Administrative Receptionist: (904)-225-0331Dispatch Non-Emergency Lines: (904)225-5174Toll Free (855)725-2630Jail Receptionist: (904)548-4002
NASSAU COUNTY SHERIFF’S OFFICE
An Accredited Florida Law Enforcement Agency
Step 1 of 15
This form is broken down into parts, ALL parts must be filled out for this application to be submitted.
Certain disqualifiers can stop you from applying, review these before you begin:
1. Date and Place of Birth:
8. State Approximate number of words per minute:
List chronologically ALL employment beginning with present employment, including summer and part-time employment while attending school.
All time must be accounted for.
If unemployed for a period, set forth dates of unemployment. (Enter "Unemployed" for Employer)
List chronologically ALL employment AFTER your present employment, including summer and part-time employment while attending school.
All time must be accounted for. If unemployed for a period, set forth dates of unemployment.(Enter "Unemployed" for Employer if unemployed)
Actual places of residence for past 10 years - list chronologically all addresses, including residences while at school and in the U.S. military.
Be Sure to include all residences for the past 10 years.
Pursuant to Section 945.0585(6), Florida Statutes, candidate for employment with criminal justice agency may NOT lawfully deny or fail to acknowledge the arrests covered by an expunged record.
Active Duty Dates:
Give three (3) references (not relatives, former or present employees, fellow employees, or school teachers) who are responsible adults of reputable standing on their communities, such as property owners, business or professional men or women, who have known you well for the past five (5) years. If retired, give former occupation.
THE INFORMATION CONTAINED HEREIN MAY BE CONFIDENTIAL AND NOT AVAILABLE FOR PUBLIC INSPECTION
3. Please provide information of next of kin or other person to be contacted in case of an emergency
4. Please provide information of personal or family physician to be contacted in case of an emergency
The information contained herein MAY BE a confidential medical record under the Americans with Disabilities Act if the applicant is a rehabilitated drug or alcohol abuser or under section 119.071(4)(b) whether the medical information, if disclosed, would identify the applicant.
I understand that my employment 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 an applicant 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 further fully understand and consent to a polygraph examination concerning the veracity of my responses to the information requested on this application or which is discovered as a result of the background investigation, or any physical examination or drug test. I also understand that I may be fingerprinted. I understand that this employment 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 further understand and agree that my employment will be contingent upon the results of a complete drug test.
I understand that the use of drugs or alcohol is not permitted, during work or duty time, whether paid or unpaid, in the areas, including vehicles, where work is performed by employees or appointees.
I understand that my continued employment may be contingent upon the results of medical or psychological examina- tions that I may be required to take during the term of my employment.
I further authorize the Sheriff's Office or agent of the Sheriff's Office, without need of further authorization, to obtain medical records allowed by law if I claim rights to payment or receipt of any benefit pursuant to state or federal law.
I further agree to execute any authorization as may be required by the Health Insurance Portability Accountability Act of 1996 (HIPAA) for health care providers to release the necessary medical information to process my application for employ- ment.
I understand and agree that any employment offered to me will be contingent upon my acceptance of compensatory time off, instead of cash, in payment for overtime hours that I work, to the extent allowed by law. I understand, however, that the Sheriff has the absolute discretion to periodically substitute cash, in whole or part, for my accrued compensatory time.
I understand that unless otherwise defined by applicable law, any employment relationship with this office is "at will", which means that the employer may discharge me 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 authorize any of the persons or organizations referenced in this application to furnish information, personal or other- wise, regarding my ability and fitness for employment 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, regu- lations 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.
This form shall be completed and signed by every applicant for background screening purposes. It is recommended that a copy of the signed acknowledgement be securely retained in the applicant's personnel file for the duration of their employment with the agency.
I hereby authorize the Nassau County Sheriff's Office to process a set of my fingerprints for the purpose of accessing and reviewing Florida and national criminal history records that may pertain to me to determine eligibility for employment or licensure.
I understand the following:
Non-Emergency Lines:(904) 225-5174(904) 548-4009
Toll Free(855) 725-2630
77151 Citizens Circle, Yulee, FL 32097
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