Fillable Eotapplication (Eastern Florida State College)

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Eotapplication (Eastern Florida State College)

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The Eotapplication (Eastern Florida State College) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Eastern Florida State College

BROWSE EASTERN FLORIDA STATE COLLEGE FORMS

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Brevard Police Testing Center
Equivalency of Training Application
Law Enforcement Corrections
Corrections Probation
Officer
DO NOT E-MAIL THIS FORM! Please fill the form out on your computer, print it & mail or carry it to our offices.
Mail completed form to: Brevard Police Testing Center, 3865 N. Wickham Rd. Melbourne, FL 32935
Last Name First Name Middle Initial
Street Address Apt. #
City
State Zip Code
These items are required by FDLE.
DO NOT SEND THIS FORM VIA E-MAIL!!
I am seeking Equivalency
of Training for (check one)
Sex
Race
Original Certification
Home Ph # Mobile Education Level
SSN
Please read the accompanying instructions before you complete this application. You must also attach FDLE Form CJSTC 58
"Authority For Release of Information" and the appropriate fee, money order or certified check only.
Your SSN is required by FDLE.
DO NOT SEND THIS FORM VIA E-MAIL!!
My qualifying full-time employment as a law enforcement or corrections officer, which ended no more than
8-years prior to this application, was at the following agency:
Full Agency Name:
Street Address
City State Zip Code
Ph #
Employed from:
mm/dd/yyyy
Your Position/Title:
Until:
mm/dd/yyyy
Attention (Person or Unit):
Still
Employed
Full Agency Name:
If a second employer must be used to establish a cumulative one-year of full-time employment within an
eighteen-month period, please complete the following:
Your Position/Title:
Street Address
Attention (Person or Unit):
City State Zip Code
Phone Number
Page 1 of 2
D.O.B. mm/dd/yyyy
Check if you have applied for
EOT anywhere else in Florida.
Where?
email
Employed from:
mm/dd/yyyy
Until:
mm/dd/yyyy
Page 2 of 2
The basic training that establishes my qualifications for this application may be verified at the following
institution(s):
Full name of Institution
Street Address
Attention (Person or Unit):
City State Zip Code
Phone Number FAX Number
Your Class #
Full name of Institution
Second institution, if applicable:
Street Address
Attention (Person or Unit):
City State Zip Code
Phone Number FAX Number
Your Class #
APPLICANT'S SIGNATURE and ACKNOWLEDGEMENTS
I, the undersigned, hereby swear or affirm the following:
(1) All the information I have provided in this application is true and correct.
(2) I am claiming eligibility for the Equivalency Of Training path to certification as a law enforcement or corrections officer in Florida
because I meet all the basic training and full-time employment requirements.
(3) I understand that an investigator will verify the information in this application and that any omission or falsification of a material
fact will result in rejection of this application, and may prevent my future certification or employment as a law enforcement or
corrections officer in Florida.
(4) I understand that there are other legal requirements in Florida Statutes, and the rules established by the Florida Criminal Justice
Standards and Training Commission (CJSTC), related to proficiency demonstration, examination, citizenship, high school
education, criminal history, character of military discharge, and moral character, etc., which must be established in a full
background investigation by a hiring agency prior to my certification or employment as a law enforcement or corrections officer
in Florida.
Signature of Applicant
AFFIDAVIT
State of ___________County of ________________________Before me personally appeared ____________________________________
who says that he/she executed the above instrument of his/her own free will and accord, with full knowledge of the purpose therefore.
Sworn to and subscribed before me this ______ day of ___________, 200____. Personally Known____ -OR- Produced the following
identification: __________________________________________ My commission expires on _____________________, 20____.
Notary Public __________________________________________
Attended from:
mm/dd/yyyy
Until :
mm/dd/yyyy
Attended from:
mm/dd/yyyy
Until :
mm/dd/yyyy
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Eotapplication (Eastern Florida State College)

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Completed 25 July 2020

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