Referred / Recruited by: ID# Collier County Sheriff's ...

1 Page 1 of 10 Referred / Recruited by:ID# Collier County Sheriff's office , Kevin J. rambosk , sheriff employment ApplicationThe Collier County Sheriff's office is an Equal Opportunity Employer. We consider applicants for all positions without regard to race, color, national origin, sex, age, physical disability, religion or any other legally protected status. Instructions: Application may be printed, in your own handwriting, legibly in ink or typewritten. This is your application. If additional space is needed, please refer to question number and add information on 8 -1/2 x 11 inch paper. If you are provided a conditional offer of a position, you will be required to complete a questionnaire with detailed background information. Once received by the CCSO, we must retain custody of the application. Portions of the application are subject to disclosure under Florida's Public Records Laws.

2 Please do not staple any documents to any portion of this (s) Requested (list in order of preference): 1. Name: (Last name) 2. Other: List all other names you have used with time periods used ( maiden, former, alias(es)).3. Education: List highest level attained, year attained, name and address of institution/school, and type of degree (if applicable).4. Law enforcement or Corrections Officer certification (when and where obtained):5. Are you willing to work shifts? Nights: Evenings: Weekends:YesNoNoYesNoYes6. Typing or Keyboarding speed:Computer programs (software) used in your current or prior position:7. Military Experience, if applicable. List date(s) of active duty, branch, highest rank obtained and type of you wish to claim Veteran's Preference?

3 (Call for details) NoYes8. Have you had any disciplinary action from any employer including military up to & including discharge? If yes, provide details below: YesNo(Middle name) (First name) 9. Have you ever been convicted of, or pled guilty to, any criminal violation (including juvenile, expunged, sealed, and/or adjudication withheld)? If yes, provide details below: NoYesDate:Place:Charge:Court Location:Disposition:Social Security Number: xxxxxxxxx format no dashesPage 2 of 1010. List all employment beginning with present employment , including summer and part-time positions while attending school, for the past ten years. If unemployed for a period, set forth date of more space is needed continue, in above format, on separate sheet of Security Number: xxxxxxxxx format no dashesPage 3 of 1011.

4 Residences: List all residence addresses for the past ten years beginning with current address:12. The Collier County Sheriff's office collects your Social Security number which may be used for any of the following purposes: collection of information related to background investigations, to include fingerprints, NCIC/FCIC checks, Credit Bureau reports, verification of employment , local and state records checks, clarification for duplicate names, verification of Military Services. Initial here 13. Driving History: You are not required to complete this question if applying for clerical position or any position that does not require driving a vehicle. State where licensed: License No: List any traffic violation conviction, including adjudication withheld, within the past ten years.

5 Provide date, charge, court location, and disposition:Social Security Number: xxxxxxxxx format no dashesPage 4 of 10 Name:Confidential Application History1. Current Address (including street address, city, state, zip):Mailing address, if different from above:Residential Phone:Alternate Phone:2. If a test or examination is required for this position, would you require an accommodation due to a qualifying disability to participate in this test or examination: If yes, explain what accommodation(s) you would need to take the test or examination. YesNo3. Aside from any substance abuse for which you have undergone treatment, have you used or experimented with any narcotic or controlled substance such as, but not limited to, marijuana, hashish, cocaine, LSD, amphetamines, heroin, steroids, or any drug of a similar nature?

6 If yes, please explain which drug(s) and the circumstances (where, when, why) of the use. Please indicate frequency and approximate date last used. YesNo4. Have you ever supplied or sold any illegal narcotic or controlled substance such as, but not limited to, marijuana, hashish, cocaine, LSD, amphetamines, heroin, steroids, and any drug of a similar nature? If yes, please complete the following: a. Drug(s):b. Circumstances (when, where, why):c. Number of times supplied to others:d. Date last supplied to others:e. Number of times sold to others:Date last sold: f. Was it sold for profit?YesNo5. Physical description (used to check your criminal history):Height:Weight:Hair Color:Eye Color:Scars/Marks/Tattoos:YesNoYesNoDate , Place, Court:E-mail Address:YesNoSocial Security Number: xxxxxxxxx format no dashesPage 5 of 10 AUTHORITY FOR RELEASE OF INFORMATION (Background Investigation Waiver) Incorporated by Reference in Rule (2)(b), Department of Law EnforcementCJSTC 58To: Concerned Person or Authorized Representative of Any Organization, Institution or Repository of RecordsAPPLICANT'S NAME:DATE OF BIRTH:SOCIAL SECURITY NUMBER (Optional):EMPLOYING AGENCY REQUESTING BACKGROUND INFORMATION.

7 Collier County Sheriff's OfficeI hereby authorize any employee or authorized representative bearing this release, or copy thereof, to obtain any information in your files pertaining to my employment records including, but not limited to, achievement, attendance, personal history, disciplinary records, medical records, credit records, and criminal history records. I hereby direct you to release such information upon the request of the bearer. This release is executed with full knowledge and understanding that the information is for the official use of the requesting agency. Consent is granted for the agency to furnish such information, as is described above, to third parties in the course of fulfilling its official responsibilities. I hereby release to you, as the custodian of such records, and employer, educational institution, physician, hospital or other repository of medical records, credit bureau or consumer reporting agency, including its officers, employees, and related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information, or any attempt to comply with it.

8 A photocopy of this form will be as effective as the original. I hereby authorize the National Records Center, St. Louis, Missouri, or other custodian of any military record to release information or photocopies from my military personnel and related medical records, including a photocopy of my DD 214, Report of Separation, to: Collier County Sheriff's office - 3319 Tamiami Trail East, Naples, FL 34112-4901 , , titled Employer Immunity from Liability; disclosure of information regarding former employees states: An employer who discloses information about a former employee's job performance to a prospective employer of the former employee upon request of the prospective employer or of the former employee is presumed to be acting in good faith and, unless lack of good faith is shown by clear and convincing evidence, is immune from civil liability for such disclosure of its consequences.

9 For the purposes of this section, the presumption of good faith is rebutted upon showing that the information disclosed by the former employer was knowingly false or deliberately misleading, was rendered with malicious purpose, or violated any civil right of the former employee protected under Chapter 760. Pursuant to Sections (2)(a) and (4), , Chapter 2001-94, Laws of Florida, disclosure of information unless contrary to state or federal law. Civil penalties may be available for refusal to disclose non-privileged legally obtainable information. _____ _____ Applicant's Signature Date _____ Applicant's Address AFFIDAVIT STATE OF _____ County OF _____ Before me personally appeared _____ who says that he/she executed the above instrument of his or her own free will and accord, with full knowledge of the purpose therefore.

10 Sworn and subscribed in my presence this _____ day of _____, 20 _____. My Commission Expires on _____, 20 _____. Personally known _____ - or - Produced Identification _____ Notary Public: _____ Type of identification produced: _____Effective: 8/9/2001 Pursuant to Original - Employing Agency Sections (2)(a) and (4), Page 6 of 10 APPLICATION PROCESS 1. Application submitted for review. 2. Application information input for automated tracking. 3. Application reviewed for compliance with minimum standards. 4. Candidate is sent a letter to schedule testing, if position requires. 5. Letter sent notifying candidate of eligibility for interview. 6. Candidates ranked based upon interview scores. 7. Written conditional offer of position presented detailing tests / evaluations to follow, not necessarily in the order shown: * Polygraph Exam * Background Investigation * Lab work and Medical Examination * Psychological Evaluation * Physical Agility Evaluation (for certified positions) * Final Review 8.