special process server program 2013/2014 - Broward Sheriff's Office

Employer: __________________________________________________Street: ____________________________________Suite: ________City, State, and Zip Code: ________________________________________Telephone Number: (______) ___________________________________1. Is there currently ANY PENDING criminal charges against you?YesNoIf yes, you are REQUIRED to supply BSO with an official copy of any policereport, unless already on file. (Attach additional sheets, if necessary)Agency: ____________________________________________________Charge(s): ____________________________________________________Date Charged: _____________________Current Status: _________________________________________________Have you EVER been DETAINED, ARRESTED, SUMMONED TO APPEAR,or CHARGED for ANY CRIMINAL VIOLATION? Yes NoIf Yes,You are REQUIRED to supply BSO with an official copy of anyPolice reports and court case dispositions. Include any records that havebeen sealed / expunged.(Attach additional sheets, if necessary)Already in SPS File _______ (applies to renewals, only)NOTE: Failure to disclose ALL of the above, to include providing therequired documentation, regardless of how long ago the incidentoccurred, will be grounds for disapproving applications.Page 10 of 162013-2014 Program Year_________Initials