Application Package - Broward Sheriff's Office - Online Employment ...

Broward County Sheriff's Office
Firefighter Reserve
NON-PAID OPPORTUNITY
Salary Information
Shift
Non-paid (part-time position)
Ability to work nights, weekends and holidays
NATURE OF WORK
FIREFIGHTER RESERVE work is of a technical nature assisting certified firefighter/paramedics within the Broward Sheriff's Office's
Department of Fire Rescue and Emergency Services. Must agree to complete a minimum of one (1) twelve (12) hour ride per
month, attend a minimum of two (2) training sessions per month, and participate in a minimum of one (1) community event per
month if accepted into the program. Work may involve the prevention, control and suppression of both structural and non-structural
fires and in the response to man-made and natural disasters. Work is public safety oriented in the protection of life and property.
Work is of a physical nature and involves an element of personal danger. Participants must be able exercise discretion in
addressing emergency situations. Work assignments and instructions are received from a supervisor who reviews work methods
and results through observation, reports and conferences. Performs related work as directed.
Requirements
A BSO application demonstrating the following must be completed and submitted to Human Resources:
1. Minimum of 18 years of age.
2. High school diploma or equivalent. An evaluation of foreign high school diploma may be required.
3. Live in the tri-county area (Broward, Miami-Dade or Palm Beach County)
4. Current State of Florida Firefighter II certificate. MUST BE MORE THAN SIX (6) MONTHS FROM EXPIRATION AT TIME OF
ACCEPTANCE INTO THE PROGRAM.
5. Current State of Florida Emergency Medical Technician or Paramedic license.
6. Current Healthcare Provider (BLS) certification.
7. Paramedic candidates must provide current Advanced Cardiovascular Life Support (ACLS) Certification, and Pediatric
Advanced Life Support (PALS) certification or Pediatric Education for Prehospital Professionals (PEPP) card.
8. Proof of completion of the Emergency Vehicle Operators Course.
9. Nonuser of tobacco or tobacco products for at least 1 year immediately preceding application, as evidenced by sworn affidavit of
the applicant. F.S. 633.34(6).
10. Current Broward County-Wide Physical Ability Test (PAT) card issued by the Broward Fire Academy or any other Florida State
certified academy which contains a swim component.
11. Current listing on the Municipal Employment Screening and Hiring (MESH) Program eligibility list is preferred.
12. Possess and maintain a valid Florida Driver License without any restrictions affecting job performance. Driver license must
show current address. All candidates MUST submit with the application, a Certified Department of Motor Vehicles "complete"
driving history for every state in which a driver license was held within the last 7 years. The search date MUST be within one
month of the date the application is received in Human Resources. Please note that online driving history records will not be
accepted.
13. Provide official court dispositions for any previous arrests. Official court dispositions can be obtained form the Clerk of the Court
in the county in which the incident occurred.
14. Agree to complete a minimum of one (1) twelve (12) hour ride per month, attend a minimum of two (2) training sessions per
month, and participate in a minimum of one (1) community event per month if accepted into the program.
Note: All above noted documents are required to be submitted at time of application. Candidates who do not submit all
required documentation at time of application may not be considered.
WORK LOCATION
Any location within the Department of Fire Rescue and Emergency Services.
CLOSING DATE
April 12, 2013
HOW TO APPLY
You are encouraged to download an application packet from our website, www.sheriff.org. If you do not have access to the
Internet, you may visit the Bureau of Human Resources to obtain an application packet, Monday-Friday from 8:00 a.m. until 4:00
p.m. in the Ron Cochran Public Safety Complex, 2601 West Broward Boulevard, Fort Lauderdale, Florida 33312. Completed
applications must be submitted by the closing date.
Applicants who qualify will be subject to an extensive selection process and screening program, which may include, but not be limited to
evaluation of training and experience; interview; fingerprint and background check; medical examination and drug screen. The expected
duration of the selection process varies by position and could last 12 to 16 weeks. Reapplication will be determined on a case-by-case
basis.
BSO is an equal opportunity employer and does not discriminate on the basis of age, citizenship status, color, disability, marital status,
national origin, race, religion, sex, or sexual orientation. Veterans' preference per Florida law.
Posting Date: 02/18/13
LIST 13FFRESV (KW)
H:\SLASSESS\POSTINGS\POSTINGS.2013\13FFRESV FIRE RESERVE.doc

BROWARD COUNTY SHERIFF'S OFFICE
Firefighter Reserve
SELECTION PROCESS
The following is a summary of the selection process for the position of Reserve Firefighter with
the Broward County Sheriff’s Office Department of Fire Rescue and Emergency Services.
1. PHYSICAL ABILITY TEST
Applicants must pass the Physical Ability Test (PAT) conducted by the Broward Fire
Academy or any other Florida State certified academy which includes a swimming
component.
2. ORAL BOARD INTERVIEW
Applicants will participate in a formally structured oral board interview which is
administered and evaluated by a panel comprised of Department of Fire Rescue and
Emergency Services personnel. Appropriate business attire is required. Applicants are
evaluated on knowledge, skills, and abilities important to the Firefighter Reserve position.
An applicant who is not successful may reapply six (6) months from the interview date,
providing applications are being accepted.
3. BACKGROUND INVESTIGATION
Background investigations are conducted on applicants who successfully complete the
oral board interview. Investigations will include verification of an applicant’s qualifying
credentials to include, at a minimum: educational requirements, employment history,
review of criminal history, driver license history, at least three (3) personal references,
moral character (includes controlled substance history) and military service, if any.
4. MEDICAL EXAMINATION
Prior to a final job offer, all candidates are required to successfully complete a job-related
medical examination at their own cost. Exams must be performed by a licensed
physician. A 10-panel drug screen which includes nicotine must be part of this
examination.
5. FINAL FILE REVIEW
An applicant's file is reviewed in totality and in a competitive manner. Placement of the
best-qualified candidates is determined using the pool of eligible candidates. An
additional interview may be required prior to final selection.

Certified Driving History – State of Florida
A Certified Driving History can be obtained the same day at the following local courthouse
locations between the hours of 8:00 a.m. and 4:30 p.m. The fee is $16.25 for a “complete”
driving history. For additional information, contact (954) 831-6565.
NORTH REGIONAL COURTHOUSE
1600 W. Hillsboro Blvd.
Deerfield Beach, Florida 33442
WEST REGIONAL COURTHOUSE
100 North Pine Island Road
Plantation, Florida 33324
BROWARD COUNTY COURTHOUSE
201 S.E. 6 TH Street
Fort Lauderdale, Florida 33301
SOUTH REGIONAL COURTHOUSE
3550 Hollywood Blvd.
Hollywood, Florida 33021
PLEASE NOTE:
Three (3) year, seven (7), and electronic (on-line) driving histories WILL NOT be accepted. You
must request a “complete” driving history.

*TOB*
Broward Sheriff’s Office
Department of Fire Rescue & Emergency Services
Tobacco Product Use Affidavit
Pursuant to Section 633.34 (6), Florida Statutes, and for consideration of my application
for a firefighter position in the State of Florida, I _______________________________
do hereby affirm that I have been a nonuser of tobacco or tobacco products for at least
one (1) year immediately preceding this application dated _____________________, as
evidenced by this sworn affidavit.
_________________________________________
Signature
____________________________
Date
State of ___________________________, County of __________________________________
The foregoing instrument was acknowledged before me this __________ day of
____________________, 20______, by _____________________________________________
(Print name of person acknowledging)
who is personally known to me or who has produced ___________________________________
(Type of Identification Produced)
as identification and who did take an oath.
____________________________________
(Signature of Notary Public)
_________________________________
(Printed name of Notary Public as commissioned)
____________________________________
(Commission Number)
Revised 02/13

Broward Sheriff’s Office
APPLICATION FOR EMPLOYMENT
*APP*
Broward Sheriff’s Office
Bureau of Human Resources
2601 West Broward Boulevard
Fort Lauderdale, Florida 33312
Human Resources: 954-321-4400
Jobline: 888-276-7827
TDD Line: 954-831-8948
Online: www.sheriff.org
INSTRUCTIONS
PLEASE USE BLACK INK AND PRINT CLEARLY OR TYPE.
DO NOT leave any areas blank. Resumes may NOT SUBSTITUTE for any information
requested on this application. INCOMPLETE APPLICATIONS WILL NOT BE
PROCESSED.
The Broward Sheriff’s Office is an equal opportunity employer and does not discriminate on the basis of age, citizenship, color, disability, marital status, national origin, race, religion,
sex, or sexual orientation. These factors are NOT used as selection criteria, except in rare instances where such factors are bona fide occupational qualifications. This information may
be used, however, for identification purposes in conducting a background investigation.
In accordance with the “Americans with Disabilities Act of 1990”, the Broward Sheriff’s Office will reasonably accommodate qualified individuals with a disability. The reasonable
accommodation requirement applies to the application process, any pre-employment test, interview, and actual employment. If you are disabled and require accommodation, you may
request it and the Broward Sheriff’s Office will make every reasonable endeavor to provide it to you. However, some types of accommodations may require some preparation before
they can be provided. Therefore, we suggest that you make such requests in writing as early as possible by contacting the Bureau of Human Resources.
Position You Are Applying For
Date Of Application
Employee Who Referred You
If this position is available in part-time hours, would you be interested YES
TO BE COMPLETED BY ALL APPLICANTS
Personal Information:
Referring Employee’s CCN
NO
SECTION I
Social Security Number
Last Name First Name Middle Name
Residential Address (No PO Box)
Apt.
City State Zip Code E-Mail Address
Home Phone Work Phone Extension Cell Phone/Other
U.S. Citizen: By Birth Naturalized If not a citizen, are you legally authorized to work in the U.S. YES NO
Have you EVER applied for employment with the Broward Sheriff’s Office YES NO
Are you currently an employee of the Broward Sheriff’s Office YES NO CCN Classification
Do you wish to claim Veterans’ Preference per Florida Statute YES NO If YES, please complete the Veterans’ Preference Claim Form (page 4) and
provide a copy of your DD-214 Member 4 form with your application.
Have you ever used any other name YES NO If YES, please list those names below:
Last Name First Name Middle Name .From (mm/yy) To (mm/yy)
Reason
Last Name First Name Middle Name From (mm/yy) To (mm/yy)
Reason
By signing this document, I certify that all of the information on this entire application is true and complete to the best of my knowledge.
I understand that all information is subject to investigation and that omission, falsification, or misrepresentation is sufficient cause for rejection
of this application, removal of my name from consideration, or dismissal from service.
Signature
Date
For Office Use Only:
CS: ____________Code: __________
Reviewed By: __________________________
Revised 01/2013
1

EDUCATION/TRAINING
SECTION I
Are you a high school graduate YES NO GED
High School Name City State
Colleges/Universities Attended
Check here if not applicable
College/University City State
To (mm/yy) Total Credit Hours__________ Semester
Quarter
From (mm/yy)
Type of Degree Earned
Field of Study
Date of Degree (mm/yy)
College/University City State
To (mm/yy) Total Credit Hours__________ Semester
Quarter
From (mm/yy)
Type of Degree Earned
Field of Study
Date of Degree (mm/yy)
College/University City State
To (mm/yy) Total Credit Hours__________ Semester
Quarter
From (mm/yy)
Type of Degree Earned
Field of Study
Date of Degree (mm/yy)
Academy, Business, Trade or Other Schools Attended
Check here if not applicable
Academy/School Name City State
To (mm/yy) Total Credit Hours__________ Semester
Quarter
From (mm/yy)
Type of Certificate
Date of Certification/
Graduation (mm/yy)
Field of Study
Academy/School Name City State
To (mm/yy) Total Credit Hours__________ Semester
Quarter
From (mm/yy)
Type of Certificate
Date of Certification/
Graduation (mm/yy)
Current Professional Licenses or Certifications
Type of License/
Certification
Date Issued (mm/yy)
Check here if not applicable
Field of Study
State
Issuing Agency
Expiration
Type of License/
Certification
Date Issued (mm/yy)
State
Issuing Agency
Expiration
2

RELATED EMPLOYMENT HISTORY
SECTION I
LIST ALL FULL-TIME AND PART-TIME work experience which you feel relates to the position for which you are applying. Start with the
most recent related position. Major changes in duties or job titles with the same employer should be listed as separate positions.
Describe the job duties in detail to demonstrate that you meet the minimum requirements of the position that you are applying for. If you
need additional space, please photocopy this form and provide all information.
Employer
Position Total Hours Per Week _________ Full Time
To (mm/yy)
Part Time
From (mm/yy) Salary $
Detailed Job Duties
Employer
Position Total Hours Per Week _________ Full Time
To (mm/yy)
Part Time
From (mm/yy) Salary $
Detailed Job Duties
Employer
Position Total Hours Per Week _________ Full Time
To (mm/yy)
Part Time
From (mm/yy) Salary $
Detailed Job Duties
Employer
Position Total Hours Per Week _________ Full Time
To (mm/yy)
Part Time
From (mm/yy) Salary $
Detailed Job Duties
Employer
Position Total Hours Per Week _________ Full Time
To (mm/yy)
Part Time
From (mm/yy) Salary $
Detailed Job Duties
Employer
Position Total Hours Per Week _________ Full Time
To (mm/yy)
Part Time
From (mm/yy) Salary $
Detailed Job Duties
3

VETERANS’ PREFERENCE CLAIM
SECTION I
Per Florida Statute Chapter 295 and Rules of the Florida Department of Veterans’ Affairs, Veterans’ Preference points shall be awarded
to the earned ratings of eligible applicants who have achieved a minimum qualifying score on an examination. Special consideration will
be given to eligible applicants who apply for positions where examinations are not used.
SUMMARY OF CHANGES EFFECTIVE JULY 1, 2007:
1. Preference eligibility no longer expires upon appointment of the eligible person to a position with the state or any political
subdivision in the state.
2. Persons who were previously ineligible for preference because they held or are currently holding a job with a public employer
are now eligible to use their Veterans’ Preference again with all employers covered by law.
3. Persons who were previously ineligible for preference because they did not serve during an eligible wartime period may now be
eligible for Veterans’ Preference if they served during Operation Enduring Freedom (beginning October 7, 2001 – present) or
Operation Iraqi Freedom (beginning March 2003 – present). The receipt of a campaign or expeditionary medal is not required,
only service during those wartime periods.
In order to receive preference, an applicant must complete the following requirements by the closing date of the employment opportunity
specified on the posting:
Indicate claim for Veterans’ Preference on this application.
Answer all questions below.
Provide a copy of DD-214 Member 4 Form.
1. Do you wish to claim Veterans’ Preference under Florida Statute Chapter 295
YES
2. Are you:
A
B
C
D
E
F
NO
A veteran of any war who has served on active duty for one (1) day or more during a wartime period, excluding active
duty for training, and who was discharged under honorable conditions from the Armed Forces of the United States of
America
A disabled veteran who has served on active duty in any branch of the Armed Forces of the United States of America
who has a presently existing service-connected disability compensable under public laws administered by the V.A.
A disabled veteran who has served on active duty in any branch of the Armed Forces of the United States of America,
who is receiving compensation, disability retirement benefits, or pension by reason of public laws administered by the
V.A. and the Department of Defense
The spouse of any person, who has a total and permanent service-connected disability and who, because of this
disability, cannot qualify for employment
The spouse of any person who is missing in action, captured in the line of duty by a hostile force, or forcibly detained or
interned in the line of duty by a foreign government or power
An unremarried widow/widower of a veteran who died of a service-connected disability
3. If you have a service-connected disability, such disability has been rated by the V.A. or Department of
Defense to be ______________ percent.
A Veterans’ Preference-eligible applicant has a right to an investigation by the Florida Department of Veterans’ Affairs if a non-preference-eligible
applicant is selected to the position for which he or she applies, meets the minimum requirements, and achieves a minimum qualifying score. In order for
an investigation to be considered, a request must be filed within twenty-one (21) calendar days of the applicant receiving notice of the hiring decision by
the Broward Sheriff’s Office. Such requests should be made with the Florida Department of Veterans’ Affairs Division of Benefits and Assistance, PO Box
31003, St. Petersburg, FL 33731; Contact Name: John Burns (727) 319-7462. Any other inquiries regarding Veterans’ Preference should also be sent to
this address. You may also visit the Florida Department of Veterans’ Affairs website at www.floridavets.org.
You may be eligible to benefit under the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended. Submission of this information is
voluntary and refusal to provide it will not subject you to any adverse treatment. If you are an individual with a disability or a covered veteran, we would
like to include you under the affirmative action program. It would assist us if you provide the information below:
Veteran Status: Vietnam era veteran
Disability Status: Individual with a disability
Other protected veteran (served on active duty during a war or in
a campaign or expedition for which a campaign badge has been
authorized, under laws administered by the Department of Defense)
Recently separated veteran (discharged or released from active duty
less than one year ago)
4

CONTROLLED SUBSTANCES
Current employees of the Broward Sheriff’s Office are not required to complete this page.
SECTION I
Do you NOW, or have you EVER tried, purchased or sold any illegal drugs or controlled substances (“Tried” includes smoking; inhaling;
swallowing; placing/rubbing on gums, lips, or tongue; injecting; or ingesting by any other means.) YES NO
Please be advised that if you are extended a conditional offer of employment, you will be required to provide information regarding
frequency of controlled substance use.
Do you NOW, or have you EVER purchased or sold any illegal drugs or controlled substances YES NO
Have you ever used marijuana YES NO
If yes, when was the last time you used marijuana (mm/dd/yy) _________________________________
Have you ever used cocaine YES NO
If yes, when was the last time you used cocaine (mm/dd/yy) ___________________________________
Have you ever used anabolic steroids YES NO
If yes, when was the last time you used anabolic steroids (mm/dd/yy) ____________________________
Have you ever used any other controlled substance not listed above, such as ecstasy, mushrooms, acid, oxycontin, or heroin YES NO
NAME OF DRUG:
LAST TIME USED:
CRIMINAL HISTORY
CHARGES When applying for a position with a law
enforcement agency, ALL arrests and charges must be
disclosed, regardless of the disposition. These include, but
are not limited to, all charges that have been dismissed/no
action; found not guilty; sealed, expunged and/or purged;
“Withheld Adjudications”; and Juvenile charges.
CONVICTIONS The circumstances surrounding the
conviction are considered, such as: the nature, number,
severity, date of the offense, subsequent history, efforts at
rehabilitation, and relation of the offense to the requirements
of the position for which you are applying. Most
misdemeanor convictions are not an automatic
disqualification for employment.
SECTION I
Have you EVER been arrested or detained by ANY law enforcement
agency for ANY reason This includes arrests or detentions [held for
questioning, Notice to Appear or Promise to Appear] as a juvenile or for
violations which were not prosecuted or where some type of pre-trial
intervention was offered, and includes all arrests regardless of your plea.
YES
NO
Have you EVER been convicted of, or have you EVER been found to
have committed any civil or criminal law violation other than minor
traffic violations
YES
NO
Have you EVER had a criminal charge or record sealed, expunged
or purged
YES
NO
If YES, please LIST ALL CRIMINAL AND CIVIL LAW VIOLATIONS. Copies of all court dispositions must be submitted with
application. Be sure to include charges from all states, regardless of the outcome or timeframe. Attach additional pages if
necessary.
Charge, Violation, or
Circumstances
Date (mm/dd/yy)
Location (City & State)
Detention, Disposition, or
Penalty
Date (mm/dd/yy)
Please explain disposition
Charge, Violation, or
Circumstances
Date (mm/dd/yy)
Location (City & State)
Detention, Disposition, or
Penalty
Date (mm/dd/yy)
Please explain disposition
5

DISTINGUISHING MARKS, TATTOOS OR PIERCINGS
Current employees of the Broward Sheriff’s Office are not required to complete this page.
SECTION I
The Broward Sheriff's Office has a Dress Code policy to include the following:
Employees are prohibited from piercings (except normal piercing of the earlobe).
The use of gold, platinum, or other veneers or caps for purposes of dental ornamentation is prohibited.
Employees are prohibited from intentionally altering, modifying, or mutilating any part of their bodies in order to achieve
a visible physical effect that disfigures, deforms or otherwise detracts from a professional image.
Tattoos/body art/brands visible anywhere on the body that are extremist, indecent, sexist, or racist are prohibited.
Tattoos/body art/brands anywhere on the head, face, and neck above the shirt collar are prohibited.
Excessive tattoos/body art/brands are prohibited. Excessive is defined as exceeding 1/4 of the exposed body part.
Prior to being employed, candidates accepting an offer of employment will be required to disclose in writing the
existence of any visible tattoos/body art/brands and must complete removal of inappropriate tattoos/body art/brands.
Do you have any distinguishing mark, tattoo and/or piercing YES NO
If yes, on the space provided below, please identify any distinguishing mark, tattoo and/or piercing:
TYPE (CHECK ONE) DESCRIPTION LOCATION ON BODY
Distinguishing
Mark Tattoo Piercing
Distinguishing
Mark Tattoo Piercing
Distinguishing
Mark Tattoo Piercing
Distinguishing
Mark Tattoo Piercing
Please use page 8 of the application to list any additional distinguishing mark/tattoo/piercing that does not fit in the
space provided above.
Please check one of the statements below:
I will comply with the Dress Code policy.
I am unable and/or unwilling to comply with the Dress Code policy.
6

EQUAL EMPLOYMENT OPPORTUNITY AND RECRUITING SURVEY
SECTION I
______________________________________________
__________________________________
Today’s Date (mm/dd/yy) Date of Birth (mm/dd/yy) Sex: Male Female
______________________________________________
Position Applied For
________________________________________________________________________________________________
Other Languages Spoken
Race/Ethnic Category
(Check only 1 category. Refer to the chart for descriptions.)
Hispanic or Latino
White (Not Hispanic or Latino)
Black or African American (Not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander
(Not Hispanic or Latino)
Asian (Not Hispanic or Latino)
American Indian or Alaska Native
(Not Hispanic or Latino)
Two or More Races
(Not Hispanic or Latino)
Hispanic or Latino
White
Black or
African American
Native Hawaiian or
Other Pacific
Islander
Asian
American Indian or
Alaska Native
Two or More Races
Description of EEOC Race/Ethnic Categories:
All persons of Mexican, Puerto Rican, Cuban, Central or
South American, or other Spanish culture or origin, regardless
of race.
All persons having origins in any of the original peoples of
Europe, North Africa or the Middle East.
All persons having origins in any of the Black racial groups of
Africa.
All persons having origins in any of the peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.
All persons having origins in any of the original peoples of the
Far East, Southeast Asia, or the Indian Subcontinent,
including, for example, Cambodia, China, India, Japan, Korea,
Malaysia, Pakistan, the Philippine Islands, Thailand, and
Vietnam.
All persons having origins in any of the original peoples of
North and South America (including Central America) and
who maintain a tribal affiliation or community attachment.
All persons who identify with more than one of the above five
races.
Please take the time to complete the section below. Your response is valuable and will be used for research purposes to
better determine where our recruitment efforts are successful.
How did you FIRST learn of this position
(Check only one)
Referred by BSO employee
Name: _____________________________________
CCN: ______________________________________
Work Location: _____________________________
Newspaper/Publication
Sun-Sentinel
Miami Herald
Palm Beach Post
Brochure
Employment Guide – Atlanta
Minority Publication
The Chief
The Employment Guide
Trade Journal
Other Newspaper/Publication
Internet:
Sheriff.org
Jobing.com
Google.com
Careerbuilder.com
Yahoo.com
MSN.com
Craigslist.com
Flipdog.com
Other Website
Other:
Applicant is a BSO employee
Broward College Testing Center
BSO Bulletin Board
BSO Mailing/Letter
Job Fair
Internship Program
Job Line
Military Recruitment
Neighborhood/Community Meeting
One Stop/Other Employment Agency
Open House
Other Academy/State Exam
Poster/Ad
(bus, billboard, bus bench, taxi)
Radio
Referred by a Friend
Religious/Church Recruitment
Television
Walk In
7

Please use this page to provide any additional information that does not fit in other sections of the application.
8

Broward Sheriff’s Office
Bureau of Human Resources
2601 West Broward Boulevard
Fort Lauderdale, Florida 33312
Human Resources: 954-321-4400
Jobline: 888-276-7827
TDD Line: 954-831-8948
Online: www.sheriff.org
*APP*
Date of Application Position You Are Applying For Social Security Number
Last Name First Name Middle Name
EMPLOYMENT HISTORY
SECTION II
LIST ALL FULL-TIME, PART-TIME, TEMPORARY and SELF-EMPLOYMENT you have had during the last 7 years, ensuring that ALL time is accounted for. Start with your
CURRENT employment. Self-employment requires supporting documentation. You will need to provide a detailed explanation of how you financially supported yourself for all
periods of unemployment in the space provided below. If you have had more than 11 jobs, please photocopy page 3.
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
Revised 01/2013 1

EMPLOYMENT HISTORY CONTINUED
SECTION II
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
2

EMPLOYMENT HISTORY CONTINUED
SECTION II
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
To (mm/dd/yy)
From (mm/dd/yy)
Starting Salary $
Position
Employer
Street Address
Phone
Fax
Supervisor
(Full Name)
Ending Salary $
Full Time
Part Time
City State Zip
Reason for Leaving
Between these jobs (If Applicable) Unemployed In School From (mm/dd/yy) ________________ To (mm/dd/yy) ________________
Explanation of financial support during period of unemployment noted above:
3

ADDITIONAL EMPLOYMENT INFORMATION
1. Have you ever been dismissed from any employment; been asked to resign from any employment; resigned from any employment
following allegations of misconduct or unsatisfactory performance; or left a job by mutual agreement YES NO
If YES, please provide details below. Please be specific and attach additional pages if necessary.
SECTION II
Date (mm/dd/yy) Name of Agency/Employer Position
Reason/Outcome
Date (mm/dd/yy) Name of Agency/Employer Position
Reason/Outcome
2. Have you ever received an unsatisfactory performance evaluation(s) or any disciplinary action(s), including verbal or written reprimands,
from an employer YES NO
If YES, please provide details below. Please be specific and attach additional pages if necessary.
Date (mm/dd/yy) Name of Agency/Employer Position
Circumstances
Date (mm/dd/yy) Name of Agency/Employer Position
Circumstances
3. Have you ever performed any service for any law enforcement agency or been employed by any law enforcement, corrections or public
service agency not listed in this application YES NO
If YES, please provide details below. Please be specific and attach additional pages if necessary.
From (mm/dd/yy) To (mm/dd/yy) Name of Agency/Employer Position
Reason for Leaving
From (mm/dd/yy) To (mm/dd/yy) Name of Agency/Employer Position
Reason for Leaving
4. Are you an owner, partner, or corporate officer in any other business not listed as an employer YES NO
If YES, please provide details below.
Business Name
Type of Business
Business Name
Type of Business
APPLICATIONS WITH OTHER AGENCIES
SECTION II
Please list ALL public safety agencies to include law enforcement, corrections, and fire rescue and emergency services to which you have
applied within the past 5 years. Include all testing completed and results, and/or why you were not hired. Attach additional pages if
necessary.
Agency Position Application Date (mm/yy) Results/Status
4

RESIDENTIAL BACKGROUND
SECTION II
Please list all residential addresses you have lived at during the past 7 years. Please do not use PO Box Addresses. Begin with
your current residence and include any addresses you may have resided at during school or the military. Attach additional pages if
necessary.
From (mm/yy) To (mm/yy) Street Address Apt. City State Zip Code
DRIVING HISTORY
List ALL driver’s licenses issued to you, starting with your current driver’s license.
SECTION II
State Type Issue Date (mm/yy) Expiration/Surrender Date (mm/yy)
Is your driver’s license CURRENTLY valid YES NO
Has your driver’s license EVER been revoked/suspended or have you ever been refused a driver’s license YES NO
If you answered Yes, please provide details:
MILITARY
SECTION II
Have you ever served in the Armed Forces of the United States (including Reserves and National Guard) YES NO
DD-214 Member 4 Form must be provided for each enlistment period.
Branch of Military
List All Disciplinary Offenses
NONE
To (mm/yy)
From (mm/yy)
Character of Service (Box 24
on DD-214 Member 4 Form)
List All Disciplinary Action(s), including non-judicial punishment(s).
NONE
Branch of Military
List All Disciplinary Offenses
NONE
To (mm/yy)
From (mm/yy)
Character of Service (Box 24
on DD-214 Member 4 Form)
List All Disciplinary Action(s), including non-judicial punishment(s).
NONE
5

PERSONAL REFERENCES
SECTION II
List 5 personal references and their contact information. References cannot be related to each other, family members or current/former
supervisors. To expedite the background investigation, please include e-mail addresses for each reference (if available). Please print clearly.
Reference’s Name (PRINT) Reference’s Daytime Phone Number Extension
Reference’s Occupation Reference’s Other Phone Number Extension
Reference’s City
State
Reference’s E-Mail Address
Reference’s Name (PRINT) Reference’s Daytime Phone Number Extension
Reference’s Occupation Reference’s Other Phone Number Extension
Reference’s City
State
Reference’s E-Mail Address
Reference’s Name (PRINT) Reference’s Daytime Phone Number Extension
Reference’s Occupation Reference’s Other Phone Number Extension
Reference’s City
State
Reference’s E-Mail Address
Reference’s Name (PRINT) Reference’s Daytime Phone Number Extension
Reference’s Occupation Reference’s Other Phone Number Extension
Reference’s City
State
Reference’s E-Mail Address
Reference’s Name (PRINT) Reference’s Daytime Phone Number Extension
Reference’s Occupation Reference’s Other Phone Number Extension
Reference’s City
State
Reference’s E-Mail Address
6

NEIGHBOR REFERENCES
To Be Completed By Applicants For Deputy Sheriff Positions (Law Enforcement and Detention)
SECTION II
List 4 neighbors from where you currently reside (For example households to the left, right, in front, and behind).
Last Name (PRINT)
First Name (PRINT)
Street Address
Apt.
City State Zip Code
Home Phone Number Work Phone Number Extension Cell Phone Number / Other
Last Name (PRINT)
First Name (PRINT)
Street Address
Apt.
City State Zip Code
Home Phone Number Work Phone Number Extension Cell Phone Number / Other
Last Name (PRINT)
First Name (PRINT)
Street Address
Apt.
City State Zip Code
Home Phone Number Work Phone Number Extension Cell Phone Number / Other
Last Name (PRINT)
First Name (PRINT)
Street Address
Apt.
City State Zip Code
Home Phone Number Work Phone Number Extension Cell Phone Number / Other
7

BACKGROUND INVESTIGATION WAIVER
FDLE BACKGROUND INVESTIGATION WAIVER
SECTION II
SECTION II
Florida Department of
Law Enforcement
AUTHORITY FOR RELEASE
OF INFORMATION
(Background Investigation Waiver)
Incorporated by Reference in Rule 11B-27.0022(2)(b), F.A.C
CJSTC
58
To:
Concerned Person or Authorized
Representative of Any Organization,
Institution or Repository of Records
APPLICANT’S NAME: _____________________________________
DATE OF BIRTH: _________________________
LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER: __________
AGENCY REQUESTING BACKGROUND INFORMATION: Broward Sheriff’s Office
ADDRESS: 2601 West Broward Boulevard, Fort Lauderdale, FL 33312
Having made application for certification or employment as a law enforcement, correctional, or correctional probation officer within the state of Florida, I
hereby authorize for one year, from the date of execution hereof, any authorized representative of a Florida criminal justice agency or a Regional
Criminal Justice Selection Center bearing this release to obtain any information pertaining to my employment, credit history, education, residence,
academic achievement, personal information, work performance, background investigations, polygraph examinations, any and all internal affairs
investigations or disciplinary records, including any files that are deemed to be confidential and/or sealed.
I also authorize release of any criminal justice records of arrests, citations, detentions, probation and parole records, or any police reports or other police
records in which I may be named for any reason, including any files that are deemed to be juvenile and confidential. I hereby direct you to release this
information upon the request of the bearer, whether in person or by correspondence. I further authorize the bearer to make copies of these records.
This release is executed with the full knowledge and understanding that these records and information are for the official use of a Florida criminal justice
agency or Regional Criminal Justice Selection Center in fulfilling official responsibilities, which may include sharing the records or information with other
criminal justice agencies, Regional Criminal Justice Selection Centers or the State of Florida or release to third parties as may be required by Florida
public records laws. I hereby release 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. A copy of this form will be as effective as the
original.
I hereby authorize the National Records Center, St. Louis, Missouri, or other custodian of my military record to release information or copies from my
military personnel and related medical records, including a copy of my DD 214, Report of Separation, or other official documents from the United States
Military denoting discharge status or current active military status to:
Broward Sheriff’s Office - 2601 West Broward Boulevard, Fort Lauderdale, FL 33312
Section 768.095, F.S., titled Employer Immunity from Liability; disclosure of information regarding former or current employees states: An employer who
discloses information about a former or current employee to a prospective employer of the former or current employee upon request of the prospective
employer or of the former or current employee, is immune from civil liability for such disclosure of its consequences, unless it is shown by clear and
convincing evidence that the information disclosed by the former or current employer was knowingly false or violated any civil right of the former or
current employee protected under chapter 760, Florida Statutes. Pursuant to Sections 943.134(2)(a) and (4), F.S., Chapter 2001-94, Laws of Florida,
disclosure of information is required unless contrary to state or federal law. Civil penalties may be available for refusal to disclose nonprivileged
legally obtainable information.
Applicant’s Signature:
Date:
Applicant’s Address:
AFFIDAVIT
STATE OF____________________________________________________________ COUNTY OF _______________________________________________________
The forgoing instrument was acknowledged before me this date _____________________________ By: __________________________________________________
Who is personally known _______________________________________________________ or who has produced identification.
Type of identification: _______________________________________________________
__________________________________________________________________________
Notary’s Signature
_______________________________________________________
Print, type, or stamp Commissioned Name of Notary
Notary Seal: _______________________________________________________________________
Upon witnessing the applicant signing of this affidavit, the notary public shall complete the notary block.
Effective: 08/09/2001 Pursuant to
Sections 943.134(2) and (4), F.S.
Original – Employing Agency Commission-Approved Revisions: 08/06/2009
Form Effective: 06/03/2010
8

Broward Sheriff’s Office
Bureau of Human Resources
2601 West Broward Boulevard
Fort Lauderdale, Florida 33312
Human Resources: 954-321-4400
Jobline: 888-276-7827
TDD Line: 954-831-8948
Online: www.sheriff.org
ATTEST, CONSENT, AUTHORIZE, AND RELEASE
SECTION II
I, _______________________________________________________________________________________________,(PRINT YOUR FULL NAME)
thoroughly understand that I am being considered for employment in the position for which I have applied, and consent to submitting to a background
investigation and other selection processes which may include, but not be limited to: fingerprint processing, polygraph, post-conditional employment offer
medical and/or urinalysis, psychological evaluation, job interview, and other means deemed necessary and proper by the Broward Sheriff’s Office to
complete its investigation as to my fitness and suitability for the classification for which I have applied. I thoroughly understand that I must successfully
complete the above-mentioned process. I am attesting that I understand and meet all of the minimum requirements as stated on the job announcement.
I am seeking employment on the basis that I know that the Broward Sheriff’s Office, or other individuals or agencies, will develop no unfavorable
information, with the exception of what I have indicated in this application, which has been thoroughly explained by me in detail during the hiring process.
By signing this document, I certify that all of the information contained in this entire application and all documents submitted are true and complete to the
best of my knowledge. I understand that all information is subject to investigation and that omission, falsification, misrepresentation, or other unfavorable
information developed is sufficient cause for removal of my name for consideration for employment or dismissal from service. I further understand that
unfavorable information disclosed during the selection process can and may be forwarded to past/current employers and other law enforcement agencies.
I understand that the application and all documents submitted are the property of the Broward Sheriff’s Office and non-exempt information contained in
said forms and documents is public record.
I understand that the Broward Sheriff’s Office will not reimburse any expenses I might incur in seeking this position. I recognize that the time required to
process and select employees for this position may be lengthy and time consuming. No promises or commitments are expected by me as to a time when
a hiring decision and/or actual hiring might take place.
I understand that unless defined by applicable law, any employment relationship with the Broward Sheriff’s Office is "at will", that I may be discharged at
any time with or without cause, and that this "at will" relationship may not be changed unless authorized, in writing, by the Sheriff.
I understand and agree that any employment offered to me will be contingent upon my acceptance of compensatory time off instead of cash payments of
overtime hours that I work, to the extent allowed by law and that the Sheriff has the absolute discretion to periodically substitute cash, in whole or in part,
for my accrued compensatory time.
I understand that the Broward Sheriff’s Office is a Drug-Free Workplace and that employees are subject to random drug testing.
I authorize and direct any persons or organizations to release and furnish records and information as may be relevant to determine my fitness and
suitability for employment in the position for which I have applied.
I further agree to execute any authorizations as may be required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for healthcare
providers to release the necessary medical information to process my application for employment.
I agree to conform to rules, regulations, and orders of the Broward Sheriff’s Office and acknowledge that these rules, regulations, and orders may be
changed, interpreted, withdrawn, or added to by the Broward Sheriff’s Office at its discretion at any time and without prior notice to me.
This authorization is executed with full knowledge and understanding that information and/or copies of records disclosed shall become the property of the
Broward Sheriff's Office, shall be used for official employment evaluation, and are used as selection criterion only where related to performance of the job
for which I have applied; that the Broward Sheriff's Office will take appropriate measures to protect aforementioned information and/or copies of records
against unauthorized disclosure; and that certain non-exempt portions of the information and/or copies of records disclosed may be made available for
inspection by third parties pursuant to public records and other laws.
I understand and consent to all of the above statements and conditions.
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.
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: ________________________________________________________________________
9

Broward Sheriff’s Office
Bureau of Human Resources
2601 West Broward Boulevard
Fort Lauderdale, Florida 33312
Human Resources: 954-321-4400
Jobline: 888-276-7827
TDD Line: 954-831-8948
Online: www.sheriff.org
CONSUMER CREDIT REPORTING
DISCLOSURE AND AUTHORIZATION
SECTION II
By this document, the Broward Sheriff’s Office discloses that a consumer credit report may be obtained for
employment purposes as a part of the pre-employment background investigation. If hired, this authorization shall
remain on file and shall serve as an ongoing authorization for the Broward Sheriff’s Office to procure consumer
credit reports at any time during your employment period.
First Name (PRINT) Middle Name (PRINT) Last Name (PRINT)
Social Security Number
Applicant’s Signature
Date (mm/dd/yy)
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.
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: ________________________________________________________________________
10

REQUIRED DOCUMENTS
SECTION II
Below is a list of all required documents that must be submitted with this application. Each document should be
photocopied on a separate piece of paper and must be clear and legible.
Original documents must be presented for comparison
REQUIRED DOCUMENTATION
Pages 8, 9 and 10 must be notarized
Deputy Sheriff Positions
Detention Deputy Positions
Firefighter/Paramedic Positions
For Civilian Positions
Birth Certificate or Certificate of Naturalization
Social Security Card (with current legal name and signature)
Driver’s License (with current legal name/address)
Name change document(s) (such as marriage license, divorce decree, court
document for name change, etc.) for EACH name used
High School Diploma, transcript, or equivalent
College Diploma(s) or transcript(s)
DD-214 Member 4 Form (for each enlistment period)
Entire driving history (from each state you have held a driver’s license during the
past 7 years)
Court Disposition(s) for ALL arrests/charges and copies of police report(s)
Documents for each year of self-employment (include corporate papers, business
licenses, etc.)
Certification Documentation (if applicable)
Law Enforcement Deputy Sheriff: Florida Department of Law
Enforcement (FDLE) Certification
Detention Deputy Sheriff: Basic Recruit Certificate
Firefighter/Paramedic: State of Florida Firefighter II certificate and a
State of Florida Paramedic license
Birth Certificate or valid U.S. Passport or Certificate of
Naturalization
Social Security Card (with current legal name and signature)
Driver’s License or State ID (with current legal name/address)
Resident Alien Card: front & back (with current legal name)
Name change document(s) (such as marriage license,
divorce decree, court document for name change, etc.) for
EACH name used
High School Diploma, transcript, or equivalent
College Diploma(s) or transcript(s)
DD-214 Member 4 Form (for each enlistment period)
Court Disposition(s) for ALL arrests/charges and copies of
police reports
Documents for each year of self-employment (include
corporate papers, business licenses, etc.)
Performance Evaluations (for last 3 years, for current Law Enforcement Officers,
Corrections Officers or Firefighter/ Paramedics only)
11

Certified Firefighter/Paramedic (13FFRESV)
Supplemental Questionnaire
Please answer all of the following questions by circling Yes or No.
1. Are you included on the current Municipal Employment Screening and
Hiring Program eligibility list (MESH)
Yes
No
2. Are you 18 years of age or older
Yes
No
3. Do you have a valid State of Florida driver license
Yes
No
4. Do you have a high school diploma or GED from an accredited
institution
Yes
No
5. Do you have a State of Florida Firefighter certificate
Yes
No
6. Do you have a State of Florida Paramedic license
Yes
No
7. Do you have a valid Physical Ability Test (PAT) card issued by the
Broward Fire Academy or any other Florida State certified academy which
contains a swimming component
Yes
No
8. Have you used tobacco or tobacco products in the last twelve (12)
months
Yes
No