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

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*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
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Page 23 and 24: REQUIRED DOCUMENTS SECTION II Below

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

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