
mm/dd/yyyy
Where?
Do you have any family members employed/retired in LE?
If yes, list: __________________________________________
Name
_____________________________________
Relationship
_________________________________
phone #
__________________________________________
Page 1 of 20
agency
Birth /Citizenship Information:
Are you a citizen of the United States?
Yes
City of Birth:
No
County of Birth:
State of Birth:
Country of Birth:
Have you ever renounced your United States Citizenship?
YES
NO
What is your official state & country of residence?
List all other names you have used. Please include former names, aliases, maiden name, etc.
Please indicate reason for the other names you have used:
___________________________________________________________________________________________
Last Name
First
Middle
(Reason)
___________________________________________________________________________________________
Last Name
First
Middle
(Reason)
___________________________________________________________________________________________
Last Name
First
Middle
(Reason)
Additional Personal Information:
Have you ever taken a polygraph examination?
If yes, indicate where, when and why you took it.
YES
NO
________________________________________________________________________________________________
Have you ever been fingerprinted for any reason? (Other than for this application)
(arrest, job application, military, security clearance, etc.) If yes, please provide details:
YES
NO
_______________________________________________________________________________________________
Are you now able to participate in defensive tactics, firearms, or physical training, operation of a motor vehicle,
or otherwise perform the duties set forth in the job description or task analysis related to the training for which
you are applying?
YES
NO
If your answer to the above is no, would you be able to perform these tasks with an accommodation?
YES
NO
If yes, please suggest the accommodation__________________________________
___________________________________________________________________________________________
Marital Status:
Married
Single
Widowed
Page 2 of 20
Divorced
EDUCATON
HIGH SCHOOL EDUCATION: (Please note if you earned a GED.)
High School Name, City, State
From
Mm/yyyy
To
Mm/yyyy
Years
Did You
Completed Graduate?
Type of
Diploma
COLLEGE EDUCATION: (Degree programs only)
College/University Name/City, State
From
Mm/yyyy
To
Mm/yyyy
Did You
Graduate?
Completed Degree Awarded
Credits
or Sought
Describe any awards, honors, citations, positions held in school organizations, and any other special recognition
you received while attending school:
___________________________________________________________________________________________
Describe any special abilities, interests, and hobbies including the degree of proficiency:
___________________________________________________________________________________________
Indicate any type of special license such as pilot, radio operator, etc., showing licensing authority, where the
license was first issued, and date current license expires (except vehicle operator's license):
___________________________________________________________________________________________
Indicate any special skills you possess and equipment you can use which may be related to law enforcement
work. (For example: two-way radio communications, Breathalyzer, speed detection equipment, firearms,
computers):
___________________________________________________________________________________________
___________________________________________________________________________________________
Page 3 of 20
RESIDENCE/LANDLORD INFORMATION:
Starting with most recent, list chronologically all places of residence for the last ten (10) years, including any
residences while in school or military service. For a college campus residence, give dormitory name, college,
city, and state. If residences in military service cannot be shown as street addresses, indicate complete military
unit designation, base, city and state.
Use an additional sheet if needed.
Dates of Residence: From______________________ to _____________________Rent _______ Own _______
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
Page 4 of 20
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
mm/yyyy
mm/yyyy
Residence Address:
Apt #: _____________
City: _________________________________________________ State: _________________ Zip: ___________
Page 5 of 20
EMPLOYMENT HISTORY:
Starting with most recent, list chronologically your last 3 employers, including summer and part-time
employment while attending school. All time must be accounted for. If unemployed for a period, set forth
dates of unemployment. Addresses and phone numbers MUST be current and complete. If the business no
longer exists, use the old address and not “no longer in business”. You MUST provide us with all the
information, use the internet if necessary to obtain information. Use an additional sheet if needed.
Dates of Employment: From: __________________ To: _________________
mm/yyyy
mm/yyyy
Name of Company: _____________________________________________________________________
Address:
________________________________________________________________________
Street address
City
____________________________________________________________________________________
State
zip code
phone#
Position Held _______________________________ Duties: __________________________________________
___________________________________________________________________________________________
Name of Immediate Supervisor: ________________________________________________________________
Reason for Leaving: __________________________________________________________________________
___________________________________________________________________________________________
mm/yyyy
mm/yyyy
Name of Company: _____________________________________________________________________
Address:
________________________________________________________________________
Street address
City
____________________________________________________________________________________
State
zip code
phone#
___________________________________________________________________________________________
___________________________________________________________________________________________
mm/yyyy
mm/yyyy
Name of Company: _____________________________________________________________________
Address:
________________________________________________________________________
Street address
City
____________________________________________________________________________________
State
zip code
phone#
___________________________________________________________________________________________
Page 6 of 20
Cont. Employment
Have you ever applied to or performed paid or unpaid services for a law enforcement agency not listed as an
employer?
YES
NO
If yes, please provide name and address of business, corporation or organization and describe your relationship
or position.
Have you received any law enforcement or corrections training or education?
Did you receive a certificate for this training?
YES
YES
NO
NO
If yes, please indicate the type and date of training and certificate number:
Have you ever applied for employment as a law enforcement officer with any agency, or previously applied to
this or any other academy?
YES
NO
If yes, indicate the agency and date of application:
______________________________________________________________________________________
Agency
Date
______________________________________________________________________________________
Agency
Date
______________________________________________________________________________________
Agency
Date
Have you ever been denied employment with a law enforcement agency for any reason?
YES
NO
If yes, indicate the agency, the date, and the reason:
Page 7 of 20
Cont. Employment
Have you ever been dismissed from any employment or position you have held?
If you answered yes, please provide details; as well as employer name.
Have you ever been asked to resign from any employment or position you have held?
YES
YES
NO
NO
Have you ever had any disciplinary action taken against you from any employment or position you have held?
YES
NO
Have you resigned, or left a job by mutual agreement following allegations of misconduct or unsatisfactory job
performance?
YES
NO
Page 8 of 20
MILITARY HISTORY:
Have you ever served on active duty in the Armed Forces of the United States?
YES
NO
Branch of Service:
Highest Rank:
Principal Duties:
Duty Dates: From: ________________________ To: ___________________
mm/dd/yyyy
mm/dd/yyyy
From: _________________________ To: ___________________
mm/dd/yyyy
mm/dd/yyyy
From: _________________________ To: ___________________
mm/dd/yyyy
mm/dd/yyyy
Date and Type of Discharge: _________________________________________________________________
Are you now or have you ever been a member of a reserve unit or the National Guard?
Were you ever convicted by a military court martial?
YES
NO
Was any type of disciplinary action taken against you in the military?
If yes, please explain:
YES
NO
YES
NO
Date: _____________________ Place: ____________________________________________________
Nature of Offense: _____________________________________________________________________
Action Taken: _________________________________________________________________________
Have you ever served in the Armed Forces of a foreign country?
If yes, Please explain:
YES
Have you been discharged from the Armed Forces under dishonorable conditions?
If yes, Please explain:
Page 9 of 20
NO
YES
NO
CIVIL COURT HISTORY:
Have you ever been involved in any civil litigation (lawsuit) of any kind? (This includes divorces, small claims,
evictions, foreclosures, etc.)
YES
NO
If yes, explain below and provide county and state where case(s) filed:
Have you or your spouse ever been a plaintiff or defendant in a court action?
YES
NO
Have you ever declared bankruptcy?
YES
NO
Have you ever had a judgment against you or your spouse?
YES
NO
Page 10 of 20
DRIVING HISTORY:
Do you have a valid Florida driver’s license?
Does your current driver's license contain any restrictions?
If yes, list the restriction(s):
YES
NO
YES
NO
_________________________________________________________________________________________
List ALL STATES and driver's license number where you have held a driver's license. Provide Driving Record if out
of State license has been held in last 7 years.
Driver’s License Number
_______________________________ State ___________________________
_______________________________ State ___________________________
_______________________________ State ___________________________
In the last FIVE (5) YEARS have you been issued any traffic citations for moving violations, such as speeding,
reckless driving, DWI/DUI, running red lights, improper lane changes, etc.?
YES
NO
If yes, please list the type of violation(s), where the violation took place, and the date you received the citation:
Violation Type
City/State
Date
In the last FIVE (5) YEARS have you been involved in any traffic accidents in which you were the driver, whether
you were at fault or not?
YES
NO
If yes, give number of accidents and explain the circumstances:
of accident.)
Page 11 of 20
(List investigating agency and location
Have you ever been denied issuance of a driver's license?
YES
NO
Have you ever had a driver's license suspended or revoked?
YES
NO
If yes, please provide complete details including why license was suspended or revoked.
ON THE JOB USE OF ALCOHOL:
Have you ever held a job where the use of alcohol (on-the-job) was common practice?
Have you ever used alcohol on the job where it was a violation of company policy?
If yes please explain:
Page 12 of 20
YES
NO
YES
NO
CRIMINAL ACTIVITY:
Please answer all questions accurately and completely. IF YOU ANSWER "YES" TO ANY OF THE QUESTIONS
BELOW, THE QUESTION NUMBER AND DETAILS MUST BE LISTED ON PAGE PROVIDED.
All dates, locations, arresting agency and dispositions MUST be included in your explanation.
NOTE: If you are arrested or detained by a law enforcement agency at any time after completing this
packet, while still in the selection process or while in the academy, it is your responsibility to notify the
Criminal Justice Selection Center at 352-271-2945. Failure to do so could result in disqualification from
the selection process or dismissal from the academy.
Definitions:
Committed: You have committed any act that is illegal whether or not you were caught or the crime went
undetected.
Arrested: Taken into custody, issued a Notice to Appear, fingerprinted, booked, Mirandized, or pled no
contest for any offense, etc., whether or not charges were dropped or abandoned, or adjudication was
withheld.
Charged: A formal accusation of criminal activity that requires you to appear in court to answer to a criminal
charge.
Indicate if you have ever committed, been arrested, or been charged for any of the following:
COMMITTED
YES
NO
Burglary
Armed Robbery/Robbery
Illegal Possession of Narcotics
Sale of Narcotics
DWI or DUI
Passing Worthless/Bad Checks
Auto Theft
Shoplifting
Assault/Battery
Murder
Theft/Theft from an Employer
Vandalism
Rape/Other Sex Crimes
Indecent Exposure
Perjury/False Statements
Possession/Distribution of Child Pornography
Domestic Battery
Child Abuse/Neglect
Forgery/Uttering a Forgery/Fraud
Prostitution/Soliciting
Under age consumption of alcohol
Any Other Criminal Offense (explain on page
provided)
Page 13 of 20
ARRESTED
YES NO
CHARGED
YES NO
AGE AT TIME
Cont. Criminal Activity
1. Have you ever been under investigation or questioned by any law enforcement agency for any crime in the
past? This includes any investigation of a criminal nature and does not include crimes such as speeding,
careless driving, etc.
YES
NO
If yes explain:
2. Have you ever been arrested?
YES
NO
Arrested: Taken into custody, issued a Notice to Appear, fingerprinted, booked, Mirandized, or pled
no contest for any offense, etc.), whether or not charges were dropped or abandoned, or adjudication
was withheld? Provide an explanation for any of the above to include the initial charge, charges that
may have been reduced and the disposition of each charge.
If yes list the following and provide “court disposition”: (Additional space on page provided)
Arresting Agency
Charge
City/County/State
3. Have you ever had a record sealed or expunged?
YES
Date
NO
Expunged: A defendant can do a motion to seal/expunge his file that will be heard by the court. This
motion is either granted or not granted. When granted, the records of the clerk, sheriff, and state
attorney is deleted.
If yes list the following:
Arresting Agency
Charge
City/County/State
Date
4. Have you ever been charged with or convicted of a crime by ANY court of law?
YES
NO
Charged: A formal accusation of criminal activity that requires you to appear in court to answer to a
criminal charge.
Convicted: A person who has been declared to be guilty of a criminal offense by the verdict of
a jury or the decision of a judge in a court of law.
If yes explain:
Page 14 of 20
5. Have you ever had a criminal sentence plea-bargained?
YES
NO
Plea Bargaining: Negotiations between the defense counsel and the prosecution, seeking an
agreement under which the defendant enters a plea of guilty.
If yes explain:
6. Have you ever had criminal prosecution deferred?
YES
NO
Prosecution deferred: In a deferred prosecution, the proceedings in a criminal case are put off for a
period of time, subject to certain conditions. Condition is that the defendant not be charged or
convicted of other crimes during this period. At the end of the time period, if all conditions have
been met, the charges are dismissed.
If yes explain:
7. Have you ever been placed on probation?
YES
NO
Probation: A plan whereby a defendant, found guilty of a crime, is released by the court, without
imprisonment, under the supervision of a probation officer for a specific length of time and with
specific restrictions placed on his lifestyle.
If yes explain:
8. Have you ever served community service in lieu of a criminal conviction?
YES
NO
Community Service: A condition imposed as a part of a sentence through which the judge orders the
defendant to perform various tasks within the community for a certain number of hours, i.e., picking
up trash, washing police cars.
If yes explain:
Page 15 of 20
9. Are you currently a fugitive from justice or is there warrant for your arrest?
If yes explain:
YES
NO
10. Are you or have you ever been subject to a court order restraining you from harassing, stalking, or
threatening an intimate partner or child of such partner?
YES
NO
If yes explain:
11. Have you ever been charged with and/or convicted of domestic violence? This includes the use or
attempted use of physical force against a current or former spouse, parent, guardian, child, girlfriend,
boyfriend or a person with a similar relationship?
YES
NO
If yes explain:
12. Have you ever been adjudicated mentally defective OR have you ever been committed to a mental facility?
YES
NO
Adjudicated Mentally Defective: - A determination by a court, board, commission, or other lawful
authority that a person, as a result of marked subnormal intelligence, or mental illness,
incompetency, condition, or disease: (1) is a danger to himself or to others; (2) lacks the mental
capacity to contract or manage his own affairs. This term shall include: (1) a finding of insanity by a
court in a criminal case; and (2) Those persons found incompetent to stand trial or found not guilty
by reason of lack of mental responsibility.
Committed to a Mental Facility: - A formal commitment of a person to a mental facility by a court,
board, commission, or other lawful authority. The term includes a commitment to a mental facility
involuntarily. The term includes commitment for mental defectiveness or mental illness. It also
includes commitments for other reasons, such as for drug use. The term does not include a person
in a mental facility for observation or a voluntary admission to a mental facility.
If yes explain:
Page 16 of 20
Criminal Activity explanation: (number each explanation to correspond to the question and page number)
Page 17 of 20
DRUG QUESTIONNAIRE
Other than your own prescription, have you ever used, or had experience with any of the following substances,
drugs, or narcotics?
In the space provided, indicate any and all illegal drug usage INCLUDING MONTH AND YEAR USED. Provide
information regarding all drug usage on the following page. Include a description of the circumstances, type of
drug and any additional explanation on the following page..
Have you ever used
Substance
Used
YES NO
Past 18 months
(specify
month/year)
Last time used
18 months-3
years
(specify
month/year)
Amphetamines
(uppers)
Barbiturates
(downers)
Cocaine Powder
Crack Cocaine
Ecstasy (MDMA
GHB/GBL
Hashish
Heroin
Inhalants/Whippets
LSD/Hallucinogens
Marijuana/THC
Mushrooms
Opium
PCP/Angel Dust
Quaaludes
Rohypnol/Roofies
Speedballs
Steroids
STP/Speed
Valium
Other: List
Page 18 of 20
3-5 years
(specify
month/year)
5-10 years
(specify
month/year)
Frequency
2X or
More
Less
than 2X
Cont. Drug Questionnaire
1. Are you an unlawful user of, or addicted to, Marijuana or any depressant, stimulant, narcotic drug, or any
other controlled substance?
YES
NO
2. Have you ever sold, purchased, and/or supplied any illegal drugs, including marijuana (even to/from friends
or relatives at no profit to yourself)?
YES
NO
3. Have you ever used any prescription drug, which was not specifically prescribed to you?
YES
NO
Page 19 of 20
IMPORTANCE OF HONESTY STATEMENT
The Criminal Justice Selection Center is seeking applicants who demonstrate certain characteristics.
Honesty is the most important characteristic that you must demonstrate. It is extremely important that
you are completely honest in all of your answers. The importance of honesty cannot be overemphasized.
Failure to respond to any question truthfully, whether orally or in writing could result in disqualification.
While filling out documents you are cautioned to take your time, to be thorough, and to be specific in all
of your answers. If you have any doubt in your mind concerning a particular question or if you are unsure
whether to include certain information, the answer is “Yes”, include it.
You may think that something you have done will disqualify you from further consideration; it may or
may not. What will certainly disqualify you is lying or distorting the truth. For example, an arrest (either
when you were a juvenile or as an adult) may or may not disqualify you. However, lying about that arrest
will disqualify you from further consideration. The use of drugs, including marijuana, may or may not
disqualify you. However, lying about it will disqualify you from further consideration.
Applicants should be aware that per Florida Administrative Code 11B-27.0011, titled “Moral
Character”, falsifying an employment application may result in the suspension or revocation of your
Florida law enforcement certification, thereby disqualifying you from employment as a law
enforcement/correction officer within the State of Florida.
I,
, hereby certify that all answers or
statements in this personal data packet are true and complete to the best of my knowledge and belief.
I understand and agree that any misstatements, falsifications, or omissions herein may cause my
selection into the Santa Fe College Institute of Public Safety to be withdrawn. I further understand
that information provided herein is public record and may be subject to review upon request.
Additionally, I understand that Santa Fe College may share my information with criminal justice agencies
and/ or other colleges. I hereby certify that I have been given sufficient opportunity and time to review
the questions and their intent, and that I have answered them correctly.
Applicant’s Signature
Date
AFFIDAVIT
STATE OF
COUNTY OF
day of
_,
20
by
who is personally known to me or who has
produced
as identification.
(Type of identification)
SEAL:
PRINT

Application Packet

Transcription

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