Page 1 of 25
APPLICATION
Thank you for your interest in employment with the Groveland Police Department. This application must be either
typed or printed legibly. Non-legible applications will NOT be accepted. Applications MUST be submitted in person
to the Groveland Police Department unless otherwise instructed.
COMPLETE THE APPLICATION AS FOLLOWS:
Answer ALL questions - if a question does not apply to you, place an “N/A” in the blank space provided for your answer.
Provide names of former employers along with their complete mailing addresses (including zip code), a good
contact phone number, and your dates of employment, your rate of pay, your job title and specific duties.
List complete and correct physical and mailing addresses (including zip code) of your former residences.
This application MUST include certified copies of the
following:
This application MUST also include copies of the
following:
1. Birth Certificate
2. High School Diploma
3. Proof of Name Change (if applicable)
1. Driver’s License
2. Social Security Card
3. DD 214 FormMilitary Service Discharge
Documents (if applicable)
4. Sealed College Transcripts (if applicable)
5. Police Academy Certificate (if applicable)
6. State Officer Certification Examination Test Results
(CJSTC 516) or State Law Enforcement Certification
(if applicable).
Note: Any falsification of information on your application will automatically disqualify you from consideration for
employment with Groveland Police Department.
ACKNOWLEDGMENT:
You are hereby informed that a thorough background investigation, including information regarding your character,
general reputation, personal characteristics, and mode of living will be part of the application process. This information
is solely for the purpose of evaluating your qualifications and eligibility for employment with The Groveland Police
Department. The submission of this application carries the understanding that you are authorizing The Groveland
Police Department to contact any and all available sources for the purpose of obtaining information regarding your
qualifications.
EXAMINATIONS:
Prior to making a final recommendation for hire, applicants being considered for employment / placement will be
required to undergo a thorough background investigation in addition to the following selection process
examinations:
NOTE: The City of Groveland and its Police Department provides
equal employment opportunities to all employees and applicants
for employment and prohibits discrimination and harassment of
any type without regard to race, color, religion, age, sex, national
origin, disability status, genetics, protected veteran status, sexual
orientation, gender identity or expression, or any other
characteristic protected by federal, state or local laws. This
applies to all terms and conditions of employment, including
recruiting, hiring, placement, promotion, termination, layoff,
recall, and transfer, leaves of absence, compensation and training.
1. Oral Board Interview
2. Polygraph
3. Psychological
4. Physical / Drug Screen
5. Written Examination
6. Physical Assessment Test (P.A.T.)
Page 2 of 25
Position:
:Applying
For:
(Last)
(First)
(Middle)
Street Address:
City:
State:
Zip:
Phone #:
Alternate Phone #:
Social Security #:
Email:
Social Media Addresses:
Do you have a valid Florida driver license?
Yes / No
License Class:
Driver License #:
Expiration Date:
Are you at least 18 years of age for civilian employment or 19 years of age for sworn employment?
Yes / No
Are you legally authorized to work in the United States?
Yes / No
(Note: Employment is subject to verification of minimum legal age and the provision of documentation to confirm U.S. work authorization).
Have you ever served in the US Armed Forces?
Yes / No
If yes, complete following information:
Branch:
Entry Date:
Discharge Date:
Discharge Type:
(Note: Explain a dishonorable discharge, so the underlying circumstances can be weighed individually to avoid an improper disqualification.)
Are you claiming Veteran’s employment preference?
Yes / No
If yes, file documentation with application.
Are you now using or have you ever used illegal controlled substances or illegal drugs?
Yes / No
If yes, explain:
Have you ever been employed by the City of Groveland?
Yes / No
If yes, when?
Have you ever been dismissed from a job for inefficiency, delinquency, misconduct, or other reason?
Yes / No
If yes, when? Describe circumstances:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
An Equal Opportunity Employer
APPLICATION
Page 3 of 25
Have you ever been formally or informally accused of unlawful harassment or discrimination?
Yes / No
If yes, when?
Describe circumstances:
Are you currently under charges for any offense against the law?
Yes / No
If yes, describe charges:
Have you EVER at any time had adjudication withheld, plead guilty, no contest or been convicted of ANY offense
against the law?
Yes / No
If yes, describe circumstances:
(Note: a conviction is not necessarily a disqualifying factor. Truthfully give all facts so a decision can be made.)
Have you ever been a defendant in a civil action for an intentional tort?
Yes / No
If yes, explain:
EDUCATION
Level of
School Name
Course of
Years to
Degree / Diploma
Education
Street Address
Study
Complete
or
Received?
City / State / Zip
# of Credits
Yes / No
Type
G.E.D.
Yes / No
High School
Yes / No
Trade School
Yes / No
College /
University
Yes / No
List other education or special courses taken (include total hours and the training provider / sponsor name.
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 4 of 25
Answer if applicable:
Is G.E.D. sanctioned by a State Board of Education?
Yes / No
While in school were you ever suspended, expelled, or otherwise disciplined?
Yes / No
If yes, please explain:
List honors, awards, scholarships, etc.:
Extracurricular activities:
Foreign language spoken:
Foreign language read:
Foreign language written:
Certification / License Type
Are You
Issued In / By
Date
Expiration
Certified or
Which State
Issued
Date
Licensed?
(Mo / Yr)
(Mo / Yr)
Building Inspector
Yes / No
Code Enforcement Level I, II or III
Yes / No
Emergency Medical Technician (EMT)
Yes / No
Firefighter Minimum Standards
Yes / No
Lifeguard
Yes / No
Paramedic
Yes / No
Police Officer Minimum Standards
Yes / No
Wastewater Treatment Operator A, B or C
Yes / No
Water Treatment Operator A, B or C
Yes / No
Water Safety Instructor (WSI)
Yes / No
Other:
Yes / No
Other:
Yes / No
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 5 of 25
EMPLOYMENT HISTORY
(Begin with present employer and list all jobs held since you started working)
1.
Company Name:
Employed From:
To:
Street:
Duties:
City:
State / Zip Code:
Telephone #:
Reason for Leaving:
Supervisor Name:
Pay Rate Start:
End:
Job Title:
2.
Company Name:
Employed From:
To:
Street:
Duties:
City:
State / Zip Code:
Telephone #:
Reason for Leaving:
Supervisor Name:
Pay Rate Start:
End:
Job Title:
3.
Company Name:
Employed From:
To:
Street:
Duties:
City:
State / Zip Code:
Telephone #:
Reason for Leaving:
Supervisor Name:
Pay Rate Start:
End:
Job Title:
4.
Company Name:
Employed From:
To:
Street:
Duties:
City:
State / Zip Code:
Telephone #:
Reason for Leaving:
Supervisor Name:
Pay Rate Start:
End:
Job Title:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 6 of 25
5.
Company Name:
Employed From:
To:
Street:
Duties:
City:
State / Zip Code:
Telephone #:
Reason for Leaving:
Supervisor Name:
Pay Rate Start:
End:
Job Title:
6.
Company Name:
Employed From:
To:
Street:
Duties:
City:
State / Zip Code:
Telephone #:
Reason for Leaving:
Supervisor Name:
Pay Rate Start:
End:
Job Title:
7.
Company Name:
Employed From:
To:
Street:
Duties:
City:
State / Zip Code:
Telephone #:
Reason for Leaving:
Supervisor Name:
Pay Rate Start:
End:
Job Title:
8.
Company Name:
Employed From:
To:
Street:
Duties:
City:
State / Zip Code:
Telephone #:
Reason for Leaving:
Supervisor Name:
Pay Rate Start:
End:
Job Title:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 7 of 25
PERSONAL DATA
Applicant Name:
Maiden Name (if applicable):
Have you ever had your name legally changed?
Yes / No
If you answered “Yes” to the above question, what was:
1. Your previous name(s):
2. Date and location of change:
3. Reason for change:
Have you ever been known by any other name?
Yes / No
If you answered “Yes”, list all names (include nicknames and street names):
Date of Birth:
Place of Birth:
Are you eligible to work in the United States?
Yes / No
List all social networking addresses:
PLACES OF RESIDENCE
(Note: List in chronological order all previous places of residence since elementary school. Begin with your
present address and work backwards. If necessary, attach a separate sheet of paper for additional residences.)
From / To
Street Address
City
State
Zip
(Month / Year)
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 8 of 25
CAREER INTEREST
Names of relatives and friends employed by GPD:
Have you ever worked for or applied to GPD before?
Yes / No
If yes, explain:
Have you ever applied to any other law enforcement agency?
Yes / No
If yes, complete the following chart:
Date Applied
Agency Name
Reason for Non-Selection
Are you currently on any employment eligibility list?
Yes / No
If yes, state agency name(s):
Have you had any law enforcement training by any local, state or federal agency?
Yes / No
If yes, complete the following chart:
Date
Location
Training Received
Certificate Title
(If Applicable)
If it becomes necessary in the course of performing the duties of a police officer to take a human life, would you
have reluctance to do so?
Yes / No
If yes, explain:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 9 of 25
Have you ever been dismissed, disciplined, and/or asked to resign employment due to misconduct or unsatisfactory
service and/or job performance?
Yes / No
If “Yes, complete below chart:
Date
Employer Name
Description of Circumstances
DRUG USE
Have you ever used an illegal drug?
Yes / No
If “Yes”, complete the below chart:
Date(s) Type of Drug Used Circumstances Leading to Usage
Have you ever used a prescription drug prescribed for someone else?
Yes / No
If “Yes”, complete the below chart:
Date(s) Type of Prescription Medication Circumstances Leading to Usage
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 10 of 25
SOCIAL HISTORY
List all clubs, societies, civic and/or organizations to which you are or have been a member:
Name of Organization
Street Address
Active
Date of
Phone #
City / State / Zip
Membership
Membership
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
FAMILY BACKGROUND
List alphabetically by last name all members of your immediate family and if applicable your spouse’s immediate
family to include father, father-in-law, step-father, mother, mother-in-law, step-mother, brother, brother-in-law,
step-brother, sister, sister-in-law, step-sister, guardians, and foster parents. Please include deceased relatives.
Relationship
Name (Last, First, Middle)
Address
Occupation
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 11 of 25
MILITARY RECORD
If you have NEVER served in the Armed Forces of the United States, please SIGN the below statement:
I,
, have never served in any branch of the United States Armed Forces.
Signature of Applicant
If you HAVE served in the Armed Forces of the United States, please complete the following:
Branch of Service:
Highest Rank:
Service #:
Duty Dates:
From:
To:
From:
To:
Branch of Service:
Highest Rank:
Service #:
Duty Dates:
From:
To:
From:
To:
Military specialization and duties:
Are you now or have you ever been a member of the Reserve Unit of the National Guard?
Yes / No
If “Yes”, state the branch of service, name and location of your unit and whether you attended drills, meetings, or
camps:
Have you ever been tried on charges, or were you the subject of a summary court, court martial, deck court,
captain’s mast, company punishment, or any other type of disciplinary action while a member of the armed forces?
Yes / No
If “Yes”, please provide the following details:
Date:
Place:
Nature of Offense:
Action Taken:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 12 of 25
FOREIGN MILITARY RECORDS
Have you ever served in the Armed Forces of any foreign nation?
Yes / No
If “Yes”, indicate Nation:
Highest Rank Held:
Duty Dates:
From:
To:
Type of Separation:
RESIDENCE
Own / Buying:
Renting:
Leasing:
Living w/ Relatives / Friends:
Other:
If “Other”, please explain:
FINANCIAL HISTORY
Have you ever been a party to a financially related court action?
Yes / No
If “Yes”, please explain:
If you are responsible for making child support payments, has legal action ever been taken against you for either
failing to make payments or delaying payments?
Yes / No
If “Yes”, please explain:
Yes / No
Have you ever been bonded?
Yes / No
If employed by Groveland PD, do you anticipate any income other than your
salary? If “Yes, list sources of income:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 13 of 25
CRIMINAL AND JUVENILE RECORD
Have you ever been arrested, charged or received a notice or summons to appear for any criminal violation?
Yes / No
Have you ever been convicted of a felony and/or misdemeanor?
Yes / No
Have you ever been detained by any law enforcement officer for investigative purposes OR have you ever been the
subject of OR a suspect in any criminal investigation?
Yes / No
If you answered “Yes” to the above questions, please complete the following chart even if you were not formally
charged, did not appear in court, pled not guilty or nolo contendere, had adjudication withheld or deferred, were
found not guilty, or had the matter settled by payment of a fine or forfeiture of collateral. Note: include all matters
taking place while you were classified as a juvenile under the law of any state.
Date
Charge
Agency
Court
Disposition
To your knowledge, has any member of your family ever been arrested for any reason other than a traffic violation?
Yes / No
If “Yes”, complete below chart:
Relatives Name
Relationship
Date
Charge
Disposition
Have you ever been reported as a missing person?
Yes / No
If “Yes”, please explain:
Have you (or your spouse if applicable) ever been the plaintiff or defendant in a civil and/or criminal court case?
Yes / No
If “Yes”, please explain below:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 14 of 25
GANGS / GROUPS
Have you ever belonged to or been associated with any criminal youth gang such as the Bloods, Crips, Latin Kings,
Folk Nation, People Nation, etc. either locally or in another state?
Yes / No
If “Yes”, please explain:
Have you ever belonged to or been associated with any criminal motorcycle gang such as the Hell’s Angels,
Pagans, Outlaws, etc. either locally or in another state?
Yes / No
If “Yes”, please explain:
Have you ever been the member of any local or national group that advocates hatred against another race?
Yes / No
If “Yes”, please explain:
Have you belonged to or associated with any local or national group which advocates the overthrow of the
government of the United States?
Yes / No
If “Yes”, please explain:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 15 of 25
TATTOOS / MARKINGS
Do you have any tattoos or other markings?
Yes / No
(Note: if “No”, continue to next page.)
Do you have any tattoos or other markings which indicate past or current gang memberships, affiliation or activity?
Yes / No
Do you have any tattoos or other markings that represent hatred against other races or cultures?
Yes / No
Do you have any tattoos or other markings which indicate participation in any type of criminal activity?
Yes / No
If you have neck or arm tattoos, are they visible when wearing a collared or short sleeve shirt?
Yes / No
If you answered “Yes” to any of the above questions, please describe and ATTACH PHOTOS of each one:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 16 of 25
MOTOR VEHICLE OPERATING RECORD
Can you operate a motor vehicle?
Yes / No
Has your driver license ever been suspended or revoked?
Yes / No
If “Yes”, please complete the below chart:
Date
Location
Charges
Final Disposition
Have you ever been refused a driver license by any state?
Yes / No
If “Yes”, please explain:
Have you ever received a traffic citation other than parking?
Yes / No
Date
Agency
State
Charge
Final Disposition
Do you have any unpaid or outstanding summonses against you for any parking violation?
Yes / No
If “Yes”, please explain:
Have you ever been declined an automobile insurance policy or hand a policy cancelled?
Yes / No
If “Yes”, please explain:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 17 of 25
REFERENCES
Fill in the names of persons NOT RELATED TO YOU and NOT FORMER EMPLOYERS who have known you
for at least five (5) years. All persons listed may be contacted and asked to appraise your character, ability,
experience, personality, and other qualities. Make certain their contact information is current and accurate.
1.
Name:
Street Address:
State:
Zip:
City:
State:
Zip:
Phone:
Email:
Years Known:
2.
Name:
Street Address:
City:
State:
Zip:
Phone:
Email:
Years Known:
3.
Name:
Street Address:
City:
State:
Zip:
Phone:
Email:
Years Known:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
click to sign
signature
click to edit
Page 18 of 25
LOYALTY
Have you ever, by word of mouth or in writing, advocated, advised, or taught the doctrine that the Government of
the United States of America, or any political subdivision thereof, should be overthrown by force, violence, or any
unlawful means?
Yes / No
POLYGRAPH EXAMINATION
Are you willing to take a polygraph examination to verify all information supplied in this application and all
other information supplied by you to the Groveland Police Department?
Yes / No
Applicant’s Signature
If “No”, state your reason:
TRAINING STATUTE
Be in enacted by the Legislature of the United States of Florida: Section 1, Section 943-16, Florida Statutes, is
amended to read:
943-16: Payment of tuition or officer certification examination fee by employing agency; reimbursement of
Tuition, other course expenses, wages and benefits.
(1) An employing agency is authorized to pay any cost of tuition of a trainee in attendance at an approved basic
recruit training program.
(2) A trainee who attends such approved training program at the expense of any employing agency must remain
in the employment or appointment of such employing agency for a period of not less than two (2) years after
graduation from the basic recruit training program. If employment or appointment is terminated on the trainee’s
Own initiative within two (2) years, he or she shall reimburse the employing agency for the full cost of his or her
Tuition and other course expenses.
(3) An employing agency may institute a civil action to collect such cost of tuition and other course expenses as
provided in this section if it is not reimbursed, provided that the employing agency gave written notification to
the trainee of the two-year employment commitment during the employment screening process. The trainee shall
return signed acknowledgement of receipt of such notification.
(4) For purposes of this section, the term “other course expenses” include the cost of meals.
(5) This section does not apply to trainees who terminate employment with the employing agency and resign
their certification upon termination in order to obtain employment for which certification under this chapter is
not required. Further, this section does not apply to trainees attending auxiliary officer training.
I,
, have read and agree to the contents of the aforementioned Statute.
Applicant’s Signature
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 19 of 25
ESSAY QUESTION
Why should we consider you for the position to which you have applied? Please keep answer to one page.
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 20 of 25
Groveland Police Department
An Equal Opportunity Employer
READ THIS APPLICATION AND YOUR ANSWERS CAREFULLY BEFORE SIGNING BELOW
I, , affirm that all statements made by me on this application are true,
complete and correct to the best of my knowledge and belief. I understand and agree that if I make any misstatements
or omissions of fact, I am subject to disqualification or dismissal and to such other penalties prescribed by law,
personnel policy or regulations. I am aware that statements made by me in this application are subject to later
investigation. I am further aware that should any investigation disclose any misrepresentation, falsification, omission,
or concealment of material fact, my application may be rejected. If already appointed, I may be dismissed. I voluntarily
give The Groveland Police Department, or its duly authorized representative, the right to make a thorough
investigation of my past employment and activities. I agree to cooperate in such investigation and I further release
from all liability and responsibility any and all persons, companies or corporations supplying such information.
Please sign below in the presence of a Notary.
Applicant’s Signature:
Date:
State of Florida
County of
Sworn to before me this
day of
, 20
Signature of Notary
(Notary Seal)
DO NOT WRITE IN THIS SECTION
(For Human Resources Office Use Only)
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 21 of 25
Groveland Police Department
An Equal Opportunity Employer
FCRA NOTICE AND CONSENT
CITY OF GROVELAND
PLEASE READ THIS NOTICE AND CONSENT FORM CAREFULLY
This notice and consent form is provided to you in compliance with the Fair Credit Reporting Act (“FCRA”). The
FCRA is a federal law governing the provision of certain data to employers by third-party provides called “consumer
reporting agencies.”
In connection with your application and/or employment, and provided that you give written consent below, The
Groveland Police Department may obtain a consumer report containing information about you. A consumer report is
defined as a written, oral, or other communication of any information by a consumer reporting agency bearing on your
creditworthiness, credit standing, credit capacity, character, general reputation, general personal characteristics, or
mode of living (including criminal history and background), which will be used or will be expected to be used or
collected whole or in part for the purpose of serving as a factor in establishing your eligibility for employment. Please
be informed and understand that you may obtain a copy of any such report, and that you may dispute the accuracy or
completeness of the information report to the City of Groveland Police Department by writing or calling the consumer
reporting agency directly.
I hereby agree and consent that the City of Groveland conduct security consumer report(s) on me, and using
the consumer report(s) in whole or in part in arriving at a decision regarding my employment.
Applicant’s Signature:
Date:
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 22 of 25
A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of
consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and
specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history
records). Here is a summary of your major rights under the FCRA. For more information, including information about
additional rights, go to www.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade
Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
You must be told if information in your file has been used against you. Anyone who uses a credit report or
another type of consumer report to deny your application for credit, insurance, or employment or to take another
adverse action against you must tell you, and must give you the name, address, and phone number of the agency
that provided the information.
You have the right to know what is in your file. You may request and obtain all the information about you in the
files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper
identification, which may include your Social Security number. In many cases, the disclosure will be free. You
are entitled to a free file disclosure if:
o a person has taken adverse action against you because of information in your credit report;
o you are the victim of identity theft and place a fraud alert in your file;
o your file contains inaccurate information as a result of fraud;
o you are on public assistance or
o you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon request from each
nationwide credit bureau and from nationwide specialty consumer reporting agencies. See
www.ftc.gov/credit for additional information.
You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness
based on information from credit bureaus. You may request a credit score from consumer reporting agencies that
create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some
mortgage transactions, you will receive credit score information for free from the mortgage lender.
You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is
incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your
dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute procedures.
Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information.
Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days.
However, a consumer reporting agency may continue to report information it has verified as accurate.
Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting
agency may not report negative information that is more than seven years old, or bankruptcies that are more than
10 years old.
Access to your file is limited. A consumer reporting agency may provide information about you only to people
with a valid need usually to consider an application with a creditor, insurer, employer, landlord, or other
business. The FCRA specifies those with a valid need for access.
You must give your consent for reports to be provided to employers. A consumer reporting agency may not give
out information about you to your employer, or potential employer, without your written consent given to the
employer. Written consent generally is not required in the trucking industry. For more information, go to
www.ftc.gov/credit.
(continued on next page)
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 23 of 25
You may limit “prescreened” offers of credit and insurance you get based on information in your credit report.
Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if
you choose to remove your name and address from the lists these offers are based on. You may opt-out with the
nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).
You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer
reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in
state or federal court.
Identity theft victims and active duty military personnel have additional rights. For more information, visit
www.ftc.gov/credit.
Enforcement and other rights. States may enforce the FCRA, and many states have their own consumer reporting
laws. In some cases, you may have more rights under state law. For more information, contact your state or local
consumer protection agency or your state Attorney General.
Groveland Police Department
408 W. Orange Street,
Groveland, Florida 34736
Page 24 of 25
The information requested below is used for EEO (Equal Employment Opportunity) purposes only and NOT
to evaluate your application for employment with The Groveland Police Department. Completion of this form
by you is strictly voluntary. You are NOT legally required to supply this information; however, your
Assistance in doing so is appreciated. Thank you.
Date:
Position Applied For:
Gender:
Male / Female
Age Group:
16 - 22
23 - 39
40 - 70
Over 70
Race / Ethnic Origin:
White, Non-Hispanic or Latino
Black or Black and White, Non-Hispanic or Latino
Hispanic or Latino
Asian or Asian and White, Non-Hispanic or Latino
American Indian / Alaskan Native, Non-Hispanic or Latino
Native Hawaiian Other Pacific Islander, Non-Hispanic or Latino
2+ Races, Non-Hispanic or Latino
Disabled:
Yes / No
If “Yes”, describe disability:
Military Status:
Non-Veteran
Veteran
Disabled Veteran
Actively Served During Which (Check Applicable):
WWII / Korea
Persian Gulf
Iraq / Afghanistan
Operation Enduring Freedom
Other:
How did you hear about the position to which you are applying?
News Chief
The Ledger
Other Newspaper
Magazine / Publication
Word of Mouth
Walk-In / General Job Search
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Groveland Police
Department An Equal Employment
Opportunity Employer
Page 25 of 25
Florida Department of
Law Enforcement
AFFIDAVIT OF APPLICANT
Incorporated by Reference in Rule 11B-27.002(1)(f), F.A.C.
Created 1/1/1992 Original - Agency Copy – FDLE 1 of 1 Commission-Approved Revisions: 12/16/2010
Form Effective Date: 3/2013
CJSTC
68
Please type or print in black or blue ink and use capital and small letters for names, titles, and addresses
Social Security Number:
Applicants Legal Name:
Last First MI
Employing agency:
Use this form to verify your compliance with the employment requirements of Section 943.13, F.S. I fully understand that to qualify for employment as a law enforcement, correctional, or
correctional probation officer, I shall comply with the following provisions of Section 943.13, F.S.:
Be at least 19 years of age.
Be a citizen of the United States.
Be a high school graduate or equivalent.
Not have been convicted of any felony or of a misdemeanor involving perjury or false
statement. 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 a false statement
shall not be eligible for employment or appointment as an officer, notwithstanding suspension
of a sentence or withholding of adjudication.
Have been fingerprinted by the employing agency.
Have passed a physical examination by a licensed medical specialist approved in Rule
11B-27.002(1)(d), F.A.C..
Be of good moral character.
Have not received a dishonorable discharge from the U.S. Military.
True False NA In addition, I attest to the following statements: Each statement shall be checked “True” “False” or “NA”
1. I completed my employment application and it is true and correct, and all other information
I furnished in conjunction with my application is true and correct.
2. I provided documentation of proof of my qualifications to the above listed employing agency.
3. I meet the qualifications as specified above.
4. I had a criminal record sealed pursuant to Section 943.059(4)(a), F.S. , or expunged pursuant to Section 943.0585(4)(a), F.S.
5. I am under investigation by a local, state, or federal agency or entity for criminal, civil, or administrative wrongdoing to the best of my knowledge and belief.
6. I separated or resigned from a previous criminal justice employment while under investigation.
7. I am currently serving in good standing in the U.S. Military.
8. I previously served in the U.S. Military.
9. I received a dishonorable discharge from my previous U.S. Military service.
10. I am currently certified as a Florida criminal justice officer in the following area(s): Please check the appropriate box(es).
Law Enforcement Correctional Correctional Probation
11. I authorize the employing agency listed above to apply for my certification. Please check the appropriate box(es).
Law Enforcement Correctional Correctional Probation
NOTICE: This document shall constitute as an official statement within the purview of Section 837.06, F.S., and is subject to verification by the employing agency and the 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
disqualify the officer for employment as an officer.
PLEASE READ CAREFULLY BEFORE SIGNING. You must complete the remainder of this affidavit in the presence of a notary public. Upon witnessing your signing of this affidavit, a notary public
shall complete the notary block by entering the same date the affidavit is signed. I hereby certify that to the best of my knowledge and belief, the information that I’ve entered on this form is
true.
12. 13.
Applicant’s Signature Date Signed
14. OATH
Pursuant to Section 117.05(13)(a), Florida Statutes
STATE OF COUNTY OF
Sworn to (or affirmed) and subscribed before me this
day of , year , By
Signature of Notary Public – State of Florida
Print, Type, or Stamp Commissioned name of Notary Public
Personally Known OR Produced Identification
Type of Identification Produced
*NOTE: Private Correctional facilities must submit original and shall forward the completed affidavit stapled to the Registration of Employment, Affidavit of Compliance
Form CJSTC-60 to FDLE, Criminal Justice Professionalism Program, Post Office Box 1489, Tallahassee, Florida 32302-1489, Attention Records Section
Page 1 of 2
Groveland Police Department
Communications Officer
Pre-Employment Acknowledgement
Applicant’s Name: Date:
Experience has shown that many applicants for the Communications Operator position consider
only certain aspects of the position, while ignoring less appealing features. As a result, when new
employees encounter undesirable job features, they sometimes react by leaving the position before
training is completed or within a few months of release from the training program.
While there are many satisfying and rewarding aspects of the Communications Operator position,
there is no question that they make significant contributions to the welfare and safety of our fellow
citizens and law enforcement officers; however, it is important for applicants to carefully consider
BOTH the negative and positive features of a new career BEFORE considering the position.
Below is a list detailing various aspects of the Communications Operator position that many
applicants are often unaware of. This information is being provided as part of the application
process, so that applicants may have a descriptive overview of topics that may be encountered in
this type of position.
This information should be carefully considered when applying for the
Communications Officer position. Applicants may consider discussing these topics with
their families to determine the personal impacts of each item listed. This acknowledgement
will become part of the applicant’s permanent personnel file, should an employment offer be
made and accepted.
SECTION I WORKING ENVIRONMENT:
1. You must have regular and predictable attendance.
2. You must arrive for work on time with all issued equipment, and be immediately prepared
for work.
3. You may be required to work different shifts in a 24 hour/day 7 days/week work
environment.
4. You may have no choice about which shift you are assigned to work.
5. You may have no choice about which days you work.
6. You may be required to work all shifts, including during the training period.
7. You may be required to work weekends on a regular basis.
8. You must be prepared to work any and all Federal, State and religious holidays on the
recognized and/or actual date.
9. You must be prepared to work on personally important or special days; i.e. birthdays,
anniversaries, sporting events, etc.
10. You must be able to obtain childcare for all types of shifts on a regular basis.
11. You must be able to obtain childcare for weekends and holidays on a regular basis.
12. You must be able to obtain childcare on short notice for shift coverage and other events.
13. You must be able to work voluntary overtime, before or after a shift, sometimes with little
or no notices.
14. You may be asked to work mandatory overtime, before or after a shift, sometimes with little
or no notice.
15. You must have reliable means for getting to your assigned shift that is also available for
24/7 call-out.
16. You must be willing to respond back to work with little to no notice.
Page 2 of 2
17. Communications Officer must often be at their workstation for extended periods of time,
including regularly eating meals at your workstation. Leaving the building is often
restricted or prohibited during your shift; depending on work load, unscheduled breaks (i.e.
to walk around, get coffee, etc.) are sometimes restricted.
18. You must be able to work within an organization structured on the military model;
specifically, you must be willing to:
a. Work through a highly structured chain of command,
b. Have all phone and radio activities recorded,
c. Work in accordance with departmental policies,
d. Work in a restricted access area.
19. You must be able to work at a radio console and computer terminals for an entire shift.
20. You must be able to work at a console with three computer monitors, numerous radios and
ringing telephones, while multi-tasking seamlessly between the computers (accurate typing
required), telephone and radios.
21. You must be able to work in a confined room with low lighting.
22. You must be able to work in a high stress environment.
23. You must be able to get along with and assist your co-workers.
24. You must be able to receive criticism from co-workers, supervisors, law enforcement
officers and civilians.
25. During the training period, you will receive daily observation reports, which will rate your
job performance and provide feedback for specific areas in need of improvement.
26. You must be able to retain caller information so that it may be entered accurately into your
computer in real time.
27. You must be able to work at a rapid pace.
28. You must be able to maintain concentration and attention for extended periods of time,
often under intense conditions.
SECTION II TYPES OF CALLS:
1. You must be able to answer calls and maintain composure under the following possible
scenarios
a. Caller is screaming at you,
b. Caller directs obscene language at you,
c. Caller is hysterical, intoxicated, irrational and/or confused,
d. Caller is difficult to understand or speaks another language,
e. Caller is suicidal; must be prepared to handle a call where the subject may commit
suicide while on the phone with you,
f. Caller is involved in a violent crime in progress.
2. You must be able to answer and respond to law enforcement calls quickly and accurately.
3. You must be able to make quick decisions that may directly affect the safety of one or more
persons.
4. You must be able to prioritize calls to be dispatched, to determine which will receive
immediate response.
5. You must be able to maintain the safety of law enforcement officers at all times.
By signing below, I acknowledge that I have read, considered and understand each topic as
described herein.
Signature Date
Name Printed
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