Apply for Employment with the Arcadia Police 5%Complete this Application Checklist BEFORE Applying Create a readable document in one of the following formats: .PDF, .JPG, .JPEG, .PNG, or .GIF for the following documents: Copy of Driver's License Copy of Birth Certificate Copy of High School Diploma or GED Copy of FDLE State Certificate or proof of passing Florida Certification Test (Law Enforcement Applicants Only) If military veteran, a copy of your DD-214 showing honorable discharge And the following documents: Neighborhood check, tobacco waiver, and FRS Document Once the above is gathered, please be sure to fill out this form fully, clearly, and accurately supply information on the application regarding education, experience, and qualifications. The application must be notarized in the notary in the Arcadia Police Department. Applications that are not completed will not be accepted.I have completed the checklist above and I am ready to complete the Arcadia Police Job application*I am readyNext PageEmail address*Confirm Email address*Previous PageNext PageThe Police Department is an Equal Employment Opportunity/Affirmative Action Employer. We consider all qualified applicants for employment without regard to race, color, national origin, sex, age, disability, marital status, religion, protected veteran status, sexual orientation or any other legally protected status.Positional Applying for:*Please selectPolice OfficerCrossing GuardRecordsOtherOther Position:*Previous PageNext PageName*FirstMiddleLastSuffixAre there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoName 2*FirstMiddleLastSuffixDates from*Are there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoCircumstanceDates toName 3*FirstMiddleLastSuffixDates from*Are there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoCircumstance*Dates to*Name 4*FirstMiddleLastSuffixDates from*Are there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoCircumstance*Dates to*Name 5*FirstMiddleLastSuffixDates from*Are there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoCircumstance*Dates to*Name 6*FirstMiddleLastSuffixDates from*Are there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoCircumstance*Dates to*Name 7*FirstMiddleLastSuffixDates from*Are there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoCircumstance*Dates to*Name 8*FirstMiddleLastSuffixDates from*Are there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoCircumstance*Dates to*Name 9*FirstMiddleLastSuffixDates from*Are there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoCircumstance*Dates to*Name 10*FirstMiddleLastSuffixDates from*Are there any other names you have used? (For example: maiden name, former name(s), alias(es), or nickname(s).)*YesNoCircumstance*Dates to*Names continued*Complete the list by following the format for the previous entries. Previous PageNext PageBackground Information Date of Birth*City*State*CountyCountry (If not the United States)Are you a citizen of the United States of America?*YesNoIf naturalized, please provide:DateCourtPlaceNaturalization NumberMarital Status*MarriedDivorcedSeparatedWidowedNever MarriedDo you or have you ever applied for a passport*Yes and is activeNoYes and it has expiredPassport Number*Previous PageNext PageEducation/ Training High SchoolHigh School Name*High School AddressHigh School State*High School City*High School Zip CodeDate Attended from*Date Attended to*Years Completed*Please selectLess than 11234Type of Diploma*Did you graduate here?*YesNoDid you attended another High School?*YesNoHigh School 2 Name*High School 2 AddressHigh School 2 State*High School 2 City*High School 2 Zip CodeDate Attended from*Date Attended to*Years Completed*Please selectLess than 11234Type of Diploma*Did you graduate here?*YesNoDid you attended another High School?*YesNoHigh School 3 Name*High School 3 AddressHigh School 3 State*High School 3 City*High School 3 Zip CodeDate Attended from*Date Attended to*Years Completed*Please selectLess than 11234Type of Diploma*Did you graduate here?*YesNoDid you attended another High School?*YesNoHigh School 4 Name*High School 4 AddressHigh School 4 State*High School 4 City*High School 4 Zip CodeDate Attended from*Date Attended to*Years Completed*Please selectLess than 11234Type of Diploma*Did you graduate here?*YesNoDid you attended another High School?*YesNoHigh School 5 Name*High School 5 AddressHigh School 5 State*High School 5 City*High School 5 Zip CodeDate Attended from*Date Attended to*Years Completed*Please selectLess than 11234Type of Diploma*Did you graduate here?*YesNoDid you attended another High School?*YesNoComplete High School's attended*Fill this field out using the same information for the other schools above. High School Diploma or Florida Police Standards approved G.E.D.*College/ UniversityDid you attend a College/ University*YesNoCollege/ University Name*College/ University AddressCollege/ University State*College/ University City*College/ University Zip CodeDate Attended from*Date Attended to*Credit Hours EarnedDid you graduate here?*YesNoType of Degree*Credit Hours Earned per Quarter or Semester?*QuarterSemesterUnsureDid you attended another College/ University?*YesNoCollege/ University 2 Name*College/ University 2 AddressCollege/ University 2 State*College/ University 2 City*College/ University 2 Zip CodeDate Attended from*Date Attended to*Credit Hours EarnedDid you graduate here?*YesNoType of Degree*Credit Hours Earned per Quarter or Semester?*QuarterSemesterUnsureDid you attended another College/ University?*YesNoCollege/ University 3 Name*College/ University 3 AddressCollege/ University 3 State*College/ University 3 City*College/ University 3 Zip CodeDate Attended from*Date Attended to*Credit Hours EarnedDid you graduate here?*YesNoType of Degree*Credit Hours Earned per Quarter or Semester?*QuarterSemesterUnsureDid you attended another College/ University?*YesNoCollege/ University 4 Name*College/ University 4 AddressCollege/ University 4 State*College/ University 4 City*College/ University 4 Zip CodeDate Attended from*Date Attended to*Credit Hours EarnedDid you graduate here?*YesNoType of Degree*Credit Hours Earned per Quarter or Semester?*QuarterSemesterUnsureDid you attended another College/ University?*YesNoCollege/ University 5 Name*College/ University 5 AddressCollege/ University 5 State*College/ University 5 City*College/ University 5 Zip CodeDate Attended from*Date Attended to*Credit Hours EarnedDid you graduate here?*YesNoType of Degree*Credit Hours Earned per Quarter or Semester?*QuarterSemesterUnsureMajor*MinorDo you have any other Major or minor Degrees?*YesNoMajor 2*Minor 2Do you have any other Major or minor Degrees?*YesNoMajor 3*Minor 3Do you have any other Major or minor Degrees?*YesNoMajor 4*Minor 4Do you have any other Major or minor Degrees?*YesNoMajor 5*Minor 5Do you have any other Major or minor Degrees?*YesNoMajor and/or Minors continued*College/ University Dipolma*Other SchoolsDid you attend other schools such as trade, vocational, business, or military?*YesNoOther School NameOther School AddressOther School StateOther School CityOther School Zip CodeDate Attended from*Date Attended to*Credit Hours Earned*Did you graduate here?*YesNoArea of Study*Type of Degree or Certificate*Did you attend another Other School?*YesNoOther School 2 NameOther School 2 AddressOther School 2 StateOther School 2 CityOther School 2 Zip CodeDate Attended from*Date Attended to*Credit Hours Earned*Did you graduate here?*YesNoArea of Study*Type of Degree of Certificate*Did you attend another Other School?*YesNoOther School 3 NameOther School 3 AddressOther School 3 StateOther School 3 CityOther School 3 Zip CodeDate Attended from*Date Attended to*Credit Hours Earned*Did you graduate here?*YesNoArea of Study*Type of Degree of Certificate*Did you attend another Other School?*YesNoOther School 4 NameOther School 4 AddressOther School 4 StateOther School 4 CityOther School 4 Zip CodeDate Attended from*Date Attended to*Credit Hours Earned*Did you graduate here?*YesNoArea of Study*Type of Degree of Certificate*Did you attend another Other School?*YesNoOther School 5 NameOther School 5 AddressOther School 5 StateOther School 5 CityOther School 5 Zip CodeDate Attended from*Date Attended to*Credit Hours Earned*Did you graduate here?*YesNoArea of Study*Type of Degree of Certificate*Major*MinorDo you have any other Major or minor Degrees?*YesNoMajor 2*Minor 2Do you have any other Major or minor Degrees?*YesNoMajor 3*Minor 3Do you have any other Major or minor Degrees?*YesNoMajor 4*Minor 4Do you have any other Major or minor Degrees?*YesNoMajor 5*Minor 5Do you have any other Major or minor Degrees?*YesNoMajor 6*Minor 6Do you have any other Major or minor Degrees?*YesNoOther Major or minor Degrees continued*Other School Degree or Certificate*Describe any awards, honors, citations, positions held in school organizations, and any other special recognition you received while attending school.LanguagesSpeak the language: Do you speak this language: *FluentGoodFairRead the language: Do you read this language: *FluentGoodFairWrite the language: Do you write this language: *FluentGoodFairDo you speak, read, or write in another language? *YesNoSpeak the language: Do you speak this language: *FluentGoodFairRead the language: Do you read this language: *FluentGoodFairWrite the language: Do you write this language: *FluentGoodFairDo you speak, read, or write in another language? *YesNoSpeak the language: Do you speak this language: *FluentGoodFairRead the language: Do you read this language: *FluentGoodFairWrite the language: Do you write this language: *FluentGoodFairDo you speak, read, or write in another language? *YesNoSpeak the language: Do you speak this language: *FluentGoodFairRead the language: Do you read this language: *FluentGoodFairWrite the language: Do you write this language: *FluentGoodFairDo you speak, read, or write in another language? *YesNoSpeak the language: Do you speak this language: *FluentGoodFairRead the language: Do you read this language: *FluentGoodFairWrite the language: Do you write this language: *FluentGoodFairDo you speak, read, or write in another language? *YesNoList additional languages that you speak, read, or write below - along with the fluency from fluent, good, or fair.*Law Enforcement TrainingIndicate any law enforcement education/ trainingDid you receive a certificate for this training?*YesNoCertificate Number*Has your law enforcement certificate ever been suspended, revoked, relinquished, or subject to discipline or investigation by the CJST?*YesNoPlease explain why the certificate was suspended, revoked, relinquished, or subject to discipline or investigation by the CJST.*Special InterestsDescribe any special abilities, interests, and hobbies including degree of proficiencyDescribe any type of special license such as pilot, radio operator, etc., showing licensing authority, where the licence was first issued, and the date current license expires (except vehicle operator's license)Indicate any special skills you possess and equipment you can use which may be related to law enforcement work. (For example: two-way radio communications, breathalyzer, speed detection equipment, firearms, computers.)Have you had any training/ education with K-9's?*YesNoPlease provide details to your K-9 training/education*Previous PageNext PageEmployment HistoryEmployerName*Address*State*Phone number*City*Zip*Dates EmployedDate from*I am currently employed here*YesNoDate to*Salary*Name of Supervisor*Title or Position*Reason for Leaving*Have you worked anywhere else?*YesNoEmployer 2Name*Address*State*Phone number*City*Zip*Dates EmployedDate from*I am currently employed here*YesNoDate to*Salary*Name of Supervisor*Title or Position*Reason for Leaving*Have you worked anywhere else?*YesNoEmployer 3Name*Address*State*Phone number*City*Zip*Dates EmployedDate from*I am currently employed here*YesNoDate to*Salary*Name of Supervisor*Title or Position*Reason for Leaving*Have you worked anywhere else?*YesNoEmployer 4Name*Address*State*Phone number*City*Zip*Dates EmployedDate from*I am currently employed here*YesNoDate to*Salary*Name of Supervisor*Title or Position*Reason for Leaving*Have you worked anywhere else?*YesNoEmployed at continued*If you have been employed at even more places, please follow the format for all the other places you worked at above, and list them below. Unemployed Period*Have you ever been unemployed for any period of time? (Remember, all time must be accounted for)YesNoStart Date*Select the date you started unemploymentEnd Date*Select the date you ended unemploymentUnemployed Period*Have you been unemployed in another period of time? (Remember, all time must be accounted for)YesNoStart Date*Select the date you started unemploymentEnd Date*Select the date you ended unemploymentUnemployed Period*Have you been unemployed in another period of time? (Remember, all time must be accounted for)YesNoStart Date*Select the date you started unemploymentEnd Date*Select the date you ended unemploymentUnemployed Period*Have you been unemployed in another period of time? (Remember, all time must be accounted for)YesNoStart Date*Select the date you started unemploymentEnd Date*Select the date you ended unemploymentUnemployed Period*Have you been unemployed in another period of time? (Remember, all time must be accounted for)YesNoStart Date*Select the date you started unemploymentEnd Date*Select the date you ended unemploymentUnemployed Period*Have you been unemployed in another period of time? (Remember, all time must be accounted for)YesNoUnemployed time continued*Fill out this field with dates of the remaining time periods you were unemployed. Dismissals, Resignations, and Disciplinary actions.*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?YesNoPlease provide details*Misconduct or Unsatisfactory Job Performance*Have you resigned, or left a job by mutual agreement following allegations of misconduct or unsatisfactory job performance?YesNoPlease provide details*Services for Law Enforcement Not Listed as Employer*Have you ever applied to or performed paid or unpaid services for a law enforcement agency not listed as an employer?YesNoPlease provide name of agency and date of application or service*Business Affiliations*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?YesNoPlease provide name and address of businesses, corporation or organization and describe your relationship or position. *Previous PageNext PageResidences Actual places of residence for the 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, indicate complete military unit designation and location by city and state. If post office box, give location of post office.Date from*Street Address*City*Country*Please selectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweDate to*Street Address Cont. (Apartment etc.)State*Did you live anywhere else in the past 10 years?*YesNoResidences 2Date from*Street Address*City*Country*Please selectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweDate to*Street Address Cont. (Apartment etc.)State*Did you live anywhere else in the past 10 years?*YesNoResidences 3Date from*Street Address*City*Country*Please selectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweDate to*Street Address Cont. (Apartment etc.)State*Did you live anywhere else in the past 10 years?*YesNoResidences 4Date from*Street Address*City*Country*Please selectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweDate to*Street Address Cont. (Apartment etc.)State*Did you live anywhere else in the past 10 years?*YesNoResidences 5Date from*Street Address*City*Country*Please selectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweDate to*Street Address Cont. (Apartment etc.)State*Did you live anywhere else in the past 10 years?*YesNoResidences 6Date from*Street Address*City*Country*Please selectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweDate to*Street Address Cont. (Apartment etc.)State*Did you live anywhere else in the past 10 years?*YesNoResidences Continued*List the remaining following the format abovePrevious PageNext PageArrest History/ Court DataArrests, summons, convictions.*Have you ever been arrested, charged, or received a notice or summons to appear, convicted, pled nolo contendere or pled guilty to any criminal violation, regardless if the record was sealed or expunged?YesNoArrestsDate*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more arrests to report?*YesNoArrests 2Date*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more arrests to report?*YesNoArrests 3Date*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more arrests to report?*YesNoArrests 4Date*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more arrests to report?*YesNoArrests 5Date*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more arrests to report?*YesNoList all remaining here, following the information requested above*Traffic Violations*Have you ever received a ticket or been charged with a traffic violation (excluding parking tickets)?YesNoTicketsDate*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more tickets to report?*YesNoTickets 2Date*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more tickets to report?*YesNoTickets 3Date*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more tickets to report?*YesNoTickets 4Date*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more tickets to report?*YesNoTickets 5Date*Charge*Disposition*Place and Department*Court and Place*Provide Details*Do you have any more tickets to report?*YesNoList all remaining here, following the information requested above*Immediate Family*To your knowledge, has any member of your immediate family ever been arrested for other than traffic violations?YesNoFamily ArrestsRelative's Name*Place and Department*Court and Place*Date*Charge*Disposition*Provide Details*Do you have any more family arrests to report?*YesNoFamily Arrests 2Relative's Name*Place and Department*Court and Place*Date*Charge*Disposition*Provide Details*Do you have any more family arrests to report?*YesNoFamily Arrests 3Relative's Name*Place and Department*Court and Place*Date*Charge*Disposition*Provide Details*Do you have any more family arrests to report?*YesNoFamily Arrests 4Relative's Name*Place and Department*Court and Place*Date*Charge*Disposition*Provide Details*Do you have any more family arrests to report?*YesNoFamily Arrests 5Relative's Name*Place and Department*Court and Place*Date*Charge*Disposition*Provide Details*Do you have any more family arrests to report?*YesNoList all remaining here, following the information requested above*Court Action*Have you or your spouse ever been a plaintiff or defendant in a court action? (Include any liens, lawsuits, bankruptcy, domestic violence injunctions, etc.)YesNoCourt ActionDate*Case Number*Court and Place*Names InvolvedName of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 2Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 3Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 4Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 5Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoList the remaining names here*Nature of Action*Final Disposition*Provide Details*Do you have any more court actions to report?*YesNoCourt Action 2Date*Case Number*Court and Place*Names InvolvedName of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 2Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 3Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 4Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 5Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoList the remaining names here*Nature of Action*Final Disposition*Provide Details*Do you have any more court actions to report?*YesNoCourt Action 3Date*Case Number*Court and Place*Names InvolvedName of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 2Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 3Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 4Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 5Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoList the remaining names here*Nature of Action*Final Disposition*Provide Details*Do you have any more court actions to report?*YesNoCourt Action 4Date*Case Number*Court and Place*Names InvolvedName of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 2Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 3Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 4Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 5Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoList the remaining names here*Nature of Action*Final Disposition*Provide Details*Do you have any more court actions to report?*YesNoCourt Action 5Date*Case Number*Court and Place*Names InvolvedName of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 2Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 3Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 4Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoNames Involved 5Name of Party Involved*FirstMiddleLastSuffixWas there another person involved?*YesNoList the remaining names here*Nature of Action*Final Disposition*Provide Details*Do you have any more court actions to report?*YesNoList all remaining here, following the information requested above*Detainment*Have you ever been detained by any law enforcement officer for investigative purposes or to your knowledge have you ever been the subject of or a suspect in any criminal investigation?YesNoProvide details to the above answer.*Fingerprinted*Have you ever been fingerprinted for any reason (arrest, job application, military, etc.)?YesNoProvide details to the above answer.*Previous PageNext PageDriving HistoryLicensed*Are you a licensed Florida automobile operator or chauffeur?YesNoLicense Number*Restrictions*Date of Expiration*Licensed in Other States*Do you hold or have you ever held an operator or chauffeur license in another state?YesNoOther State LicenseName Used*First