City of Arcadia

City of Arcadia, Florida

Apply for Employment with the Arcadia Police

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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.
The 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.

Complete the list by following the format for the previous entries.

Background Information

If naturalized, please provide:

Education/ Training

High School

Fill this field out using the same information for the other schools above.

College/ University

Other Schools

Languages

Law Enforcement Training

Special Interests

(For example: two-way radio communications, breathalyzer, speed detection equipment, firearms, computers.)

Employment History

Employer

Dates Employed

Employer 2

Dates Employed

Employer 3

Dates Employed

Employer 4

Dates Employed

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.

Have you ever been unemployed for any period of time? (Remember, all time must be accounted for)

Select the date you started unemployment

Select the date you ended unemployment

Have you been unemployed in another period of time? (Remember, all time must be accounted for)

Select the date you started unemployment

Select the date you ended unemployment

Have you been unemployed in another period of time? (Remember, all time must be accounted for)

Select the date you started unemployment

Select the date you ended unemployment

Have you been unemployed in another period of time? (Remember, all time must be accounted for)

Select the date you started unemployment

Select the date you ended unemployment

Have you been unemployed in another period of time? (Remember, all time must be accounted for)

Select the date you started unemployment

Select the date you ended unemployment

Have you been unemployed in another period of time? (Remember, all time must be accounted for)

Fill out this field with dates of the remaining time periods you were unemployed.

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?

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

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

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?

Residences

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.

Residences 2

Residences 3

Residences 4

Residences 5

Residences 6

List the remaining following the format above

Arrest History/ Court Data

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?

Arrests

Arrests 2

Arrests 3

Arrests 4

Arrests 5

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

Tickets

Tickets 2

Tickets 3

Tickets 4

Tickets 5

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

Family Arrests

Family Arrests 2

Family Arrests 3

Family Arrests 4

Family Arrests 5

Have you or your spouse ever been a plaintiff or defendant in a court action? (Include any liens, lawsuits, bankruptcy, domestic violence injunctions, etc.)

Court Action

Names Involved

Names Involved 2

Names Involved 3

Names Involved 4

Names Involved 5

Court Action 2

Names Involved

Names Involved 2

Names Involved 3

Names Involved 4

Names Involved 5

Court Action 3

Names Involved

Names Involved 2

Names Involved 3

Names Involved 4

Names Involved 5

Court Action 4

Names Involved

Names Involved 2

Names Involved 3

Names Involved 4

Names Involved 5

Court Action 5

Names Involved

Names Involved 2

Names Involved 3

Names Involved 4

Names Involved 5

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?

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

Driving History

Are you a licensed Florida automobile operator or chauffeur?

Do you hold or have you ever held an operator or chauffeur license in another state?

Other State License

Other State License 2

Other State License 3

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

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

Military History

Have you ever served on active duty in the Armed Forces of the United States?

Duty Dates

Duty Dates 2

Duty Dates 3

Discharge

Are you now or have you been a member of a reserve unit or the National Guard?

Disciplinary Action

Disciplinary Action 2

Disciplinary Action 3

Veterans' Preference

Click the appropriate button if you are claiming veteran's preference. Documentation substantiating your claim must be submitted at the end of this application. (NOT REQUIRED)

NOTE: Under Florida law, preference in appointment shall be given first to those persons included in #1 and #2 above, and second to those persons included in #3 above. If an applicant claiming veterans' preference for a vacant position is not selected for the vacant position, he/she may file a complaint with the Division of Veterans' Affairs, 11351 Ulmerton Road, Suite 311-K, Largo, FL 33778-1630.

Business Interests & Licenses

Do you or have you ever owned any stock or interest in any firm, partnership, or corporation dealing wholly or partly in the sale or distribution of alcoholic beverages?

Are you now issued or have you ever been issued a license to engage in a business or profession?

Was your business license ever cancelled, relinquished suspended, or revoked?

License or Certificate

License or Certificate 2

License or Certificate 3

Credit Data

Do you have any sources of income other than your salary or the salary of your spouse?

Are you or your spouse indebted to anyone?

Please list all debts over $500. Be sure to include student loans and charge accounts. Also, list any debt where payment is past due, regardless of amount.

Bankruptcy

Have you, your spouse, or a company controlled by you filed for bankruptcy?

Have you, your spouse, or a company controlled by you declared for bankruptcy?

Have you, your spouse, or a company controlled by you had a legal judgement rendered against you for a debt?

Have you, your spouse, or a company controlled by you been subject to a tax lien?

If you answered yes to any of the four(4) questions above, please provide details.

Organizational Membership

Please list clubs, societies, of which you are or have been a member:

(Yes or No)

(List position held & describe activity)

Are you now or have you ever been a member of any foreign or domestic organization, association, movement, group or combination or persons which has adopted, or show a policy of advocating or approving the commission of acts f force or violence to deny other persons their rights under the constitution of the United States, or which seeks to alter the form of government of the United States by unconstitutional means?

Have you ever made a financial or other material contribution to any organization of the type described in the question above?

At the time of your membership, participation, or contribution, did you know of any unlawful aims of the organization?

Did you intend to promote any unlawful aims of the organization?

Personal References & Acquaintances

Personal References: Give three (3) references (not relatives, former or present employers, or school teachers) who are responsible of reputable standing in 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.

Reference 1

Reference 2

Reference 3

Social Acquaintances: Give three (3) social acquaintances in your own age group (including both sexes) ho have known you well for the past five (5) years.

Acquaintance 1

Acquaintance 2

Acquaintance 3

Confidential Employee History

The information contained herein is confidential and will not be made available for public inspection.

Applicant's Information

Your Social Security Number if requested for the sole purpose of employment background investigations and administering employment benefits.

Spouse's Information

Please include full name and current address of all former spouses.

Are you now able to participate in defensive tactics, firearms or physical training, operation of a motor vehicle, or otherwise perform the duties set forth in the job description or task analysis related to the position for which you applied?

This position may require a physical agility test, if such a test or examination is required, would you be able to take this test or examination?

Emergency Contact

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

Physician Contact

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

Drug History

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, is disclosed would identify the applicant.

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?

Have you ever illegally experimented with or used any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogen; methoqualone, hasish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature?

Please complete the following

List all drugs, how they were taken, and the last time you illegally experimented with or used them.

Do you no or have you ever illegally obtained, possessed, supplied, or sold any narcotic or controlled substance such as, but not limited to: cannabinoids, PCP, hallucinogen; methoqualone, hasish, cocaine, LSD, amphetamines, heroin, steroid, opiates, barbiturates, benzodiazepine, a synthetic narcotic, a designer drug, or any drug of a similar nature?

Please complete the following

List all drugs, how they were taken, and the last time you illegally experimented with or used them.

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

Do you claim to be a rehabilitated alcohol. narcotics or drug user of any of the controlled substances as set forth above?

Write out full name

Applicant's Certification


I understand that my appointment or employment will be contingent u[on 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 fro the Police Department. 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 will be fingerprinted. I understand that this employment application shall become the property of the Police Department and that it and the information received in response to the background examination are public records.

I also understand that I may be required to furnish the Police Department with a copy of my Income Tax Return for the year preceding this application and for each year during my employment or appointment.

I further understand and agree that my employment or appointment will be contingent upon the results of a complete drug test and that I may be required to take drug tests during the term of my employment or appointment with the Police Department.

I understand that my continued employment or appointment may be contingent upon the results of medical or psychological examinations that I may be required to take during the term of my employment or appointment and the maintenance of personal physical fitness, to the degree necessary, to satisfactorily perform duties of my position or assignment with the Police Department.

I further authorize the Police Department or agent of the Police Department, 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 employment.

I understand and agree that any employment or appointment 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 Marshal has the absolute discretion to periodically substitute cash, in whole or part, for my accrued compensatory time.

I authorize any persons or organizations referenced in this application to furnish information, personal or otherwise, regarding my ability and fitness for employment or appointment with the Police Department and I release all such parties from any and all liability for any damage that might result from furnishing such information to the Police Department.

I agree to conform to the rules, regulations and orders of the Police Department and acknowledge that these rules, regulations and orders may be changed, interpreted, withdrawn or added to by the Police Department, 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, are you aware of any information about yourself or any person with whom you are or had been closely associated (including relative, roommates) which might tend to reflect unfavorably on your reputation, morals, character or ability?

I understand an investigation will be conducted on all of the information listed on this application. Because of this, are you aware of any information about yourself or any person with whom you are or had been closely associated (including relative, roommates) which might tend to reflect unfavorably on your reputation, morals, character or ability?

Background Investigation Waiver


Authority for Release of Information


Employing Agency Requesting Information: Arcadia Police Department

I hereby authorize any employee or authorized representative bearing this release, or copy thereof, to obtain any information in your files pertaining to my employment records including, but not limited to, achievement, attendance, personal history, disciplinary records, medical records, credit records, and criminal history records. I hereby direct you to release such information upon request of the bearer. This release is executed with full knowledge and understanding that information as is described above, to third parties in the course of fulfilling its official responsibilities. I hereby release you, as the custodian of such records, and employer, education institution, physician, hospital or other repository of medical records, credit bureau r consumer reporting agency, including its officers, employees, and related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information, or any attempt to comply with it. A photocopy of this form will be as effective as the original.

I hereby authorize the National Records Center, St. Louis, Missouri, or other custodian of my military record to release information or photocopies from my military personnel and related medical records, including a photocopy of my DD 214, Report of Separation, to:

Arcadia Police Department


 

Florida State Statute 768.095 titled employer immunity from liability; disclosure of information regarding former employees states: An employer who discloses information about a former employee's job performance to a prospective employer of the former employee upon request of the prospective employer or of the former employee is presumed to be acting in good faith and, unless lack of good faith is shown by clear convincing evidence, is immune from civil liability for such disclosure of its consequences. For the purposes of this section, the presumption of good faith is rebutted upon a showing that the information disclosed by the former employer was knowingly false or deliberately misleading, was rendered with malicious purpose, or violated any civil right of the former employee protected under chapter 760.


Pursuant to Section 943.13 (4), (5) and (7) F.S., Chapter 2001-94, Laws of Florida, disclosure of information is required unless contrary to state or federal law. Civil penalties may be available for refusal to disclose non-privileged legally obtainable information.

Write out full name

Waiver And Release From Liability And Indemnity Agreement
(Taser Exposure)


In consideration of, and as a condition precedent to receiving information regarding TASER products and a CEW exposure (the "Event") the undersigned, for himself/herself, his/her personal representatives, heirs, next of kin, acknowledges, agrees and represents that he/she:

  1. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Arcadia Police Department, Arcadia, Florida, its officers, member, employees, other participants, operators, owners and lessees of the premises used to conduct the Event, and each of them, their officers and employees; the City of Arcadia, a political subdivision of the State of Florida, its employees, agents, the administration or members of the City Council and any other person affiliated therewith, all for the purposes herein referred to as "releasees," from all liability to the undersigned, his/her personal representatives, assigns, heirs, and next of kin for any and all damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence, or gross negligence, of the releasees or otherwise while the undersigned is participating in the Event, I specifically waive any statutory rights I may have regarding the release of unknown claims.

  2. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any claims, loss, liability, damage, or cost they may incur due to the presence of the undersigned in any way participating, competing, observing, and/or working for, or for any purpose participating in the Event and whether caused by negligence, or gross negligence of the releasees or otherwise.

  3. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence, or gross negligence of releasees or otherwise and/or while participating, competing, observing, and/or working for, or for any purpose participating in the Event.

  4. HEREBY expressly acknowledges and agrees that the Event is dangerous and involves the risk of serious injury and/or death and/or property damage. Each of the undersigned further expressly agrees that the forgoing release, wavier and indemnity agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Florida and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue to dull legal force and effect.

  5. NON-WAIVER WORKER'S COMPENSATION RIGHTS: This release does not waive my rights I may have under Worker's Compensation Laws. However, I waive any Worker's Compensation subrogation rights against Released Parties and agree to defend and indemnify the Arcadia Police Department against any and all claims that may be brought against it by personal representatives, heirs, and next of kin. I agree that any recovery under Worker's Compensation Laws done not change, extend, or enlarge the waiver and protections inherent in this agreement

  6. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made.


This waiver, release, and indemnification agreement specifically embraces each and every event sanctioned, authorized or promoted by said releasees applies to each and event or activity herinabove mentioned, and has the same effect as if executed after each and every activity or event in which the undersigned participates so that the parties herein intended to be released and indemnified shall be fully and effectively released and indemnified as to each and every event hereinabove described. I affirm that I am competent to enter into and be bound by this agreement; that I have read and understand this Waiver And Release From Liability And Indemnity Agreement in its entirety; and that I sign it voluntarily and of my own free will. By signing below I understand that I am giving up certain legal rights, including the right o recover damages in case of injury.

Write out full name

Attach Identity Documents

Remarks