Apply for Level II Volunteer - Hernando County Sheriffs Office

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Apply for Level II Volunteer

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:	Level II Volunteer
ID:	1002
Location:	N/A
Department:	Administrative

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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.

Level 2 Volunteer Application

All responses are required. If a question is not applicable, please enter N/A.

The Sheriff's Office is an Equal Employment Opportunity Employer. We consider applicants for all positions without regard to race, color, national origin, sex, age, disability, marital status, religion or any other legally protected status.

NOTICE: The following additional documents must be attached to this application:

A copy of your birth certificate
A copy of your Driver's License
A copy of your Social Security Card

* DATE APPLICATION RECEIVED BY AGENCY:

* POSITION APPLYING FOR:

Volunteer II

INSTRUCTIONS

All questions must be answered. Applications which are not complete will not be considered. If space provided is not sufficient for complete answers or you wish to furnish additional information, attach sheets of the same size as this application, and number answers to correspond with questions.

I understand that the submission of this application is for a voluntary position.

PERSONAL HISTORY

1. Full Name

Last Name

First

Middle

2. Other: List all other names you have used including the circumstances and time periods you used them (For example: maiden name, former name(s), alias(es) or nickname(s).

Name

Circumstance

Dates From Mo./Yr.

Dates To Mo./Yr.

Name

Circumstance

Dates From Mo./Yr.

Dates To Mo./Yr.

Name

Circumstance

Dates From Mo./Yr.

Dates To Mo./Yr.

* 3. Do you currently use any narcotic or controlled substance, such as cannabinoids, PCP, hallucinogen, methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturate, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature, or have you used such a narcotic or controlled substance within the last year?

Yes No

* 4. Have you ever illegally experimented with or used any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogens, methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug or any drug of a similar nature?

Yes No

If yes, please complete the following

a. Drug:

b. How Taken:

c. Last time illegally experimented with or used:

* 5. Do you now or have you ever illegally obtained, possessed, supplied or sold any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogens, methaqualone, hashish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug or any drug of a similar nature?

Yes No

If yes, please complete the following

a. Drug:

b. Circumstances:

c. Number of times illegally obtained/possessed/supplied/sold:

d. First time illegally obtained/possessed/supplied/sold:

e. Last time illegally obtained/possessed/supplied/sold:

* 6. Do you now or have you within the last year, abused or illegally obtained, possessed or sold any prescription drug?

Yes No

If yes, please provide details, including drug, date and circumstances

BACKGROUND INFORMATION

THIS INFORMATION IS REQUIRED TO CONDUCT BACKGROUND INVESTIGATION ONLY!

1. Date and Place of Birth:

* Date of Birth

* City

* County

* State

* Country (if not the United States)

* 2. Are you a United States citizen?

Yes No

If naturalized, please provide:

Date

* Place

* Court

* Naturalization No.

* 3. Marital Status

Married Divorced Separated Widowed Never Married

* 4. Height

* Weight

5. Indicate any foreign languages you can speak

Langauge

Fluent Good Fair

Langauge

Fluent Good Fair

Langauge

Fluent Good Fair

6. Indicate any law enforcement education/training

* 7. Did you receive a certificate for this training?

Yes No

Certificate Number

* 8. Has your law enforcement certificate ever been suspended, revoked, relinquished or subject to discipline or investigation by the CJST?

Yes No

If yes, explain

* 9. Indicate any special skills you possess and equipment you can use which may be related to law enforcement. (For example: two-way radio communications, breathalyzer, speed detection equipment, firearms, computers)

EMPLOYMENT HISTORY

1. List chronologically 5 years' worth of employment, beginning with present employment, including summer and part-time employment while attending school. All time must be account for. If unemployed for a period of time please provide a reason.

Current or Most Recent Employer

Name

Address

City

State

Zip

Phone

Website

From

Salary

Title or Position

Full Part-Time

Name of Supervisor

Reason For Leaving

Previous Employer

Name

Address

City

State

Zip

Phone

Website

From

Salary

Title or Position

Full Part-Time

Name of Supervisor

Reason For Leaving

Next Previous Employer

Name

Address

City

State

Zip

Phone

Website

From

Salary

Title or Position

Full Part-Time

Name of Supervisor

Reason For Leaving

Next Previous Employer

Name

Address

City

State

Zip

Phone

Website

From

Salary

Title or Position

Full Part-Time

Name of Supervisor

Reason For Leaving

Next Previous Employer

Name

Address

City

State

Zip

Phone

Website

From

Salary

Title or Position

Full Part-Time

Name of Supervisor

Reason For Leaving

* 2. Have you ever been dismissed or asked to resign or had any disciplinary action taken against you from any employment or position you have held?

Yes No

From Where?

* When?

* 3. Have you resigned, or left a job by mutual agreement following allegations of misconduct or unsatisfactory job performance?

Yes No

If yes to question #2 or #3, please provide details.

* 4. Have you ever applied to or performed paid or unpaid services for a law enforcement agency not listed as an employer?

Yes No

If yes, please provide name or agency and date of application or service.

* 5. Do you own a business, or are you a partner or corporate officer in any business or organization not listed previously as a current or former employer?

Yes No

If yes, please provide name and address of business, corporation or organization and describe your relationship or position

RESIDENCES

1. Actual places of residence for past 10 years - list chronologically all addresses, including residences while at school and in military. For college on campus residences, give dormitory name, city and state. If residences in military service cannot be shown as street address, indicated complete military unit designation and location by city and state. If post office box, give location of post office.

Current Address

From

Apt. No.

Street Address

City

County

State

Previous Address

From

Apt. No.

Street Address

City

County

State

Next Previous Address

From

Apt. No.

Street Address

City

County

State

Next Previous Address

From

Apt. No.

Street Address

City

County

State

ARREST HISTORY/COURT DATA

1. Have you ever been arrested, charged or received a notice or summons to appear, convicted, pled nolo contendre or pled guilty to any criminal violation, regardless if the record was sealed or expunged?

Yes No

2. Have you ever received a ticket or been charged with a traffic violation (exclude parking tickets)?

Yes No

* 3. To your knowledge, has any member of your immediate family ever been arrested for anything other than traffic violations?

Yes No

If yes to question #1, #2 OR #3, list all such matters even if not formally charged, or no court appearance, or found not guilty or nolo contendre to any charge for which adjudication was withheld, or matter settled by payment of fine or forfeiture of collateral. (Include your juvenile record and records of your arrest(s) which have been sealed, if any.)

Incident 1

From

Place & Department

Charge

Court & Place

Disposition

Incident 2

From

Place & Department

Charge

Court & Place

Disposition

Incident 3

From

Place & Department

Charge

Court & Place

Disposition

Incident involving Relative 1

Relative's Name & Relationship to you

Place & Department

Charge

Court & Place

Disposition

Incident involving Relative 2

Relative's Name & Relationship to you

Place & Department

Charge

Court & Place

Disposition

Incident involving Relative 3

Relative's Name & Relationship to you

Place & Department

Charge

Court & Place

Disposition

* Provide details for each response to question #1, #2 or #3

* 1. Have you or your spouse ever been a plaintiff or defendant in a court action? (Include any liens, lawsuits, bankruptcy, domestic violence injunctions, etc.)? If you answered yes, give date, place or court, case number, names of involved parties, nature of action and final disposition.

Yes No

* 2. Have you ever been detained by any law enforcement for investigative purposes or to your knowledge have you ever been the subject of or a suspect in any criminal investigation?

Yes No

If yes, please provide details

* 3. Have you ever been fingerprinted for any reason (arrest, job application, military, etc.)?

Yes No

If yes, please provide details

DRIVING HISTORY

* 1. Are you a licensed Florida automobile operator or chauffeur?

Yes No

* License Number

* State

* Expiration

* Restrictions

* 2. Have you ever been denied issuance of a license or have you ever had a license suspended or revoked?

Yes No

If yes, please provide complete details including why license was revoked:

* 3. Have you ever had automobile insurance refused, withdrawn, or revoked?

Yes No

If yes, please provide complete details:

PERSONAL REFERENCES & ACQUAINTANCES

1. Personal References: Give three (3) references (not relatives, former or present employers, fellow employees or school teachers) who are responsible adults of reputable standing in their communities, such as property owners, business or professional men or women, who have known you well for at least the past five (5) years. If retired, give former occupation.

First Personal Acquaintance

* Complete Name

* Home Address

* City

* County

* State

* Zip Code

* Home Phone

* Personal e-mail address

* Yrs. Acq.

* Occupation

* Business Address

* City

* County

* State

* Zip Code

* Business Phone

* Business e-mail address

Second Personal Acquaintance

* Complete Name

* Home Address

* City

* County

* State

* Zip Code

* Home Phone

* Personal e-mail address

* Yrs. Acq.

* Occupation

* Business Address

* City

* County

* State

* Zip Code

* Business Phone

* Business e-mail address

Third Personal Acquaintance

* Complete Name

* Home Address

* City

* County

* State

* Zip Code

* Home Phone

* Personal e-mail address

* Yrs. Acq.

* Occupation

* Business Address

* City

* County

* State

* Zip Code

* Business Phone

* Business e-mail address

CONFIDENTIAL EMPLOYEE HISTORY

THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL AND WILL NOT BE MADE AVAILABLE FOR PUBLIC INSPECTION.

1. Applicant's Current Address:

* Address

* City

* County

* State

* Zip Code

* Home Telephone Number

* Cellular Telephone Number

* 2. Applicant's Social Security Number

3. Spouse's Name and Address (if different):

Name

Address

City

County

State

Zip Code

4. Please provide name and address of next of kin or other person to be contacted in case of an emergency:

Name

Address

City

County

State

Zip Code

Home Phone

Alternate Phone

5. Please provide the name and address of your personal or family physician to be contacted in case of an emergency:

Address

City

County

State

Zip Code

Business Phone

Alternate Phone

I understand that the "Applicants Certification" applies in all respects to the responses provided in number 1-5 above in this "Confidential Employee History."

Signature of the applicant as usually written

Date

APPLICANT'S CERTIFICATION

I understand that my volunteer status will be contingent upon the results of a complete background investigation. I am aware that any omission, falsification, misstatement or misrepresentation will be the basis for my disqualification as a volunteer or my dismissal from the Sheriff's Office. I agree to the conditions and certify that all statements made by me on this application are true, correct and complete, to the best of my knowledge. I also understand that I will be fingerprinted. I understand that this volunteer application shall become the property of the Sheriff's Office and that it and the information received in response to the background examination are public records.

I understand that the use of drugs or alcohol is not permitted, during work or volunteer time, in the areas, including vehicles, where work is performed by employees or appointees.

I authorize any of the persons or organizations referenced in this application to furnish information, personal or otherwise, regarding my ability and fitness for volunteering with the Sheriff's Office and I release all such parties from any and all liability for any damage that might result from furnishing such information to the Sheriff's Office.

I agree to conform to the rules, regulations and orders of the Sheriff's Office and acknowledge that these rules, regulations and orders may be changed, interpreted, withdrawn or added to by the Sheriff's Office, at its discretion, at any time and without any prior notice to me.

I understand an investigation will be conducted on all of the information listed on this application. Because of this, I certify that I am not aware of any information about myself or any person with whom I am or have been closely associated (including relatives, roommates), which might tend to reflect unfavorably on my reputation, morals, character or ability that has not been previously disclosed.

* Signature of the volunteer

* Date

Equal Opportunity Employment

We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.

Gender:

Female
Male
I Choose Not to Respond

Race/Ethnicity:

	American Indian or Alaska Native (Not Hispanic or Latino) A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
	Black or African American (Not Hispanic or Latino) A person having origins in any of the Black racial groups of Africa
	Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
	Asian (Not Hispanic or Latino) A person 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
	White (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
	Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
	Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above races
	I Choose Not to Respond

Veteran Status: (Please check all that apply)

	Individual with a Disability An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
	Vietnam Era Veteran A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
	Disabled Veteran 1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
	War/Campaign/Expedition Veteran A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
	Armed Forces Service Medal Veteran A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
	Recently Separated Veteran Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
	I Choose Not to Respond

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