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Florida 10 1777 Form in PDF

The Florida 10 1777 form is a pre-screener application used by the Seminole Police Department to collect essential information from potential applicants. This form ensures that all candidates provide complete and accurate details, as incomplete submissions will be discarded. Applicants must be at least 19 years old to apply and should be prepared to answer questions related to their personal, employment, and criminal history.

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The Florida 10 1777 form, also known as the Pre-Screener Application for the Seminole Police Department, serves as an essential tool in the recruitment process for potential law enforcement candidates. This application is designed to gather comprehensive information from applicants, ensuring that all necessary sections are filled out completely, as incomplete submissions will be discarded. To qualify, applicants must be at least 19 years old and provide personal details such as their name, contact information, and address. The form also requires applicants to indicate their preferred reservation location and the specific position they are seeking, which includes roles like Police Officer, Dispatcher, or Community Service Aide. Additionally, the application includes a series of questions regarding citizenship, education, driving history, and any past criminal activity. It is crucial for applicants to disclose any relevant information, as the form emphasizes transparency in the hiring process. Employment history and educational background are also key components, requiring applicants to detail their previous jobs and any military service. By completing the Florida 10 1777 form accurately, applicants take the first step toward potentially joining the Seminole Police Department, while the department ensures that they maintain a thorough and fair evaluation process.

Form Example

Pre-Screener Application

SEMINOLE POLICE DEPARTMENT

Human Resources Division, 3101 N State Road 7, Hollywood, Fl 33021

Tel. 954-967-5100 Fax 954-963-9134 Visit us online at www.semtribe.com

INSTRUCTIONS: The purpose of this pre-screener application is to get accurate applicant information. Please complete all portions – incomplete forms will be destroyed. Applicants MUST

be 19 years of age or older to apply.

Name:		SSN:

Phone #:	Alternate Phone #:

Address:	City:		State:	Zip:

Email Address:	Driver’s License #	-		State

RESERVATION:_________________________ Hollywood, Big Cypress, Immokalee, Brighton, Tampa, or Fort Pierce

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Position Sought (check one only):		We DO NOT accept Non-Certified Police Officer Applicants.
Police Officer	Dispatcher		Clerical / Administrative	Community Service Aide

If it is determined that you are a viable candidate and positions are available, your processing will begin. If there are no positions available, your pre-screener will be kept on file for up to one year and

you will be notified once we have openings. Do not include any documents (including certifications). resume’s, etc) unless, they are meant to explain pre-screener questions.

PERSONAL INFORMATION

Yes	No	Are you a United States Citizen? (Or registered alien for civilian position?)

Yes	No	Do you possess a high school diploma or GED?

Yes	No	Have you received 3 or more moving traffic violations within the past three years?

Yes	No	Have you ever been convicted of a felony?

Yes	No	If employed by a law enforcement or corrections agency, are you now under internal investigation?

Yes	No	Have you used, possessed, or cultivated an illegal controlled substance? Date last used:

Yes	No	Have you been cited for any drug or alcohol related charges within the past five years? When:

Yes	No	Have you ever been convicted of any crime involving, but not limited to: perjury, domestic violence,
		sexual misconduct (of any kind) or assault/battery?

Yes	No	Have you ever worked for or applied to the Seminole Police Department before?
		Position:	Date:

Yes	No	Is there any other language you can read, write or speak fluently? Specify:

Have you re

10-1777 (Revised 08/10)

EMPLOYMENT HISTORY: Describe below the last four jobs you have held (including military, part-time, temporary, or volunteer work.) Begin with your present or most recent employment. If you’ve ever worked in law enforcement or corrections, include that information. You may attach an additional information sheet if necessary. Please provide details of your job duties. You must account for all periods of unemployment.

PRESENT OR MOST RECENT

1. Employer:			Dates of Employment: From	to
Position(s) Held:			Type of Business:
Reason for Leaving:
Description of Duties:
2. Employer:			Dates of Employment: From	to
Position(s) Held:			Type of Business:
Reason for Leaving:
Description of Duties:
3. Employer:			Dates of Employment: From	to
Position(s) Held:			Type of Business:
Reason for Leaving:
Description of Duties:
4. Employer:			Dates of Employment: From	to
Position(s) Held:			Type of Business:
Reason for Leaving:
Description of Duties:

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Yes	No	Have you ever been disciplined by any current or past employer(s)? If military experience, list
Yes	No	disciplines, i.e., Article 15, etc. (List each discipline, employer, and dates.)

Yes	No	Have you ever been terminated or asked to resign from a job? (List each employer, reason and dates.)

EDUCATION RECORD

Do you have a college degree?	Yes	No	Type of degree:		Course of study:
If no, how many credits?				Course of study:
Have you received your Florida law enforcement certification				or are you currently attending an academy?		Yes	No
Type of academy:				Graduation date:

CRIMINAL HISTORY

NOTE – Because you are applying to a law enforcement agency, you must include information about any arrest, charge, conviction or other criminal activity, even if the records are sealed or expunged. If you answer “yes” to any of the following,

you must attach a full explanation before your application will be considered.

Yes	No	Have you ever been arrested or charged of any felony and/or misdemeanor?
Yes	No	Have you ever been convicted of any felony and/or misdemeanor?
Yes	No	Have you ever been involved in the sale of illegal drugs?
Yes	No	Have you ever taken anything from an employer without proper permission?
Yes	No	Are you now or have you been the member of a gang or any association that engages in criminal
Yes	No	activity?
		activity?
Yes	No	Do you have regular or continuous associations or dealings with anyone under criminal investigation or
Yes	No	indictment, or who is involved in criminal behavior?
		indictment, or who is involved in criminal behavior?

UNITED STATES MILITARY RECORD


Yes	No	Have you ever been a member of the United States Armed Forces?

		Branch:	Highest Rank:		Type of Discharge:
		Active Duty Dates from	to	Reserve Duty Dates from		to

Signature: ______________________________________________ Date: ________________

⇩ Florida 10 1777 File

Document Breakdown

Fact Name	Description
Purpose	The Florida 10-1777 form is a pre-screener application used by the Seminole Police Department to gather accurate information from applicants.
Eligibility	Applicants must be at least 19 years old to apply for positions within the Seminole Police Department.
Retention Period	If no positions are available, the pre-screener will be kept on file for up to one year.
Governing Law	The form is governed by Florida law, specifically related to employment and law enforcement hiring practices.

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