Fillable Recruit Application 5-20 (Tallahassee Community College)

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Recruit Application 5-20 (Tallahassee Community College)

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Recruit Application
5-20
Applicant Name:
Street Address:
Daytime telephone:
Cell phone:
E-Mail : @
Race: Social Security #:
Desired Class:
Law Enforcement Basic
Recruit Program (Day Class)
Law Enforcement Basic Recruit Program (Night Class)
Correctional Basic Recruit Program (Day Class)
Correctional Basic Recruit Program (Night Class)
Correctional Probation Officer Training Program
Cross-Over Correctional to Law Enforcement Program
Cross-over Correctional Probation Officer to Law Enforcement
Cross-over Law Enforcement to Correctional Program
Cross-Over Correctional to Correctional Probation Program
Proposed Method of Payment:
Self Pay VA Assistance
Financial Aid Bright Futures Florida Prepaid
Notification of Social Security Number Collection and Usage
In compliance with FL Statute 119.071, this document serves to notify you of the purpose for the collection and usage of your Social
Security number.
Tallahassee Community College collects and uses your social security number only in performance of the College’s duties and
responsibilities.
To protect your identity TCC will secure your social security number from unauthorized access, never release your social security number
to unauthorized parties, and assign you a unique student or employee identification number. This unique identification number is used for
all associated employment and educational purposes at TCC.
Page 1 of 11
Sex:
BAT Pass Date:
Paid Agency – Sponsor/Agency Name:
Other:__________________________________
Page 2 of 11
PAT THOMAS LAW ENFORCEMENT ACADEMY
TALLAHASSEE COMMUNITY COLLEGE
DECLARATION FORM
All statements and information given in this application are true to the best of my
knowledge. In the event that I am admitted to the Academy, I understand that any
information found to be omitted or incorrect on any portion of my application may
constitute grounds for dismissal.
By my signature below, I hereby authorize the Pat Thomas Law Enforcement Academy
to conduct such investigations as are necessary to determine the accuracy and
completeness of this application.
Signature Date
Before me personally appeared
signed the above document on
(Name)
(Date)
, who in my presence,
.
The applicant produced the following identification
personally known by me.
(Type of Identification)
Notary’s Name:
or is
Notary’s Signature: SEAL
Date:
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 Pat Thomas Law Enforcement Academy,
employing agency, and/or the Florida 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 enf
orcement or
corre
ctions officer in the State of Florida.
Page 3 of 11
ACADEMY FINANCIAL AID
AND REFUND DISCLOSURE
FORM
As an applicant for a recruit training program at the Tallahassee Community College
(College) Pat Thomas Law Enforcement Academy you are applying for a program of
study made up of several individual courses offered to the cohort of students that begin
the program together. Each of those courses must be successfully completed in order to
continue in the program and the program in its entirety must be successfully completed in
order to be eligible to take the State Officer Certification Exam prior to employment in
Florida as a law enforcement, corrections, or correctional probation officer.
No students may be added to the program by enrolling after the program begins.
Therefore, no refunds for courses enrolled in but not taken or successfully completed as
part of the entire program will be made after the first five days of the program.
If you are a student who receives Title IV student financial aid (Federal Pell Grants,
Federal SEOG, Federal Stafford Loans or PLUS Loans) and you withdraw, are
dismissed, or your classes are canceled for any reason, your financial aid will be
reviewed by the College under the Federal Return to Title IV policy, as required by the
Federal Government.
Students who withdraw or are dismissed and who receive Title IV Federal financial aid
may owe the Federal Government, TCC, or both, money based on the determination of
the Federal review. These funds would be in addition to any tuition you may owe.
If you have any questions about your potential financial liability, you are directed to
contact the College’s Financial Aid Office for assistance before enrolling in this program.
Your signature below acknowledges you have read and understand your financial
obligations as described above.
Date Applicant Signature
Page 4 of 11
INSTRUCTIONS FOR FILLING OUT
BASIC RECRUIT APPLICATION
You are about to take the most important step toward an exciting and rewarding career
anyone can take. The following pointers will help you succeed in gaining acceptance at
the Pat Thomas Law Enforcement Academy.
You must first the Criminal Justice Abilities Test (CJBAT) for your area (Law
Enforcement or Corrections) prior to acceptance to the academy. To set up an
appointment for testing, please call the Tallahassee Community College Testing Center at
(850) 201-8282. The cost for this test is $35.00.
When filling out this application, please type or print legibly in black ink.
Fill out the application in its entirety. Any omitted information may disqualify you from
acceptance to the Academy. Write "NA" in blanks that are not applicable. If you have
questions about whether to include any information requested, contact Academy staff for
guidance. (Do not obtain until 3 weeks prior to academy start date.)
Obtain a Level II criminal background check for State (FDLE) & Federal (FBI) via an
FDLE approved vendor and sent to our ORI (FL922480Z). A list of FDLE approved
vendors may be located at: http://www.fdle.state.fl.us/Content/Criminal-
History/Livescan-Service-Providers-and-Device-Vendors.aspx Fees for the Level II
criminal background checks are set by the vendors.
If accepted to the Academy, you will be provided the CJSTC form 75 you will
have completed by a licensed physician.
When turning in your application, make sure that all necessary documentation is attached
with the application. (See next page for checklist)
Please fill out the application carefully and recheck it for any omissions or mistakes.
Incomplete applications are not acceptable and shall not be processed.
If any of the necessary documentation that is required to be turned in with the application
is unavailable at the time you submit your application, please make note of it
on the comments form, stating when you expect to obtain the information and turn it in.
Page 5 of 11
APPLICATION CHECKLIST
1. The following items must accompany your application at the time you submit it.
Declaration Form (included in this packet)
Basic
Abilities Test results (obtained from TCC Testing Center) 7-
year Driving History (obtained from DHSMV)
Copy of Drivers License
Sealed official transcript fro high school, GED or College.
(Official transcripts are required for financial aid)
Copy of Birth Certificate
Copy of Social Security Card
Copy of Military Record (DD214) if applicable
Completed FDLE Criminal History via Livescan vendor sent to
our ORI (FL922480Z).
Completed Personal History (included in this packet)
Answered each question completely and if not applicable filled
with "NA."
2. Please note that if you your court record indicates
you have been arrested for a
drug offense you may be required to submit to a drug test, at your expense, at a
designated medical facility prior to admission into the Academy.
3. Return your application with the documentation required to the Academy at one
of the following addresses based on law enforcement or corrections programs:
PAT THOMAS LAW ENFORCEMENT ACADEMY PAT THOMAS LAW ENFORCEMENT ACADEMY
LAW ENFORCEMENT COORDINATOR CORRECTIONS COORDINATOR
75 COLLEGE DRIVE 75 COLLEGE DRIVE
SUITE 203 SUITE 203
HAVANA, FL 32333 HAVANA, FL 32333
Page 6 of 11
PAT THOMAS LAW ENFORCEMENT ACADEMY
TALLAHASSEE COMMUNITY COLLEGE
INFORMATION RELEASE FORM
Applicant:
Date of Birth:
Social Security #:
To Whom It May Concern:
I am an applicant for admission to the Pat Thomas Law Enforcement Academy in a
training program.
In order for the Pat Thomas Law Enforcement Academy (Academy) to conduct a
comprehensive investigation prior to my admission it may be necessary for certain
information that might otherwise be confidential to be released to them. Further, I hereby
acknowledge that if I am accepted for admission it may also become necessary for the
Academy to conduct an investigation of me during my Academy class.
This release authorizes disclosure of records including, but not limited to, education
records, medical records, employment records and credit records to representatives of the
Academy at any time prior to the scheduled graduation date of my class from the
Academy.
By copy of this form, I hereby authorize the release (including duplication of records) to
representatives of the Pat Thomas Law Enforcement Academy of any and all records
concerning me you may hold.
Signature of Applicant
Date
Page 7 of 11
PAT THOMAS LAW ENFORCEMENT ACADEMY
APPLICATION FOR BASIC RECRUIT
POSITION
PERSONAL HISTORY
Please print neatly in black ink or type.
1. Full N
ame:
Last First Middle
2. Have you ever had your name changed? Yes
No
If you answered “Yes” to question #2, indicate as follows:
A. Previous
Name:
B. Date
and
location
of
change:
_
C. Reason
for
change:
3. Present address:
Street, P.O. Box
City State Zip
4. Home
Phone: Business:
_ Other:
5. Age: Date
of
Birth:
Place
of
Birth:_
6. Weight: Height:
Color
Hair:
7. Driver’s
License#: State:
Expiration:
8. Are
you
currently:
Married: Separated:
Divorced:
Single:
9. Full name of spouse
Last First Middle
10. N
ame of person(s) to notify in the case of emergency:
1.
Name Relati
onship Home Phone Work Phone
2.
Name Relationship Home Phone Work Phone
Page 8 of 11
11. List below any current or previous family member who was employed as a law
enforcement/corrections officer:
A.
Name Relationship Agency Home Phone Work Phone
B.
Name Relationship Agency Home Phone Work Phone
CITIZENSHIP INFORMATION
1. Are you a citizen of the United States? Yes No
2. Naturalization:
Date:
Location:
Number:
CERTIFICATION REFERENCE INFORMATION
1. Are you presently certified or have you ever been certified as a law enforcement or corrections
officer?
Yes
No
If
yes,
date
certified:
State:
2. If not presently working as
a law enforcement/corrections officer, date last worked as such:
Date:
Agency
Name:
3. Number of years and months experience as a law enforcement/corrections officer:
Years:
Months:
1. GED / High School Name
City
State
2. Do you have a college or university degree?
Yes No
AA/AS MA/MS PhD/JD
BA/BS
Quarter
hours:
3. Please check highest degree:
4. College Name
5. Number
of
semester
hours:
6. Major:
Minor:
LAW ENFORCEMENT EXPERIENCE
Agency Phone Number Rank Date Employed Supervisor
EDUCATION
Page 9 of 11
EMPLOYMENT REFERENCES OTHER THAN
LAW ENFORCEMENT EXPERIENCE
List chronologically the last two employers, including part-time:
1.
Name of Employer Dates
Employed (From/To) Position Held
Address City State Zip
Name of Supervisor Telephone Number Reason for Leaving
2.
Name of Employer Dates Employed (From/To) Position Held
Address City State Zip
Name of Supervisor Telephone Number Reason for Leaving
Have you ever applied for a position with or been sponsored into basic training by any criminal justice
agency? If yes, please list below:
Agency Date
Agency Date
COURT RECORD
1. Have you been given a traffic ticket within the past five- (5) years? Any civil infractions?
Yes No If yes, please list:
Date Place
Charge
Page 10 of 11
COURT RECORD CONTINUED
3. Have you ever been arrested or charged in any state for any criminal violation (felony or
misdemeanor or contempt of court order?) Yes No If yes, list all charges below:
(please use additional pages if necessary)
Date Place
Charges
If convicted, has your record been expunged or sealed? Yes No
If yes, please provide the following information: (note: use additional page if necessary)
Date:
City:
County:
State:
(If you have a sealed or expunged record that you have not disclosed in
this application, you may not be eligible for employment or appointment
as a criminal justice officer.) If you have doubts or questions about a sealed
or expunged record affecting your employability, it is your responsibility to
review FSS 943.13 & .14 for employment eligibility requirement.
ESSAY PORTION
(Please answer the following in your own words.)
WHY DO YOU WANT TO BECOME A CRIMINAL JUSTICE OFFICER?
Page 11 of 11
COMMENTS FORM
Use this page to list any additional information.
SPECIAL NOTE: This page should also be used to list any pre-existing injuries you may have
that may be aggravated by physical exercise or activity. Pre-existing
injuries of a serious nature (back injuries, recent surgery, joint injuries or
disease, etc.) must be medically cleared prior to participating in any
physical activity or training. This should also include any other medical
conditions that would place you or anyone else at risk during the academy.
IF YOU HAVE NO PRE-EXISTING INJURIES WRITE "NONE"
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Recruit Application 5-20 (Tallahassee Community College)

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Completed 7 September 2020

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