PAT Invitation With FHP Fillable Supplemental Application

FLORIDA HIGHWAY PATROL
STATE TROOPER APPLICANT

SPECIAL INSTRUCTIONS
**Carefully read and follow ALL below instructions**
This packet of information is part of the selection process for a position as a State Trooper with the Florida Highway
Patrol. Your failure to follow any of these instructions or provide the required information will result in your file being
placed in an inactive status and/or being disqualified from the hiring process. This affidavit is part of the applicant
screening process and is used to determine your ability to follow instructions.
Step 1: TYPE all fields of this fillable packet on a computer and print out this ENTIRE packet (print only one-
sided copies and do NOT staple). This entire packet is a fillable PDF.
Step 2: Ensure you have all forms requiring a notary’s signature signed and notarized (we will NOT notarize any
of the forms for you). Also, ensure you have ALL requested forms and documents along with this packet.
Failure to have all forms and notarizations will result in your application being placed in an inactive status.
If you’re waiting for driving records or transcripts to arrive, you can still attend PAT testing and mail those
records to our office at a later time.
Step 3: Make a copy of the completed packet and bring it with the original packet to Physical Abilities Testing
(PAT) on your scheduled date (we will NOT make copies for you). DO NOT MAIL THE PACKET.
Step 4: Prior to attending your scheduled PAT Testing, you MUST visit your physician (Medical Doctor) and have
the Florida Highway Patrol Medical Release Form (page 8 of this packet) completed by your physician.
A Licensed Practical Nurse, or equivalent, completing this form will NOT satisfy the requirement of
your clearance by a Medical Doctor.
Step 5: You will need to take and pass the Criminal Justice Basic Abilities Test (CJBAT) for Law Enforcement
Officer and bring WRITTEN proof of a passing score to PAT testing. The Florida Highway Patrol does
NOT administer this test. The CJBAT (or FBAT) must be scheduled by you and paid-for AT YOUR OWN
EXPENSE. Your application will NOT be processed without proof of a passing score on this test. If you
have taken and passed the CJBAT for Law Enforcement Officer within the last four years, or if you are
certified as a law enforcement officer in the State of Florida, you will not need to retake the CJBAT.
However, you WILL need to bring written proof of a passing score to PAT Testing. More information about
this test, study materials, and where the test is administered can be found at the following website:
http://www.fdle.state.fl.us/CJSTC/Officer-Requirements/Basic-Abilities-Test.aspx
Step 6: The conditions of employment are based upon your successful completion of the Physical Abilities Test.
Arrangements should be made for you to be at the testing facility for the entire day.
Step 7: If you have any tattoos, you will need to ensure they comply with FHP Academy policy (see page 51 of
this packet for more information).
Step 8: DO NOT ARRIVE LATE. Applicant orientation is completed prior to PAT Testing. Late arrivals will
NOT be admitted. PAT Testing will occur immediately after orientation. Bring pens with you to orientation.
Your invitation to the FHP PAT Test listed three testing sites (Tallahassee, Orlando, and Miami). You MUST notify
us which PAT Testing session you will be attending by emailing us at FHPPAT@flhsmv.gov PRIOR to the scheduled
testing date. If you fail to notify us of the date and location where you will be participating in PAT Testing, you WILL
NOT BE ADMITTED INTO TESTING and YOUR APPLICATION WILL BE PLACED IN AN INACTIVE
STATUS. If you fail to appear at your scheduled PAT Testing, you will be considered no longer interested in a position as
a State Trooper. Please allow 3 weeks after PAT Testing before calling 850-617-2315 regarding the status of your
application.
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INSTRUCTIONS FOR COMPLETING THE APPLICATION
Notice: Read and follow these instructions exactly. Any unanswered, incomplete, or omitted information may result in
rejection of your application. Any falsification WILL result in disqualification of your application and potential
disqualification from future employment consideration with FHP. The information in this packet WILL be used in all
stages of the background process to include POLYGRAPH so ensure you are completely TRUTHFUL! This document,
when completed, along with its attachments, will be used by the Florida Highway Patrol as an investigative aid. Retention
of this personal data will remain in the files of the Personnel Office and Background Investigations Office.
A. TYPE (this form is fillable) OR PRINT in black or blue ink only. If printing, make sure it is completely legible.
B. Answer all questions. If one does not apply to you, write N/A in the corresponding area. Do NOT leave any section
blank.
C. If the space provided is insufficient, use a separate sheet of 8 1/2 x 11 paper to continue answering the question(s)
and precede each answer with the number of the section to which it refers. Attach that sheet and any others to the
back of this packet.
D. Do not misstate or omit any material fact in this application. All information you provide WILL BE VERIFIED
to determine your qualifications for employment. Omitted information will be considered a falsification.
E. Answer all questions accurately and completely. Do not make exaggerated, false or misleading statements, or
otherwise falsify information as it will cause the rejection of your application. If you are chosen for employment
and it is discovered that you falsified any information in this packet, it may be grounds for dismissal.
F. Each and every question has a purpose for being asked; answer each question completely and accurately,
even if you think it is not important.
G. The following items MUST accompany this application (Do NOT bring original copies unless otherwise noted):
1. Photocopy of your high school diploma or high school transcript
2. Official college transcripts in envelopes sealed by the issuing institution (“issued to student” or photocopied
transcripts are not acceptable)
3. Photocopy of GED diploma (GED test scores are required if obtained outside of the State of Florida)
4. Photocopy of DD214 Form(s) member four (4) copy for all periods of service (applies to previous military
personnel only)
5. Photocopy of birth certificate (U.S. or U.S. Territories only) or
Original certificate of naturalization, if applicable. Bring the ORIGINAL certificate along with a
photocopy of it with you to PAT Testing. The original will be returned to you at PAT Testing.
6. Photocopy of marriage certificate, divorce decree, adoption or legal name change paperwork (if name on
birth certificate is different from your name on the application)
7. A current individual passport-style color photo (no hats or sunglasses) AND a full-body color photo
(appropriate, professional clothing only). Ensure the photos do not cover any notarization areas.
8. Proof of registration with the U.S. Selective Service System (see below website for more information)
https://www.sss.gov/Registration-Info/Who-Registration
9. All driving records (must be ORIGINAL CERTIFIED copies from the State DMV).
10. State of Florida Law Enforcement Standards Certification/Test Scores (Florida Certified Law Enforcement
Officers only)
11. Photocopy of Social Security Card
12. Photocopy of current Driver License with photograph
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MINIMUM EMPLOYMENT REQUIREMENTS
H. You MUST be a United States citizen. Naturalized citizens must provide an ORIGINAL “Certificate of
Naturalization.” (As previously indicated, it will be returned to you at PAT Testing.)
I. You must be at least 19 years of age.
J. MINIMUM VISION REQUIREMENTS: You must have minimum correctable vision of 20/30 in each eye,
normal color-distinguishing capability and a 140-degree field of vision.
K. If you are hired, you must complete a period of training and serve in a probationary status for twelve months (Section
§321.04(2), Florida Statutes).
L. You must be willing to accept a duty assignment ANYWHERE in the State of Florida.
M. A thorough background investigation, including information as to your character, general reputation, personal
characteristics and lifestyle will be part of the screening process. This information is solely for the purpose of
evaluating your qualifications for employment with the Florida Highway Patrol and shall remain the property
of the Division. Any willful falsification or misrepresentation of information on this or any application will be
reason for disqualification. By submitting this application, you are authorizing the Florida Highway Patrol to
contact any and all available sources for the purpose of obtaining information as to your qualifications for
employment as a State Trooper with the Florida Highway Patrol.
N. You must possess a VALID driver license.
HAVE YOU READ AND DO YOU UNDERSTAND ALL OF THE ABOVE INFORMATION? YES NO
________________________________________ _________________________________ (MMDDYY)

Applicant’s Signature Date
______________________________________
Printed Name
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Official (FHP) Use Only:
Applicant Information Survey
(Print or Type Clearly) BRC___ TRC___ LRC___
Position for which you are applying (Check One): State Trooper Auxiliary Officer
PAT Testing Location (Check One): Tallahassee Orlando Miami Other: _________________
Driver License Number: ______________________ State: ___________ Race: _____________ Sex: ________
Social Security Number: _____-______-_________ Date of Birth: _____________________ (MM/DD/YY)
First Name: ___________________ Middle Name: ________________ Last Name: _______________________

Maiden Name (If applicable):___________________________________
Mailing Address: ____________________________________________________________________________

Street Address City County State Zip Code
Home Phone: (_____)___________________ Work Phone: (_____)_________________________
Cell Phone: (_____)__________________ Personal Email:___________________________@_______________
Is the above address different from your original State of Florida application? Yes No
Education Level: BS / BA Degree or Higher: AS / AA Degree:

120+ Credit Hours: 60+ Credit Hours: 90+ Quarter Credit Hours:
Military Experience: Yes No Honorable Discharge: Yes No
Are you an active/current Law Enforcement Officer? Yes No
Are you currently employed as a Florida Law Enforcement Officer? Yes No

If yes, name of agency: _____________________________________________
Have you been previously employed as a Florida Law Enforcement Officer? Yes No
If yes, name of agency(s): ______________________________________________________________________
___________________________________________________________________________________________
Are you willing to relocate ANYWHERE in the State of Florida? Yes No
How did you hear about employment with the Florida Highway Patrol? (Check all that apply)
FHP Employee ____________________________ FHP Recruiter ______________________________
Name Name
BeATrooper.com Facebook Instagram Other Social Media (Specify) __________________
Recruitment Video ___________________________ Other Law Enforcement Agency Referral
Specify Video
College/Vo-Tech Referral _______________ Job Fair _______________ Radio ___________
Location Location Location
Billboard U.S. Military Referral FHP Station Open House Self-Initiated
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Applicant Name: Social Security Number: _______-______-________
Check One: Male Female Date of Birth: ________ / ________ / ____________ (MM/DD/YYYY)
Pass:
Official (FHP) Use Only: Weight: Height: Tattoo DQ: ________ PAT Time: __________ DQ:
(Max 6:04 to Pass)
MALE FEMALE
HEIGHT MAXIMUM HEIGHT MAXIMUM
______________ 4'5" 133 4'5" 134 ______________

PAT Date 4'6" 137 4'6" 138 FHP Staff Initials
4’7” 142 4’7” 141
Official (FHP) Use Only: 4’8” 147 4’8” 144
H/W Proportionate 4’9” 151 4’9” 148

4’10” 156 4’10” 151
Yes No
4’11” 160 4’11” 154
5’0” 165 5’0” 158
5’1” 170 5’1” 161
5’2” 175 5’2” 164
5’3” 178 5’3” 169
5’4” 183 5’4” 172
5’5” 187 5’5” 176
5’6” 193 5’6” 181
5’7” 198 5’7” 185
5’8” 203 5’8” 189
5’9” 207 5’9” 194
5’10” 213 5’10” 199
5’11” 218 5’11” 205
6’0” 224 6’0” 210
6’1” 229 6’1” 215
6’2” 235 6’2” 221
6’3” 240 6’3” 227
6’4” 251 6’4” 233
6’5” 258 6’5” 239
6’6” 265 6’6” 246
6’7” 272 6’7” 253
6’8” 280 6’8” 260
6’9” 289 6’9” 267
6’10” 297 6’10” 274
6’11” 305 6’11” 282
7’0” 314 7’0” 290
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February 12, 2019
TO: Certified Physicians, Certified Advanced Registered Nurses, Physician’s

Assistant’s and State Trooper Applicants
FROM: Major Nancy D. Rasmussen

FHP Training Academy Director
SUBJECT: Physical Fitness Assessment / Physical Fitness Conditioning Program
It is a requirement for any recruit enrolled or employed in a recruit training program to

participate in a physical fitness evaluation and training program. The Florida Highway Patrol (FHP) Training
Academy has a physical fitness program that covers the entire course of recruit training. Recruits are involved in
physical fitness every day, Monday through Friday, for 45 to 50 minutes for each battery of exercise.
Mondays, Wednesdays, and Fridays are run days. The training session begins with static
stretching. Once the recruits are stretched, they run together as a group. An FHP Training Academy Staff member,
who is a Criminal Justice Standards and Training Commission (CJSTC) certified instructor, leads the run.
Distances of the group run range from 1.5 miles to 6 miles during each battery of exercise. At the completion of
the run, there is a brief cool-down by marching, followed by more static stretching. Running does not occur on
days when the temperatures are below freezing, when the heat index is unsafe, or when other inclement weather
is present.
Tuesdays and Thursdays are gym days. These training sessions take place in a climate-
controlled gym with padded floors. Gym days consist of static stretching, calisthenics (including but not limited
to push-ups, sit-ups, jumping jacks, windmills, mountain climbers, etc.), followed by static stretching and a cool-
down session. An FHP Training Academy Staff member, who is a CJSTC certified instructor, leads the gym
session.
Most of the FHP Training Academy Staff are certified first responders and instructors.
Automated External Defibrillators (AED’s) are located throughout the facility for emergency use, if needed.
Recruits who become injured in any way are referred to a physician for treatment, and if so ordered, are excluded
from fitness training until cleared by the physician.
The FHP Training Academy takes great pride in its physical fitness and wellness program
and has taken every necessary step to provide a safe fitness training environment for its recruits.
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WAIVER OF LIABILITY
I (print name) ____________________________________________ attest that I am in good physical condition. I

understand that as an applicant to the Florida Highway Patrol, I will submit to a physical assessment of my ability to perform
the essential functions of a law enforcement officer. I understand and acknowledge this involves strenuous and exhaustive
physical activities. I received a description of the activities I am requested to perform in advance of these activities.
I understand that employment is based upon successful completion of the following: Criminal Justice Basic Abilities
Test, Physical Abilities Test, polygraph examination, psychological screening, background investigation, physical
examination, vision examination, and drug screening. I understand the Florida Highway Patrol will continue to consider me
for employment as long as I pass the aforementioned examinations. THIS IS NOT A GUARANTEED JOB OFFER.
I hereby release the State of Florida, the Department of Highway Safety & Motor Vehicles, the Division of Florida
Highway Patrol, its employees, agents, representatives and assignees from liability for any injury I may sustain while
involved in, or as a result of the Physical Abilities Test (PAT).
_________________________________________________ ___________________ (MM/DD/YYYY)
_____________________________________________________________________________________
AFFIDAVIT
STATE OF __________________________ COUNTY OF __________________________
Before me personally appeared the said _______________________________________ who says that the execution of
the above instrument is by free will and accord, with full knowledge of the purpose therefore.
Sworn to and subscribed before me on this ______________________ day of __________________________, 20 _____.
_______________________________________________________ My Commission expires __________, 20______.

Notary Public
Personally-Known ____ OR Produced Identification ____. Type of Identification Produced ________________________
_____________________________________________
Notary Seal
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MEDICAL RELEASE FORM

THIS FORM IS TO BE COMPLETED AND THE DOCTOR’S APPROVAL MUST APPEAR ON THIS FORM
IN ORDER TO PARTICIPATE IN THE PHYSICAL ABILITIES TEST.
Name of Participant: _______________________________________ ________-_______-__________

Print Name Social Security Number
Dear Physician,
The above-named individual intends to participate in the Florida Highway Patrol pre-employment physical abilities test.
We are aware of the fact that strenuous physical activity may be inadvisable for some individuals. Therefore, we request
that you indicate whether the above-named participant has any medical condition or disorder that would preclude
participation. It’s emphasized that we are not asking you to assume responsibility for the participant while participating
in this test. Rather, we want to have as much information as possible when making decisions concerning applicability of
testing.
The testing program will consist of a series of physical abilities tests conducted at our training site. The battery of job-
related field tests are intended to be completed in the fastest possible time and will require maximum effort by the
participant. Tests are designed to measure balance, muscular endurance and strength, flexibility, anaerobic power and
capacity, fine motor skills and aerobic power. Tests will include two 220 yard runs, dragging a 150-pound object 100 feet,
jumping over obstacles (12-24 inches high), climbing over a wall (40 inches high), two 50-foot sprints and movement
around a series of pylons. The primary goal of this testing is to determine whether the participant is capable of performing
minimum standards appropriate to law enforcement, corrections or correctional probation.
I have examined this participant and his/her medical history, and based upon my evaluation I recommend that:
Within a reasonable degree of probability, no medical condition or disorder exists which precludes this participant from
participation in the physical abilities tests as described.
Participation is NOT advisable at the present time.

(If you advise against participation, please do not disclose the participant’s medical condition on this form.)
____________________________________________ _________________________________
Signature of Physician Date Physician Signed
**This form only valid for 90 DAYS

____________________________________________ from the above date**
Printed Name of Physician
___________________________________________________________________
Name and address of Facility, Clinic, or Physician’s Office
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The following three (3) pages are Injury and Damage Releases for the
three main locations where the Physical Abilities Test (PAT) is
administered by the Florida Highway Patrol.
You will ONLY NEED ONE INJURY AND DAMAGE RELEASE

completed for participation in PAT Testing. The location in which you
will be attending the testing will determine which release you will
complete. Below is a list of PAT Testing locations which will help you to
determine which release to complete. Without a release completed, you
will NOT be permitted to participate in PAT Testing.
Tallahassee (Havana)
Florida Highway Patrol Academy / Florida Public Safety Institute
(use this form if you are completing your PAT test in Tallahassee, Havana, or any other location OTHER THAN Valencia
Community College or Florida International University)
Orlando
Valencia Community College
(use this form if you are completing your PAT test in Orlando, Florida at Valencia Community College)
Miami
Florida International University
(use this form if you are completing your PAT test in Miami, Florida at Florida International University)
Whichever form does NOT apply to your PAT Testing location, draw
an “X” over the page and include it with the packet and submit it at PAT
Testing.
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Florida Highway Patrol Academy / Florida Public Safety Institute
INJURY AND DAMAGE RELEASE
Whereas, the below named individual, for his/her own benefit, desires to participate in a Physical Abilities Test (PAT) of
their ability to perform the essential functions of a State Trooper, administered by the Florida Highway Patrol.
Whereas, the individual realizes that participation in such assessment is subject to inherent risk, and the individual hereby
releases and holds harmless the State of Florida, the Department of Highway Safety and Motor Vehicles, the Florida
Highway Patrol, and the Florida Public Safety Institute, their agents and employees, co-sponsors and their agents and
employees, and fellow candidates, in connection with bodily injury, death or property damage incurred by the below named
individual in any way related to or arising out of this physical assessment activity, whether such injury or death arises or is
alleged to have arisen from negligence of the individual, the State of Florida, the Department of Highway Safety and Motor
Vehicles, the Florida Highway Patrol, or the Florida Public Safety Institute, their agents or employees, co-sponsors, their
agents or employees, or fellow candidates, or the contributory negligence of any of the aforementioned.
Signed this __________________________ Day of ____________________________, 20____________
Print Name: ___________________________________________________________________________
Signature: ____________________________________________________________________________
AFFIDAVIT

Notary Public
_____________________________________________
Notary Seal
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Valencia Community College Criminal Justice Center
Whereas, the below named individual, for his/her own benefit, desires to participate in a Physical Abilities Test (PAT) of
their ability to perform the essential functions of a State Trooper, administered by the Florida Highway Patrol.
Whereas, the individual realizes that participation in such assessment is subject to inherent risk, and the individual hereby
releases and holds harmless the State of Florida, Board of Regents, Valencia Community College, its agents and employees,
co-sponsors and their agents and employees, and fellow candidates, in connection with bodily injury, death or property
damage incurred by the below named individual in any way related to or arising out of this physical assessment activity,
whether such injury or death arises or is alleged to have arisen from negligence of the individual, the State of Florida, Board
of Regents, Valencia Community College, its agents or employees, co-sponsors, their agents or employees, or fellow
candidates, or the contributory negligence of any of the aforementioned.
Print Name: ___________________________________________________________________________
Signature: ____________________________________________________________________________
AFFIDAVIT

Notary Public
_____________________________________________
Notary Seal
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Florida International University
Whereas, the below named individual, for his/her own benefit, desires to participate in the Florida Highway
Patrol Physical Abilities Test (PAT) at the Florida International University.
Whereas, the individual realizes that participation in such assessment is subject to inherent risk, and the individual
hereby releases and holds harmless the State of Florida, Florida International University, its agents and employees,
co-sponsors and their agents and employees, and fellow attendees, in connection with bodily injury, death or
property damage incurred by the below named individual in any way related to or arising out of this physical
assessment activity, whether such injury or death arises or is alleged to have arisen from negligence of the
individual, the State of Florida, Florida International University, its agents or employees, co-sponsors, their agents
or employees, or fellow attendees, or the contributory negligence of any of the aforementioned.
Print Name: ____________________________________________________________
Applicant’s Signature: ________________________________________________
AFFIDAVIT

Notary Public
_____________________________________________
Notary Seal
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State of Florida
Department of Highway Safety and Motor Vehicles
Division of Florida Highway Patrol
Supplemental Affidavit for State Trooper
An Equal Opportunity Employer/Affirmative Action Employer
Florida Highway Patrol Background, Recruitment & Selection

Neil Kirkman Building
2900 Apalachee Parkway, Mail Stop 49
Tallahassee, FL 32399-0525
Print or type in black ink only
Applicant: ________________________________________________________________________________________
First Name Middle Name Last Name (Maiden)
Mailing Address: ___________________________________________________________________________________
Residence: ________________________________________________________________________________________
Home Phone: (______) ____________________________ Work Phone: (______) _____________________________
Cell Phone: (______) _______________________ Personal Email: ________________________@________________
Social Security Number: ______-_____-_________ Date of Birth: ____/_____/_______ (MM/DD/YR)
Driver License Number: ________________________ State: _______________ Sex: Male Female
(Check only one)

Race / Ethnicity: White Black Hispanic Other ________________________________________
Height: _____________ Weight: ____________ Color of Eyes (Natural): _________________

Feet / Inches Pounds
U.S. Citizen: Yes No By Birth: Yes No By Naturalization: Yes No
Place of Birth: _____________________________________________________________________________________

City State Country
For Official (FHP) Use Only:

Basic Recruit Class (BRC) Transitional Recruit Class (TRC) Lateral Recruit Class (LRC)
HSMV 91029 (Rev 02/13/2019)
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APPLICANT INFORMATION
1. _______________________________________________________________________________________
First Name Middle Name Last Name Maiden
2. _______-__________-________ 3. ______________________________
Social Security Number Nick Name (If applicable)
4. List any-and-all other names you have used, dates of use, and the circumstances surrounding their use. Provide
ALL documentation of ANY name changes.
a) Name: ______________________________________________ Dates: ___________________ (From/To)
Reason: _____________________________________________
b) Name: ______________________________________________ Dates: ___________________ (From/To)
Reason: _____________________________________________
c) Name: ______________________________________________ Dates: ___________________ (From/To)
Reason: _____________________________________________
5. Have you ever worked for the Florida Highway Patrol as a State Trooper? Yes No
If yes, give dates and years of service and reason(s) for leaving: _______________________________
__________________________________________________________________________________
6. Have you previously applied for a position as a Florida Highway Patrol State Trooper? Yes No
If yes, provide date(s) of previous application(s) and reason(s) for not completing the hiring process:
__________________________________________________________________________________
__________________________________________________________________________________
7. Have you previously applied for a position as a Florida Highway Patrol Duty Officer? Yes No
__________________________________________________________________________________
__________________________________________________________________________________
8. Have you previously applied for a position as a Florida Highway Patrol Auxiliary Officer? Yes No
__________________________________________________________________________________
__________________________________________________________________________________
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9. Have you ever been denied employment with the Florida Highway Patrol? Yes No
If yes, provide date(s) of previous denial(s) and reason(s) given for the denial(s):
__________________________________________________________________________________
__________________________________________________________________________________
10. Marital Status: Single Married (check one)
(If married or divorced, submit copy(s) of marriage certificate or divorce decree)
11. Current Spouse Information: ____________________________________________________________________

12. Current Spouse Address: _______________________________________________________________________

Number and Street City State Zip Code
13. Previous Spouse Information: ___________________________________________________________________

Previous Spouse Address: ______________________________________________________________________









(If you have had more than five previous spouses, attach a separate sheet listing the above information and
attach it to the back of this packet.)
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EDUCATION
18. List all high schools attended. (Attach a copy of your high school diploma/GED to back of this packet.
Photocopies of high school transcripts are acceptable. Photocopy of GED Test Scores are required if GED was
issued outside of the State of Florida)
School: _____________________________________ Dates Attended (From/To): _________________________
Address: ____________________________________________________________________________________
Diploma GED (Check one) Graduated? Yes No
Address: ____________________________________________________________________________________
Address: ____________________________________________________________________________________
Address: ____________________________________________________________________________________
Address: ____________________________________________________________________________________
Address: ____________________________________________________________________________________
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HIGHER EDUCATION
19. List all colleges/universities/trade schools attended. Attach OFFICIAL transcripts SEALED by each institution.
Address: ____________________________________________________________________________________
Graduated? Yes No Number of Credit Hours Earned: _______ Degree Earned: __________________
Address: ____________________________________________________________________________________
Address: ____________________________________________________________________________________
Address: ____________________________________________________________________________________
Graduated? Yes No Number of Credit Hours Earned: _______ Degree Earned: ___________________
Address: ____________________________________________________________________________________
Address: ____________________________________________________________________________________
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20. Have you ever been expelled or suspended for cheating, fighting or any criminal act in high school or college?
Yes No If yes, explain in detail: ________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
(INTENTIONALLY LEFT BLANK)
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MILITARY INFORMATION
21. Are you currently on active duty in the United States Military? Yes No
If yes, when will you be released? ________________ (MM/DD/YY)
22. Have you ever served in a military organization of the United States? Yes No
(If yes, attach a photocopy of your DD 214 Form(s) member four (4) copy for each period of service)
Branch(s) of Service: __________________________ Service Number: ________________________________
If currently still enlisted, please attach a letter from your Company Commander stating your estimated time of
separation date and type of discharge expected. Once your DD 214 has been received, forward only your member
4 copy.
23. Provide dates of all periods of active military service along with branch information: _______________________
___________________________________________________________________________________________
___________________________________________________________________________________________
24. Type of Discharge? Honorable Medical General Dishonorable

Under Honorable Conditions Less Than Under Honorable Conditions
25. If other than “Honorable Discharge,” explain circumstances surrounding separation: _______________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
26. Were you ever court martialed, tried on charges, or the subject of a summary court, deck court, captain’s mast,
company punishment, Article 15 UCMJ, or any other disciplinary action while a member of the armed forces?
Yes No
If yes, explain below and attach copies of written documentation to back of application. If documentation is
not available, an original letter from the official agency records office must be provided stating that a record
search was performed and no records were found. Attach additional sheets to the back of this packet, if necessary.
___________________________________________________________________________________________
___________________________________________________________________________________________
SELECTIVE SERVICE INFORMATION

27. If you are a male and have never served in the U.S. Armed Forces, have you registered with the U.S. Selective
Service System? (Males MUST check either Yes or No) Yes No N/A (females only)
If yes, provide registration number: ___________________
Is proof of registration attached? Yes No
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EMPLOYMENT HISTORY
28. Have you been discharged from ANY employment for reasons OTHER THAN MEDICAL?
Yes No
29. Have you ever resigned when anticipating your employer intended to dismiss (fire) you for any reason?
Yes No
30. Have you ever resigned when anticipating your employer intended to take any form of disciplinary action against
you?
Yes No
31. Have you had any extended absences from work for reasons other than medical or approved vacations?
Yes No
*If you answered “Yes” to any of questions 28 through 31, explain in full detail below (include employer names).
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
32. List ALL work and public contact experience, including military service, beginning with the most recent job and
work backward. Include ALL full-time, part-time, seasonal and summer jobs back to age 16. Include military
service and jobs in proper sequence. Do not omit any period of employment. Use addit onal sheets, if necessary.
(See "Gap" Section on page 25 to list periods of unemployment.)
Employer: ______________________________________________ Work : _________________________
Street Address: ________________________________ City: ____________________State: ________ Zip: _______
Supervisor: _______________________________________ Full Time Part Time Hours Per Week: ________
Position Held: ________________________________________ Salary per month: __________________________

Is this employer still in business? Yes No If no, explain: ___________________________________________
Employment Dates: From: ___________/__________/__________ To: __________/__________/__________

Month Day Year Month Day Year
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Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Reason(s) for Leaving: ______________________________________________________________________________
Employer: ______________________________________________ Work : _________________________


Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Employer: ______________________________________________ Work : _________________________


Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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Employer: ______________________________________________ Work Phone: _________________________


Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________


Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Employer: ______________________________________________ Work Phone: ________________________
22 of 62

Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________


Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________


Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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_________________________________________________________________________________________________


Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________


Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
24 of 62


Job duties: ________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Gaps in Employment
If there are ANY gaps in employment above (periods of time in which you were unemployed), including gaps in military
service, list them below in order to provide an unbroken timeline for employment/unemployment history. Use additional
sheets, if necessary:
 /
Dates: _______________________ (MM/YYYY) Reason(s) for gap: __________________________________
From / To
 /
From / To
 /
From / To
 /
From / To
 /
From / To
 /
From / To
 /
From / To
 /
From / To
 /
From / To
 /
From / To
 /
From / To
25 of 62
Law Enforcement Information
33. Have you EVER submitted an application to ANY other Law Enforcement Agency? Yes No
If yes, list below (use additional sheets if necessary). (This includes city, county, state and federal agencies.)
Agency Date Status or Reason for Not Being Hired

Applied
34. Have you ever taken a polygraph examination, voice stress analysis test or psychological screening with any other
Law Enforcement Agency? Yes No If yes, list below (use additional sheets if necessary).
Agency Date Type of Test Status or Result
26 of 62
35. Have you had Law Enforcement training of any kind? Yes No If yes, list type of training, providers
and dates of training: ________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
36. Are you currently certified as a Law Enforcement Officer in the State of Florida? Yes No
37. Are you currently certified as a Correctional Officer in the State of Florida? Yes No
38. Have you EVER received any disciplinary action as a Law Enforcement Officer and/or Correctional Officer?
Yes No If yes, list below and attach copies of written documentation of disciplinary action.
Agency Date Complaint Status or

Result
27 of 62
General Information
39. Do you possess a valid driver license? Yes No If yes, in which state are you licensed? _____________
Driver License Number ____________________________
40. List ALL states in which you have previously been licensed to drive.
(Attach certified copies of all out-of-state driving records to the back of this packet).
State Dates in which you were licensed Certified Copy of Record

(To/From) Attached?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
41. List ALL traffic citations, excluding parking tickets, you have received in your lifetime. (Use additional sheets, if
necessary.)
Reason/Violation City/State of Issuance Date (MM/YYYY)
28 of 62
Traffic Crash History
42. Have you EVER been involved in a traffic crash (including a patrol car crash if you are a current or former law
enforcement or corrections officer)? Yes No
If yes, list ALL traffic crashes in which you have been involved as a DRIVER, not as a passenger. Include traffic
crashes where law enforcement was NOT notified and/or those where a traffic crash report was not completed.
Use additional sheets, if necessary:
Country/State/County in which Date of traffic crash Were you determined to be

traffic crash occurred (MM/YYYY) at-fault?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
43. Have you ever been charged with Driving Under the Influence, Driving While Intoxicated or Driving with
and Unlawful Blood Alcohol Level, whether convicted or not? Yes No
Have you ever been charged with Operating Under the Influence, Operating While Intoxicated or Boating
Under the Influence of Alcohol, whether convicted or not? Yes No
Have you ever been charged with Reckless Driving or Fleeing and Eluding a Police Officer, whether
convicted or not? Yes No
44. For ANY reason, has your driving privilege EVER been:
Canceled? Yes No Suspended? Yes No Revoked? Yes No
If yes, explain fully in COMPLETE DETAIL below: _______________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
29 of 62
General Information
45. Excluding non-criminal traffic citations or infractions, have you EVER been arrested, taken into custody,
detained for investigation or charged with a crime by any Law Enforcement Agency or State/Federal
Attorney’s Office (include expungements, indictments, criminal summons’, criminal informations, sealed
records, injunctions, pre-trial diversions, pardons, nolle prosequi, etc.) as an adult or juvenile? Yes No
If yes, explain in COMPLETE DETAIL:: ________________________________

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
46. List any and ALL arrests. Attach copies of Arrest Reports or Offense Incident Reports from the arresting or
investigating agency for each incident. Attach copies of the Final Court Disposition for each arrest from the
court that had jurisdiction over each incident. Legible copies are required. If documentation is not available,
an original letter from the official agency records office must be provided stating that a records search was
performed and no record(s) found for each incident. Use additional sheets if necessary.
Final Arrest Report Court Report

Date City/State Agency Charge Disposition Attached? Attached?
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
30 of 62
47. Have you EVER used, experimented, possessed, injected, inhaled, swallowed or ingested ANY illegal drug?
Yes No
(This includes prescription drugs not prescribed to you for your use, anabolic steroids, and Designer Drugs.)
If yes, (for each drug) list the type of drug, number of times used, and dates of use. Use additional sheets,
if necessary.
Drug Type (Be Specific) Number of times used (Provide a numeric Date(s) used
response) (MM/YY)
48. Have you ever sold, given, or exchanged any goods or services for any illegal drug? Yes No
If yes, explain in detail with dates, number of occurrences, goods or services sold/given/exchanged, and for
which drug(s): ______________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
49. Have you ever been present while an illegal drug was used. sold, given, exchanged, or transported? Yes No
If yes, explain in detail with dates, number of occurrences, and circumstances surrounding your presence
when an illegal drug was used, sold, given, exchanged or transported: _______________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
31 of 62
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
50. Are you now or have you ever been a member, or supported the views or beliefs, of any foreign or domestic
organization, association, movement, group, or combination of persons which is totalitarian, fascist, communist, or
subversive, or which has adopted, or shows a policy of advocating or approving the commission of acts of 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? Yes No
If yes, explain in detail with dates, name of organization, association, movement, or combination of
persons, and the circumstances surrounding your membership in, support of, or belief in such: __________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
32 of 62
Character References
51. List FOUR character references who have definite knowledge of your qualifications and fitness for the position
of State Trooper and who are able to speak confidently about you and your reputation. All persons you list may be
asked to appraise your character, ability, personality, and other qualities. DO NOT include relatives, former
employers, former supervisors, or individuals living outside of the United States.
a) Name: _______________________________________________ Home Phone: (_____)__________________
Home Address: ___________________________________________________________________________
Street Address City State Zip Code
Business, Occupation, or Profession: __________________________________________________________
Years Known: ____________ Name of Business: ________________________________________________
Business Address: _________________________________________________________________________
Business Phone: (_____)________________Ext: ___________ Cell Phone: (_____)_____________________
b) Name: _______________________________________________ Home Phone: (_____)__________________

Home Address: ___________________________________________________________________________
c) Name: _______________________________________________ Home Phone: (_____)__________________

Home Address: ___________________________________________________________________________
d) Name: _______________________________________________ Home Phone: (_____)__________________

Home Address: ___________________________________________________________________________

33 of 62
Credit History
52. Has your credit record (including your spouse’s credit record) EVER been considered unsatisfactory, or have you
EVER been refused credit (this includes credit cards, loans, or any other forms of credit)? Yes No
If yes, explain in detail with dates, places, names of creditors and circumstances surrounding the
unsatisfactory or refusal of credit: ______________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
53. Have you EVER filed for bankruptcy? Yes No If yes, explain in detail and include dates and the
court in which the bankruptcy was filed. Attach copies of bankruptcy documents including a copy of the
Schedule F (Chapter 7, 11 or 13).
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
54. Have you EVER been the subject of a court-ordered Judgment or Lien? Yes No
If yes, explain in detail: ________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
34 of 62
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
55. List ALL debts that are, or have been, more than 60 days past-due, delinquent and/or subject to collection. Use
additional sheets, if necessary:
Name of Creditor: _____________________________________ Account #: _____________________________
Mailing Address: ____________________________________________________________________________

Number of Payments Past Due: ________ Total Amount Due: ___________ Last Payment Date: _________
Mailing Address: ____________________________________________________________________________

Mailing Address: ____________________________________________________________________________

Mailing Address: ____________________________________________________________________________

Mailing Address: ____________________________________________________________________________

35 of 62
56. Are you currently paying child support? Yes No Are you currently paying alimony? Yes No
57. If you are paying child support or alimony of any kind, have you EVER been delinquent in your payments?
Yes No N/A
If you answered yes to Question #57, explain in detail: _______________________________________________

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
58. Have you EVER sued, or been sued by, ANY person, business, entity, or employer? Yes No
If you answered yes to Question #58, explain in detail: _______________________________________________

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
36 of 62
Residence History
59. Chronologically, beginning with your CURRENT residential address and working BACKWARD, list ALL
previous places of residence for the LAST 10 YEARS. There shall be NO GAPS in dates in which you lived at a
residence. If you have lived at your current address for 10 years or more, list the THREE previous addresses where
you resided prior to your current residential address. DO NOT OMIT ANY ADDRESSES. If you have lived at your
current residential address for your lifetime, only your current residential address will need to be listed and indicated
on the page. Use additional sheets, if necessary.
Residential Address: __________________________________________________________________________

Dates lived at this residential address: From _________________ (MM/YY) To _________________ (MM/YY)
Have you resided at this address your entire lifetime? Yes No If no, continue listing addresses below.






37 of 62
EQUAL EMPLOYMENT OPPORTUNITY SURVEY
60. Notice to All Applicants: The following information is requested to aid the Florida Highway Patrol in its
commitment to Equal Employment Opportunity. Your application will NOT be rejected because of your race,
color, sex, religion, creed, handicap, national origin, political beliefs, or age, except as provided by law.
Social Security Number: ______-_____-_______ Date of Birth: ____________________(MM/DD/YYYY)
Sex: Male Female
Racial/Ethnic Data
Please identify yourself in terms of the racial / ethnic groups listed below. (Check only one)
AFRICAN-AMERICAN (not of Hispanic origin): All persons having origins in any of the black racial groups
of Africa.
AMERICAN INDIAN OR ALASKAN NATIVE: All persons having origins in any of the original peoples
of North America, and who maintain cultural identification through tribal affiliation or community recognition.
ASIAN OR PACIFIC ISLANDER: All persons having origins in any of the original peoples of the Far East,
Southeast Asia, the Indian Subcontinent or the Pacific Islands. This area includes, for example: China, Japan,
Korea, the Philippine Islands, and Samoa.
HISPANIC: All persons of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture
or origin, regardless of race.
WHITE (not of Hispanic origin): All persons having origins in any of the original peoples of Europe, North
Africa, or the Middle East.
OTHER (specify): ________________________________________________________________________
38 of 62
SOCIAL MEDIA
63. Do you currently have or have you ever had ANY Social Media accounts? Yes No
If yes, list ANY and ALL Social Media (websites and applications that enable users to create and/or share content
or to participate in social networking) accounts you CURRENTLY HAVE or HAVE EVER HAD in the past
along with the applicable username, screen name, handle, blog name, channel name, URL (web address), or other
identifying information for the account. Examples of Social Media accounts include, but are NOT limited to,
Facebook, MySpace, Twitter, Instagram, SnapChat, Skype, Zello, WhatsApp, Pinterest, LinkedIn, Google,
Google+, Vimeo, Four Square, Tumblr, Flickr, Yelp, Live Journal, and Vine. Do NOT omit any Social Media
accounts. Attach additional sheets as necessary.
Social Media Platform Username/Screen Name URL (Web Address) Active?

Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
_______________________________________ __________________________ (MM/DD/YYYY)

Signature of Applicant Date
39 of 62
*****READ EXTREMELY CAREFULLY*****
I hereby swear that there are no willful misrepresentations or omissions in, or falsifications of,
the foregoing statements and answers to questions. I am aware that should an investigation
disclose such willful misrepresentations, falsifications or omissions, my application WILL be
rejected and I WILL be disqualified from applying in the future for any position of service in
the Florida Highway Patrol or if after my acceptance for employment, subsequent investigation
should disclose omissions, misrepresentations, or falsifications, it WILL be just cause for
immediate dismissal. Furthermore, the intentional false execution of this affidavit SHALL
constitute a Misdemeanor of the Second Degree, punishable as provided in § 775.082, §
775.083, or § 775.084, Florida Statutes.
Applicant’s Signature: ____________________________________ Date: _______________________ (MM/DD/YYYY)
AFFIDAVIT
STATE OF__________________________ COUNTY OF __________________________

Notary Public
___________________________________________________
Notary Seal
Date below photograph taken: ______________ Date below photograph taken: ______________
Attach a passport style, uncovered, color, Attach FULL BODY, clothed, individual
individual photograph of your FACE here. photograph here.
(Photo MUST have been taken within (No nudity, revealing clothing or bathing
the last 30 days of this affidavit being suits. Nothing containing offensive,
notarized.) demeaning, or otherwise unprofessional
language, graphics, or references. Nothing
containing information related to drugs or
any illegal activity.)
(Photo MUST have been taken within
the last 30 days of this affidavit being
notarized.)
40 of 62
BACKGROUND INVESTIGATION AGREEMENT
If at any time during the application or selection process the applicant is arrested, taken into custody, detained for
investigation or charged with a crime by any law enforcement agency or state/federal attorney’s office, declares bankruptcy,
or becomes the defendant in a civil suit, changes employers, relocates, or information on this supplemental affidavit changes,
the applicant SHALL immediately notify the Florida Highway Patrol’s Background, Recruitment & Selection Section or
the background investigator conducting the applicant’s background investigation.
FAILURE TO DO SO WILL RESULT IN IMMEDIATE DISQUALIFICATION.
The applicant is responsible for providing complete information and any or all reports, records or other documentation
related to any factor discovered that requires further review or evaluation. The application will be suspended temporarily
until all requested information is received.
HAVE YOU READ AND DO YOU UNDERSTAND THIS AGREEMENT? Yes No
_____________________________________________ __________________________ (MM/DD/YYYY)

_________-_____-__________
Social Security Number
41 of 62
PERSONAL INQUIRY WAIVER
AUTHORITY FOR RELEASE OF INFORMATION
TO: Concerned Person or Authorized Applicant’s Name: ____________________________________

Representative of Any Organization, Date of Birth: __________________________(MM/DD/YYYY)
Institution or Repository of Records Social Security Number: _______-_______-__________
I respectfully request and authorize you to furnish the Florida Highway Patrol any and all information that you may have
concerning my work record, school record, reputation, financial, and/or credit status. Please include any and all medical,
physical, and mental records or reports including all information of a confidential or privileged nature and copies of same,
if requested. This information is to be used to assist the Florida Highway Patrol in determining my qualifications and fitness
for the position I am seeking with said agency.
I have been advised and am fully aware that I will be requested to submit to a Florida Highway Patrol polygraph
examination. The purpose of the examination is to assist in verifying all information furnished in this application and
obtained during the applicant investigation. The examination will primarily cover past employment, drinking habits,
drug habits, criminal activity and basic honesty. I am fully aware that my refusal to submit to the polygraph examination
will terminate further consideration for employment with the Florida Highway Patrol.
I am willing to take the Florida Highway Patrol polygraph examination. Yes No
I hereby release you, your organization or others from any liability or damage which may result from furnishing the
information requested above.
_______________________________________ __________________________ (MM/DD/YYYY)

_______________________________________________________________________________________
AFFIDAVIT

Notary Public
_____________________________________________
Notary Seal
42 of 62
DEPARTMENT OF HIGHWAY SAFETY
AND MOTOR VEHICLES
APPLICANT CERTIFICATION AND
BACKGROUND INFORMATION RELEASE

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43 of 62
HSMV 91120 (rev 01/19)
CURRENT SPOUSE / FUTURE SPOUSE / ROOMMATE INQUIRY WAIVER
AUTHORITY FOR RELEASE OF INFORMATION
TO: Concerned Person or Authorized Applicant’s Name: ____________________________________

Representative of Any Organization, Date of Birth: __________________________(MM/DD/YYYY)
Institution or Repository of Records Social Security Number: _______-_______-__________
Current Spouse / Future Spouse / Roommate Information:

(Include ANYONE, including family members, living in your residence. This form MUST be completed separately
for EACH current/future spouse [whether they reside with you or not], roommate, or family member living in
your residence. Make extra copies of this form [as needed] and complete for each person.)
Print FULL NAME of Current Spouse/Future Spouse/Roommate: ____________________________________________
Alias / Maiden Name(s):
Date of Birth: ____________________________ (MM/DD/YYYY) Social Security Number: ______-_______-________
Race: ________________ Sex: Male Female
Residential Address: _________________________________________________________________________________
I hereby authorize any employee or authorized representative bearing this release, or copy thereof, to obtain any information
in your files pertaining to my criminal history or civil and criminal courts. I hereby direct you to release such information
upon request of the bearer. This release is executed with full knowledge and understanding that the information is for the
official use of the requesting agency. Consent is granted for the agency to furnish such 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,
credit bureau or 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 release you, your organization or others from any liability or damage, which may result from furnishing the
information requested above.
_____________________________________________________ ______________________ (MM/DD/YYYY)
Applicant’s Current Spouse/Future Spouse/Roommate Signature Date
AFFIDAVIT

Notary Public
_____________________________________________
Notary Seal
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AGREEMENT FOR TRAINING COST REIMBURSEMENT
FOR FLORIDA HIGHWAY PATROL RECRUITS
Date of Agreement: _________________________ (MM/DD/YYYY)
Recruit’s Full Name:
Recruit’s Address: __________________________________________________________________________________

Recruit’s Social Security Number: _______-_______-__________
I understand and agree that, in consideration of my employment with the Florida Highway Patrol and pursuant to the
provisions of §943.16, Florida Statutes (see Attachment A), I will reimburse the Florida Highway Patrol for all costs and
expenses related to my initial training and uniforms required to become a Trooper, subject to the following terms and
conditions:
1. I agree to serve as a trooper with the Florida Highway Patrol for a period of not less than twenty-four (24) months
after the completion of my initial training at the Florida Highway Patrol Training Academy or after my employment
date if I am already a Florida Certified Trooper (referred to herein as “employment obligation period”).
2. I agree that if I should voluntarily leave employment with the Florida Highway Patrol at any time prior to the
expiration of my employment obligation period, I will repay 100% of the tuition and other course expenses incurred
by the Florida Highway Patrol. (See Attachment A for the itemized tuition and other course expenses.)
3. I agree that my resignation prior to the expiration of my employment obligation period, for whatever reason, shall
be prima facie evidence that I left employment with the Florida Highway Patrol voluntarily.
4. I understand and agree that this agreement does not constitute an employment contract and that the Florida Highway
Patrol reserves the right, as my employer, to reassign, discipline or to terminate me in accordance with law and the
policies of the Florida Highway Patrol and the Florida Department of Highway Safety and Motor Vehicles.
5. I also understand that this agreement does not grant me any special rights or benefits from the Florida Highway
Patrol and does not require the Florida Highway Patrol to offer me a position as a trooper.
6. I understand that if I complete the Florida Highway Patrol Training Academy or, as a presently certified law
enforcement officer, become a member of the Florida Highway Patrol, this agreement does not alter or affect any
other terms or conditions of my employment with the Florida Highway Patrol.
7. I agree to repay all outstanding expenses for which I am responsible under this Agreement and §943.16, Florida
Statutes, to the Florida Highway Patrol at the time of my resignation.
8. If I am unable to repay the entire amount due within sixty (60) days of the date of my resignation, I understand that
the Florida Highway Patrol may institute a civil action to collect the amount due. I agree that this document may be
used as evidence of my obligation to reimburse the Florida Highway Patrol for all outstanding expenses pursuant
to Florida law.
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9. I agree that if judgment is entered against me as a result of such civil action, I will pay all costs and expenses
incurred by the State of Florida or the Florida Highway Patrol including attorney fees.
10. I agree that venue for any civil action necessary to enforce this Agreement and judgment will be in Leon County,
Florida.
IN WITNESS WHEREOF I have signed this agreement on date printed below my signature.
______________________________________
Applicant's Signature Witness Signature
______________________________________ Witnessed by: ______________________________________

Applicant’s Printed Name Witness Printed Name
_______________________(MM/DD/YYYY) _______________________ (MM/DD/YYYY)

Date Date
AFFIDAVIT

Notary Public
_____________________________________________
Notary Seal
46 of 62
Attachment A
ITEMIZED COST OF TRAINING AND EXPENSE FOR STATE TROOPER
Listed below are the costs of tuition, travel and field training costs, if these costs apply. Only costs incurred by the Florida
Highway Patrol will be required to be reimbursed pursuant to §943.16, Florida Statutes (below costs are maximum).
Tuition to Academy: $0.00

Room & Board: $7,528.00
Other Training Costs*: $3,381.00
______________________________________________
TOTAL: $10,909.00
*Includes equipment, supplies and other items issued during training such as uniforms and ammunition.
I have read and understand the above listed costs for my training and agree to the total listed.
IN WITNESS WHEREOF I have signed this agreement on date printed below my signature.
______________________________________ ______________________________________
Applicant's Signature Witness Signature
______________________________________ Witnessed by: ______________________________________

Applicant’s Printed Name Witness Printed Name
_______________________(MM/DD/YYYY) _______________________ (MM/DD/YYYY)

Date Date
AFFIDAVIT

Notary Public
_____________________________________________
Notary Seal
47 of 62
DUTY ASSIGNMENT
AGREEMENT
By submission of my application for employment as a law enforcement officer with the Florida Highway Patrol,
I fully understand that, if employed, I MUST be willing to accept a duty assignment ANY place in the State of
Florida. Duty assignments upon employment are made based on existing vacancies at the time of employment.
If employed by the Florida Highway Patrol, I fully understand and agree that I must remain in my duty assignment
for one full year prior to requesting a reassignment to another location in the State of Florida. Certain assignment
locations may not always be available because of low turnover rates or lack of total positions available. I
understand there may be a waiting period involved due to troopers with more seniority having first opportunity
to fill these choice locations.
I fully understand and agree to abide by the above provisions as they relate to assignment with the Florida
Highway Patrol and reassignment after employment.
_______________________________ ___________________________(MM/DD/YYYY)
_____________________________________ ________-________-__________
Applicant’s Printed Name Social Security Number
DUTY ASSIGNMENT “WISH LIST”
While I understand and will abide by the above agreement, below are the five (5) counties in Florida,
in order of preference, where I would prefer to be assigned upon graduation from the FHP Training
Academy (you must list 5 counties):
1. __________________________________
2. __________________________________
3. __________________________________
4. __________________________________
5. __________________________________
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AGREEMENT
TO ALLOW FOR CONTACT OF MY CURRENT EMPLOYER
By submission of my application for employment as a Law Enforcement Officer with the Florida Highway Patrol, I fully
understand the necessity of having a thorough background investigation conducted on my person.
I respectively request and authorize you to conduct a complete check into information concerning my work records, school
records, reputation, financial records, and credit status.
Upon successful completion of all required phases, to include the Criminal Justice Basic Abilities Test, Physical Abilities
Test, polygraph examination, psychological screening, background check, and eye and physical examination. I do hereby
give permission to the Florida Highway Patrol to contact my current employer for the purpose of determining my suitability
to become a Trooper.
I hereby release you, your organizations or others from any liability or damage, which may result from contacting my current
employer.
_______________________________ ___________________________(MM/DD/YYYY)
_____________________________________ ________-________-__________
Applicant’s Printed Name Social Security Number
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NOTICE OF DISCLOSURE OF CONSUMER REPORT
FEDERAL FAIR CREDIT REPORTING ACT (FCRA)
TO: Consumer Reporting Agencies Applicant’s Name: ____________________________________

Date of Birth: __________________________(MM/DD/YYYY)
Social Security Number: _______-_______-__________
It is the policy of the Florida Highway Patrol that the credit history and financial condition of the applicant be reviewed.
The credit history will not be a sole basis for disqualification, except that an applicant may be denied employment if he/she
is indebted to the extent that a salary as a law enforcement officer, as supplemented by other monies that are or could be
earned by the applicant and spouse with reasonable diligence, will manifestly be insufficient to pay his/her debts as they
fall due. Failure to pay just debts will disqualify an applicant.
I have been advised and am fully aware that a consumer report will be obtained and examined. The purpose of this
examination is to assist the Florida Highway Patrol in determining my eligibility for the position I am seeking with the
Florida Highway Patrol.
I am fully aware that my refusal to allow a consumer report to be obtained and examined will terminate further consideration
for employment.
I am willing to allow a consumer report to be obtained and examined. Yes No
I respectfully request and authorize you to furnish the Florida Highway Patrol any and all information that you may have
concerning my financial and credit status. I hereby release you, your organization or others from liability or damage, which
may result from furnishing the information requested above.
_________________________________________________ ___________________ (MM/DD/YYYY)

_____________________________________________________________________________________
AFFIDAVIT

Notary Public
_____________________________________________
Notary Seal
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TATTOO and BODY MODIFICATION POLICY AGREEMENT
A Florida Highway Patrol recruit trainee, attending an approved basic recruit training program, who has visible tattoos, does so with the
understanding that they must abide by the following restrictions regarding the type of uniform they will be required to wear in the performance of
their duties and functions. For purposes of this agreement, “member” refers to an active sworn member of the Florida Highway Patrol. “Applicant”
refers to someone attempting to become a member of the Florida Highway Patrol.
A. Under NO circumstances shall any tattoo be visible while the member is in ANY uniform of the Florida Highway Patrol. Members are
permitted to have tattoos provided they conform to the following guidelines:
1. A member with a tattoo anywhere on the arm or wrist area that is visible while wearing any short-sleeve uniform shall be
required to wear the Class A uniform (or Class C uniform with long sleeves, when authorized, by virtue of their assigned
position) anytime a uniform is required.
2. A member with a tattoo anywhere on the neck, face, head, hands, or fingers shall utilize cosmetic cover-up makeup to conceal the
tattoo(s) while the member is in any authorized uniform or attire and/or when representing the Division. The cosmetic cover-up
makeup shall blend in with the natural color of the skin and shall be purchased at the member’s expense.
Trooper applicants with ANY tattoo on the neck, face, head, hands, or fingers SHALL BE DISQUALIFIED. (This section
does not apply to members who have permanent eyeliner, eyebrows or lipstick provided the permanent color is conservative and
compliments the complexion and uniform.)
3. Any tattoo that contains offensive or extremist, sexist, racist, or gang-related material is prohibited and is a disqualification factor
for Trooper applicants.
4. While at the FHP Training Academy, the recruits with tattoos that are visible while wearing the Recruit Class B uniform shall be
required to wear the Recruit Class A uniform. Those same recruits shall not be issued Class B uniforms and shall be required to
wear the Class A uniform (or Class C uniform with long sleeves, when authorized).
Members who choose to obtain tattoos after their hiring date must ensure that they conform to this policy. Any member with a
prohibited tattoo shall be subject to disciplinary action, up to and including dismissal.
B. Abnormal body modifications to any area of the body visible in any authorized uniform or attire are prohibited. Abnormal body
modifications include, but are not limited to:
1. Tongue splitting or bifurcation.
2. The complete or trans-dermal implantation of any object(s) other than hair replacement.
3. Abnormal shaping of the ears, eyes, or nose.
4. Abnormal filing of the teeth.
5. Branding or scarification.
Nothing in this policy is to be construed as prohibiting body modifications necessitated by any medically or approved procedure. I fully
understand the consequences of this agreement and have had the opportunity to ask questions about it. This form will become part of my official
personnel file.
_______________________________________________ ____________________________(MM/DD/YYYY)
AFFIDAVIT
Before me personally appeared the said _______________________________________ who says that the execution of the above
instrument is by free will and accord, with full knowledge of the purpose therefore.

Notary Public
_____________________________________________
Notary Seal
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AUTHORITY FOR RELEASE
CJSTC
Florida Department of OF INFORMATION
Law Enforcement
(Background Investigation Waiver) 58
Incorporated by Reference in Rule 11B-27.0022(2)(a), F.A.C.
To: Concerned Person or Authorized APPLICANT’S NAME:

Representative of Any Organization,
Institution or Repository of Records DATE OF BIRTH:
LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER:
AGENCY REQUESTING BACKGROUND INFORMATION:
ADDRESS:
Having made application for certification or employment as a law enforcement, correctional, or correctional probation officer within the state of Florida, I hereby authorize for
one year, from the date of execution hereof, any authorized representative of a Florida criminal justice agency or a Regional Criminal Justice Selection Center bearing this
release to obtain any information pertaining to my employment, credit history, education, residence, academic achievement, personal information, work performance,
background investigations, polygraph examinations, any and all internal affairs investigations or disciplinary records, including any files that are deemed to be confidential
and/or sealed.
I also authorize release of any criminal justice records of arrests, citations, detentions, probation and parole records, or any police reports or other police records in which I
may be named for any reason, including any files that are deemed to be juvenile and confidential. I hereby direct you to release this information upon the request of the
bearer, whether in person or by correspondence. I further authorize the bearer to make copies of these records.
This release is executed with the full knowledge and understanding that these records and information are for the official use of a Florida criminal justice agency or Regional
Criminal Justice Selection Center in fulfilling official responsibilities, which may include sharing the records or information with other criminal justice agencies, Regional
Criminal Justice Selection Centers or the State of Florida or release to third parties as may be required by Florida public records laws. I hereby release you, as the custodian of
such records, and employer, educational institution, physician, hospital or other repository of medical records, credit bureau or 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 copy 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 copies from my military personnel and related
medical records, including a copy of my DD 214, Report of Separation, or other official documents from the United States Military denoting discharge status or current active military
status to:
Section 768.095, F.S., titled Employer Immunity from Liability; disclosure of information regarding former or current employees states: An employer who discloses information about a
former or current employee to a prospective employer of the former or current employee upon request of the prospective employer or of the former or current employee, is immune from
civil liability for such disclosure of its consequences, unless it is shown by clear and convincing evidence that the information disclosed by the former or current employer was knowingly
false or violated any civil right of the former or current employee protected under chapter 760, Florida Statutes. Pursuant to Sections 943.134(2)(a) and (4), 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.
Applicant’s Address
OATH
Pursuant to Section 117.05(13)(a), Florida Statutes
STATE OF COUNTY OF
Sworn to (or affirmed) and subscribed before me this
day of , year , By
Signature of Notary Public – State of Florida
Print, Type, or Stamp Commissioned name of Notary Public
Personally Known OR Produced Identification
Type of Identification Produced
Effective: 8/9/2001 Pursuant to Original – Employing Agency 1 of 1 Commission-Approved Revisions: 12/16/10

Sections 943.134(2)(a) and (4), F.S. Form Effective Date: 3/2013
CJSTC
AFFIDAVIT OF APPLICANT
Florida Department of 68
Law Enforcement Incorporated by Reference in Rule 11B-27.002(1)(f), F.A.C.
Please type or print in black or blue ink and use capital and small letters for names, titles, and addresses
Social Security Number:
Applicant’s Legal Name:

Last First MI
Employing agency:
Use this form to verify your compliance with the employment requirements of Section 943.13, F.S. I fully understand that to qualify for employment as a law enforcement, correctional, or
correctional probation officer, I shall comply with the following provisions of Section 943.13, F.S.:
• Be at least 19 years of age. shall not be eligible for employment or appointment as an officer, notwithstanding suspension
of a sentence or withholding of adjudication.
• Be a citizen of the United States.
• Have been fingerprinted by the employing agency.
• Be a high school graduate or equivalent.
• Have passed a physical examination by a licensed medical specialist approved in Rule
• Not have been convicted of any felony or of a misdemeanor involving perjury or false
11B-27.002(1)(d), F.A.C..
statement. Any person who, after July 1, 1981, pleads guilty or nolo contendere to or is
found guilty of a felony or of a misdemeanor involving perjury or a false statement • Be of good moral character.
• Have not received a dishonorable discharge from the U.S. Military.
True False NA In addition, I attest to the following statements: Each statement shall be checked “True” “False” or “NA”
1. I completed my employment application and it is true and correct, and all other information
I furnished in conjunction with my application is true and correct.
2. I provided documentation of proof of my qualifications to the above listed employing agency.
3. I meet the qualifications as specified above.
4. I had a criminal record sealed pursuant to Section 943.059(4)(a), F.S. , or expunged pursuant to Section 943.0585(4)(a), F.S.
5. I am under investigation by a local, state, or federal agency or entity for criminal, civil, or administrative wrongdoing to the best of my knowledge and belief.
6. I separated or resigned from a previous criminal justice employment while under investigation.
7. I am currently serving in good standing in the U.S. Military.
8. I previously served in the U.S. Military.
9. I received a dishonorable discharge from my previous U.S. Military service.

10. I am currently certified as a Florida criminal justice officer in the following area(s): Please check the appropriate box(es).
Law Enforcement Correctional Correctional Probation
11. I authorize the employing agency listed above to apply for my certification. Please check the appropriate box(es).
Law Enforcement Correctional Correctional Probation
NOTICE: This document shall constitute as an official statement within the purview of Section 837.06, F.S., and is subject to verification by the employing agency and the Criminal Justice
Standards and Training Commission. Any intentional omission when submitting this application or false execution of this affidavit shall constitute a misdemeanor of the second degree and
disqualify the officer for employment as an officer.
PLEASE READ CAREFULLY BEFORE SIGNING. You must complete the remainder of this affidavit in the presence of a notary public. Upon witnessing your signing of this affidavit, a notary public
shall complete the notary block by entering the same date the affidavit is signed. I hereby certify that to the best of my knowledge and belief, the information that I’ve entered on this form is
true.
12. 13.
Applicant’s Signature Date Signed
14. OATH
Pursuant to Section 117.05(13)(a), Florida Statutes
STATE OF COUNTY OF
Sworn to (or affirmed) and subscribed before me this
day of , year , By
Signature of Notary Public – State of Florida
Print, Type, or Stamp Commissioned name of Notary Public
Personally Known OR Produced Identification
Type of Identification Produced

*NOTE: Private Correctional facilities must submit original and shall forward the completed affidavit stapled to the Registration of Employment, Affidavit of Compliance
Form CJSTC-60 to FDLE, Criminal Justice Professionalism Program, Post Office Box 1489, Tallahassee, Florida 32302-1489, Attention Records Section
Created 1/1/1992 Original - Agency Copy – FDLE 1 of 1 Commission-Approved Revisions: 12/16/2010

Form Effective Date: 3/2013
PHYSICAL ABILITIES TEST INSTRUCTIONS
The Florida Highway Patrol (FHP) Physical Abilities Test (PAT) was designed to assess physical attributes
which reflect core enabling knowledge, skills and abilities and essential tasks common for law enforcement,
corrections and correctional probation officers. The PAT is to be conducted in a continuous flow manner that
is time-dependent to determine the participant’s level of physical conditioning and aerobic capacity. The PAT
MUST be completed in a maximum time of six-minutes and four-seconds for successful completion. The test
measures specific physical abilities through a series of tasks which are listed as follows:
1. Unfastening seatbelt, activating trunk release latch, opening door, exiting vehicle and opening trunk
2. Conducting a reaching exercise
3. Removing handgun and baton from trunk, placing handgun on chair, and retaining baton
4. 220-yard run with baton
5. Obstacle course with baton
6. Dummy drag (150 pounds)
7. Obstacle course with baton (repeat)
8. 220-yard run with baton (repeat)
9. Placing baton on chair, dry-firing of handgun (six trigger-pulls) with each hand (while counting aloud), picking-up baton
10. Placing handgun and baton in trunk, closing trunk
11. Re-entering vehicle, closing door, fastening seatbelt, and placing hands on steering wheel
TASK 1: The test begins with the participant seated in a full-sized motor vehicle, seatbelt on, with hands at the 10 and 2
o’clock positions on the steering wheel. Around the applicant’s waist is a pull-away flag belt with flags positioned over each hip. A
handgun and baton are positioned on the front-center of the trunk floor and the trunk lid in the closed/locked position. On the
command of “Go,” the stopwatch is started and the participant removes their hands from the steering wheel, unfastens the seatbelt, and
exits vehicle leaving the door open. The participant moves to the rear of the vehicle and opens the trunk. Immediately after opening
the trunk, the participant touches each flag with the opposite hand, from behind their back, and the belt is removed by the participant
(letting the belt fall to the ground). The participant then removes the handgun and baton from the trunk before closing the trunk lid.
The participant then moves to the chair and places the handgun on the chair while still retaining the baton. The participant then
proceeds to the starting position of the 220-yard run.
TASK 2: While carrying the baton, the participant runs 220-yards on a flat surface to the entrance of the obstacle course.
TASK 3: Upon completion of the 220-yard run, the applicant passes through the pylons at the entrance to the obstacle portion
of the course. Ten feet into the obstacle course, the participant must climb over a 40-inch wall, followed by a series of three (24, 12,
and 18-inch) hurdles five feet apart, located 10 feet beyond the wall. 10 feet beyond the final hurdle, the participant encounters the
first of nine pylons (spaced five feet apart) in a single row. The participant then must serpentine through the pylons. 10 feet beyond the
last pylon, the participant must crawl under a 27-in high, eight-foot long low crawl area after which the participant stands, moves to
the pylons located seven feet beyond the low crawl and drops the baton beside one of the pylons. (NOTE: If at any time during the
obstacle course the applicant knocks over a hurdle or pylon, they must immediately replace the hurdle or pylon and repeat that portion
of the obstacle course.)
TASK 4: The participant then sprints 50 feet, grabs the 150-pound dummy and drags it 100 feet on a cut-grass surface.
TASK 5: Upon completion of the dummy drag, the participant sprints back to the pylons, picks-up the baton and reverses
course through the obstacles. Following the wall climb, the participant moves through the pylons to prepare for the 220-yard run.
TASK 6: While carrying the baton, the applicants runs 220 yards on a flat surface to the vehicle.
TASK 7: Upon completing the 220-yard run, the applicant places the baton on the chair and picks-up the handgun. The
applicant then assumes a proper firing position and dry fires (six trigger pulls) using the dominant hand, followed by the non-dominant
hand. The applicant then picks-up the baton in one hand while holding the handgun in the other hand.
TASK 8: Upon completing the two-rounds of dry-firing, the applicant places the handgun and baton in the floor of the
already-opened vehicle trunk, then closes the trunk. The applicant then re-enters the vehicle, closes the door, fastens the seatbelt, and
places both hands on the steering wheel at the 10 and 2 o’clock positions, at which time the test ends and the stopwatch deactivated.
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WEIGHT STANDARDS SCALE
MALE FEMALE
HEIGHT MAXIMUM HEIGHT MAXIMUM
4'5" 133 4'5" 134
4'6" 137 4'6" 138
4’7” 142 4’7” 141
4’8” 147 4’8” 144
4’9” 151 4’9” 148
4’10” 156 4’10” 151
4’11” 160 4’11” 154
5’0” 165 5’0” 158
5’1” 170 5’1” 161
5’2” 175 5’2” 164
5’3” 178 5’3” 169
5’4” 183 5’4” 172
5’5” 187 5’5” 176
5’6” 193 5’6” 181
5’7” 198 5’7” 185
5’8” 203 5’8” 189
5’9” 207 5’9” 194
5’10” 213 5’10” 199
5’11” 218 5’11” 205
6’0” 224 6’0” 210
6’1” 229 6’1” 215
6’2” 235 6’2” 221
6’3” 240 6’3” 227
6’4” 251 6’4” 233
6’5” 258 6’5” 239
6’6” 265 6’6” 246
6’7” 272 6’7” 253
6’8” 280 6’8” 260
6’9” 289 6’9” 267
6’10” 297 6’10” 274
6’11” 305 6’11” 282
7’0” 314 7’0” 290
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Bring your completed Supplemental Affidavit for State Trooper and all accompanying documentation with
you to the PAT Testing site.
Review and complete the Supplemental Affidavit Checklist.
Complete ALL notarizations of signatures and photocopying of documents BEFORE your PAT Testing date.
Birth Certificates issued by hospitals are NOT ACCEPTABLE. Birth Certificates must have been
issued by the State or County Vital Statistics Office.
Applicants who are Naturalized U.S. Citizens MUST bring the ORIGINAL Naturalization Document
along with a photocopy of the same document for verification purposes. The original document WILL
be returned to you at PAT Testing.
Make a photocopy of your completed Supplemental Affidavit for State Trooper and ALL supporting
documents for your records. WE WILL NOT MAKE PHOTOCOPIES.
Do NOT submit original copies of documents with your packet as they will NOT be returned to you.
You may mail official college transcripts and other required documents obtained after the PAT Test date to:
Florida Highway Patrol
Background, Recruitment & Selection
2900 Apalachee Parkway, MS 49
Tallahassee, Florida 32399
All documentation mailed to the Background, Recruitment & Selection Section MUST have the
applicant’s name and social security number on it so we know in which file to place the documentation.
Applicants who fail to attend ANY scheduled pre-employment testing are considered no longer interested
in a position as a State Trooper. In these cases, the applicant is eliminated from further consideration in
the selection process.
Applicants who fail to attend ANY pre-employment testing and are interested in re-entering the selection
process must complete a new State of Florida Employment Application and forward it to:
Florida Highway Patrol
Background, Recruitment & Selection Section
2900 Apalachee Parkway, MS 49
Tallahassee, Florida 32399
If you have any questions, contact the Background, Recruitment & Selection Section at 850-617-2315.
Further information about the Selection Process and the FHP Training Academy may be obtained at the
Florida Highway Patrol website at www.BeATrooper.com.
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STATE TROOPER APPLICANT
SUPPLEMENTAL AFFIDAVIT CHECKLIST
Applicant’s Name: ______________________________ Social Security Number: _____-_____-_______
CAREFULLY review this Supplemental Affidavit Checklist. As you proceed through the checklist, review each page
of the affidavit in its entirety. Ensure that you have followed ALL directions, completed ALL sections, signed where
required and had applicable forms notarized PRIOR to attending your scheduled Physical Abilities Test. Failure to
follow instructions and include all required information and documentation may result in your file being placed in an
inactive status. We cannot stress enough the importance of ensuring that all information in this affidavit is
complete and accurate. Any falsification or omission of any kind may result in your DISQUALIFICATION.
Page 1: ALL instructions CAREFULLY read, understood and followed.

Page 2: ALL instructions CAREFULLY read, understood and followed.
Page 3: Minimum Employment Requirements read and understood, applicable box checked, all fields
completed and applicant’s signature affixed.
Page 4: Applicant Information Survey completed with all applicable boxes checked.
Page 5: Applicant Weight Chart understood, all information completed and applicable box checked.
Page 6: Memorandum from Academy Director understood.
Page 7: All fields completed. Florida Highway Patrol Waiver of Liability form READ and UNDERSTOOD.
Applicant’s signature attached and the affidavit NOTARIZED.
Page 8: All fields completed. Florida Highway Patrol Medical Release Form completed by YOUR DOCTOR
and the applicable box checked reflecting his/her medical recommendation. DOCTOR’S signature
affixed.
Page 9: You understand the instructions and have determined which Release Form (page 10, 11, or 12) you must
complete based on your PAT Testing location.
Page 10: If you’re completing your PAT Test in Tallahassee (Havana), Florida, you have completed the Florida
Highway Patrol Training Academy/Florida Public Safety Institute Release Form and have ensured that
it is NOTARIZED. If this is not the location where you will be completing your PAT Test, you have
drawn an “X” across the entire page and included it in the packet.
Page 11: If you are completing your PAT Test in Orlando, Florida, you have completed the Valencia
Community College Release Form and have ensured that it is NOTARIZED. If this is not the location
where you will be completing your PAT Test, you have drawn an “X” across the entire page and
have included it in the packet.
Page 12: If you are completing your PAT Test in Miami, Florida, you have completed the Florida International
University Release Form and have ensured that it is NOTARIZED. If this is not the location where you
will be completing your PAT Test, you have drawn an “X” across the entire page and have included it
in the packet.
Page 13: All fields completed and applicable boxes checked. “For Official (FHP) Use Only” sections blank.
Page 14: All fields completed and applicable boxes checked. Additional sheets used, if necessary.
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Page 19: All fields completed and applicable boxes checked. No period of employment omitted. Additional
sheets used, if necessary. Copies of military documents attached, if applicable.
Page 20: All fields completed and applicable boxes checked. No period of employment omitted.
Page 25: All fields completed and applicable boxes checked. No period of employment omitted All gaps in
employment (if applicable) listed to ensure an unbroken timeline.
Page 26: All applications submitted to other law enforcement agencies listed and none omitted. Additional sheets
used, if necessary. All polygraph tests previously taken with other law enforcement agencies listed and
none omitted. Additional sheets used, if necessary.
Page 27: All fields completed and applicable boxes checked. If you are or have been a law enforcement officer or
correctional officer and have received ANY type of disciplinary action, they are listed and nothing is
omitted. Additional sheets used, if necessary.
Page 28: All fields completed and applicable boxes checked. CERTIFIED copies of ALL out-of-state driving
records included with packet, if applicable. ANY and ALL traffic citations EVER received during your
lifetime listed. ANY and ALL traffic crashes in which you have EVER been involved listed and none
Page 29: All fields completed and applicable boxes checked.
Page 30: All fields completed and applicable boxes checked. ANY and ALL occasions in your lifetime listed
where you were arrested and none omitted.
Page 31: All fields completed and applicable boxes checked. ALL illegal drugs you have EVER used,
experimented with, possessed, injected, inhaled, swallowed, or ingested in any way listed with number
of times used and associated dates. None omitted.
Page 32: All fields completed and applicable box checked.
Page 33: All fields completed. FOUR Character References (not including relatives, former employers, former
supervisors, or individuals living outside of the United States) listed.
Page 34: All fields completed and applicable boxes checked. COMPLETE and ACCURATE Credit History
information listed and nothing omitted.
Page 35: All fields completed. COMPLETE and ACCURATE Credit History information listed and nothing
Page 37: All fields completed and applicable boxes checked. Residential addresses for the last 10 YEARS listed
chronologically beginning with your CURRENT address and working BACKWARD. NO GAPS in
dates in which you lived at a residence. If you have lived at your current address for 10 years or more,
you have listed the THREE previous addresses where you resided prior to your current residential
address. NO ADDRESSES OMITTED. If you have lived at your current residential address for your
58 of 62
lifetime, only your current residential address listed and indicated on the page. Additional sheets used, if
necessary.
Page 38: All fields completed and applicable boxes checked.
Page 39: ALL Social Media accounts that you CURRENTLY HAVE and have EVER HAD listed. Applicant’s
signature affixed.
Page 40: READ and UNDERSTOOD ENTIRE page. CAREFULLY read the consequences of falsification
or omissions of anything during the application process and COMPLETELY UNDERSTOOD
such consequences. Recent (taken within 30 days of notarization) individual color photographs of
your face and full body attached. Applicant’s signature affixed and affidavit NOTARIZED.
Page 41: READ and UNDERSTOOD the Florida Highway Patrol Background Investigation Agreement.
Applicable box checked, all fields completed, and applicant’s signature affixed.
Page 42: All fields completed, applicable box checked, applicant’s signature affixed, and the affidavit
NOTARIZED.
Page 43: All fields completed, applicable boxes checked, and applicant’s signature affixed.
Page 44: All fields completed and appropriate box checked. Applicant’s Current Spouse, Future Spouse, or
Roommate’s Signature affixed and the affidavit NOTARIZED. This form has been completed for
EVERY person (including family members) 18 years of age and older that lives in the applicant’s
residence.
Page 45: All fields completed. Agreement for Training Cost Reimbursement for Florida Highway Patrol Recruits
READ and UNDERSTOOD.
Page 46: All fields completed. Agreement for Training Cost Reimbursement for Florida Highway Patrol Recruits
READ and UNDERSTOOD. Applicant and Witness signatures affixed and affidavit NOTARIZED.
Page 47: All fields completed. “Attachment A” Itemized Cost of Training and Expense for Trooper READ and
UNDERSTOOD. Applicant and Witness signatures affixed and affidavit NOTARIZED.
Page 48: All fields completed. Florida Highway Patrol Duty Assignment Agreement READ and
UNDERSTOOD. Applicant’s signature affixed. Duty Assignment "Wish List" completed.
Page 49: All fields completed. Florida Highway Patrol Agreement to Allow for Contact of My Current Employer
READ and UNDERSTOOD. Applicant’s signature affixed.
Page 50: All fields completed and applicable box checked. Florida Highway Patrol Notice of Disclosure of
Consumer Report Federal Fair Credit Reporting Act (FCRA) form READ and UNDERSTOOD.
Applicant’s signature affixed and the affidavit NOTARIZED.
Page 51: All fields completed, applicant’s signature affixed, and the affidavit NOTARIZED.
Page 52: FDLE CJSTC 58 Form completed, applicant’s signature affixed, and affidavit NOTARIZED.
Page 53: FDLE CJSTC 68 Form completed, applicable boxes checked, applicant’s signature affixed, and
affidavit NOTARIZED.
Page 54: Florida Highway Patrol Physical Abilities Test Instructions READ and UNDERSTOOD.
Page 55: Florida Highway Patrol Weight Standards Scale READ and UNDERSTOOD.
Page 56: ALL INFORMATION ON THIS PAGE READ, UNDERSTOOD AND FOLLOWED.
Page 57: ALL Supplemental Application Checklist boxes checked verifying each page of the packet has been
completed accurately and completely.
59 of 62
Page 61: Florida Highway Patrol Troop Boundaries Map reviewed.
Page 62: Florida Highway Patrol Background, Recruitment & Selection Contact Information retained for future
reference.
60 of 62
TROOP BOUNDARIES
FHP General Headquarters
61 of 62
BACKGROUND, RECRUITMENT & SELECTION
CONTACT INFORMATION
General Headquarters Staff
Captain Ryan M. Martina Lieutenant Williams R. Cannon Sergeant James E. Swearingin

2900 Apalachee Parkway, MS 49 2900 Apalachee Parkway, MS 49 2900 Apalachee Parkway, MS 49
Tallahassee, Florida 32399 Tallahassee, Florida 32399 Tallahassee, Florida 32399
(850) 617-2315 (850) 617-2315 (850) 617-2336
RyanMartina@flhsmv.gov WilliamsCannon@flhsmv.gov JamesSwearingin@flhsmv.gov
Recruiters / Background Investigators
Troop A Troop B Troop C

TBA (Refer to Troop H Contact Info) Trooper Shelia Walker Trooper Stanley B. Rice
6030 County Road 2321 1350 U.S. Highway 90 W 11305 N. McKinley Drive
Panama City, Florida 32404 Lake City, Florida 32055 Tampa, Florida 33612
Office: Office: (386) 754-6284 Office: (813) 558-1817
Cell: Cell: (386) 220-3345 Cell: (813) 460-0896
SheliaWalker@flhsmv.gov StanleyRice@flhsmv.gov
Troop D Troop E (1 of 2) Troop E (2 of 2)

Trooper Tara E. Crescenzi Trooper Benjamin F. Hollinger Trooper Michael L. Brown
133 S. Semoran Blvd., Suite A 1011 N.W. 111th Avenue 1011 N.W. 111th Avenue
Orlando, Florida 32807 Miami, Florida 33172 Miami, Florida 33172
Office: (407) 249-6587 Office: (305) 513-3466 Office: (305) 513-3466
Cell: (407) 319-0021 Cell: (305) 619-6983 Cell: (305) 619-2944
TaraCrescenzi@flhsmv.gov BenjaminHollinger@flhsmv.gov MichaelLBrown@flhsmv.gov
Troop F Troop G Troop H

Trooper Sherry R. Rongish Trooper Michael A. Elder Sergeant James E. Swearingin
4010 S. Tamiami Trail 7322 Normandy Blvd., 2900 Apalachee Parkway, MS 49
Venice, Florida 34293 Jacksonville, Florida 33205 Tallahassee, Florida 32399
Office: (941) 492-5856 Office: (904) 693-5050 Office: (850) 617-2336
Cell: (850) 445-1606 Cell: (904) 466-1689 Cell: (850) 274-3733
SherryRongish@flhsmv.gov MichaelElder@flhsmv.gov JamesSwearingin@flhsmv.gov
Troop K Troop L
Trooper Michael D. Thurston Trooper Elliott K. Rosen
Bldg 9330, MM94 Florida’s Turnpike 14190 W. State Road 84
Lake Worth, Florida 33467 Davie, Florida 33325
Office: (561) 357-4274 Office: (954) 837-4016
Cell: (561) 513-3007 Cell: (954) 290-6196
MichaelThurston@flhsmv.gov ElliottRosen@flhsmv.gov
62 of 62

PAT Invitation With FHP Fillable Supplemental Application

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PAT Invitation With FHP Fillable Supplemental Application

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FLORIDA HIGHWAY PATROL

STATE TROOPER APPLICANT

________________________________________ _________________________________ (MMDDYY)

Social Security Number: _____-______-_________ Date of Birth: _____________________ (MM/DD/YY)

First Name: ___________________ Middle Name: ________________ Last Name: _______________________

Mailing Address: ____________________________________________________________________________

Cell Phone: (_____)__________________ Personal Email:___________________________@_______________

Education Level: BS / BA Degree or Higher: AS / AA Degree:

Military Experience: Yes No Honorable Discharge: Yes No

Are you an active/current Law Enforcement Officer? Yes No

Are you currently employed as a Florida Law Enforcement Officer? Yes No

Are you willing to relocate ANYWHERE in the State of Florida? Yes No

______________ 4'5" 133 4'5" 134 ______________

Official (FHP) Use Only: 4’8” 147 4’8” 144

H/W Proportionate 4’9” 151 4’9” 148

7’0” 314 7’0” 290

TO: Certified Physicians, Certified Advanced Registered Nurses, Physician’s

FROM: Major Nancy D. Rasmussen

SUBJECT: Physical Fitness Assessment / Physical Fitness Conditioning Program

It is a requirement for any recruit enrolled or employed in a recruit training program to

I (print name) ____________________________________________ attest that I am in good physical condition. I

STATE OF __________________________ COUNTY OF __________________________

Sworn to and subscribed before me on this ______________________ day of __________________________, 20 _____.

_______________________________________________________ My Commission expires __________, 20______.

MEDICAL RELEASE FORM

Name of Participant: _______________________________________ ________-_______-__________

Participation is NOT advisable at the present time.

**This form only valid for 90 DAYS

You will ONLY NEED ONE INJURY AND DAMAGE RELEASE

Signed this __________________________ Day of ____________________________, 20____________

Print Name: ___________________________________________________________________________

STATE OF __________________________ COUNTY OF __________________________

Sworn to and subscribed before me on this ______________________ day of __________________________, 20 _____.

_______________________________________________________ My Commission expires __________, 20______.

Signed this __________________________ Day of ____________________________, 20____________

Print Name: ___________________________________________________________________________

STATE OF __________________________ COUNTY OF __________________________

Sworn to and subscribed before me on this ______________________ day of __________________________, 20 _____.

_______________________________________________________ My Commission expires __________, 20______.

Signed this __________________________ Day of ____________________________, 20____________

Print Name: ____________________________________________________________

Applicant’s Signature: ________________________________________________

STATE OF __________________________ COUNTY OF __________________________

Sworn to and subscribed before me on this ______________________ day of __________________________, 20 _____.

_______________________________________________________ My Commission expires __________, 20______.

Florida Highway Patrol Background, Recruitment & Selection

Print or type in black ink only

Home Phone: (______) ____________________________ Work Phone: (______) _____________________________

Cell Phone: (______) _______________________ Personal Email: ________________________@________________

Social Security Number: ______-_____-_________ Date of Birth: ____/_____/_______ (MM/DD/YR)

Driver License Number: ________________________ State: _______________ Sex: Male Female

(Check only one)

Height: _____________ Weight: ____________ Color of Eyes (Natural): _________________

U.S. Citizen: Yes No By Birth: Yes No By Naturalization: Yes No

Place of Birth: _____________________________________________________________________________________

For Official (FHP) Use Only:

HSMV 91029 (Rev 02/13/2019)

a) Name: ______________________________________________ Dates: ___________________ (From/To)

b) Name: ______________________________________________ Dates: ___________________ (From/To)

c) Name: ______________________________________________ Dates: ___________________ (From/To)

10. Marital Status: Single Married (check one)

(If married or divorced, submit copy(s) of marriage certificate or divorce decree)

11. Current Spouse Information: ____________________________________________________________________

________ _ (MMDDYY)

Social Security Number: _--_ Date of Birth: _______________ (MM/DD/YY)

First Name: _ Middle Name: Last Name: _____

Cell Phone: (_) Personal Email:_@___

4'5" 133 4'5" 134

STATE OF COUNTY OF

Sworn to and subscribed before me on this day of , 20 _.

_______________________________________________ My Commission expires , 20.

Name of Participant: ___________________________________ -_-________

Signed this __________ Day of , 20

STATE OF COUNTY OF

Sworn to and subscribed before me on this day of , 20 _.

_______________________________________________ My Commission expires , 20.

Signed this __________ Day of , 20

STATE OF COUNTY OF

Sworn to and subscribed before me on this day of , 20 _.

_______________________________________________ My Commission expires , 20.

Signed this __________ Day of , 20

STATE OF COUNTY OF

Sworn to and subscribed before me on this day of , 20 _.

_______________________________________________ My Commission expires , 20.

Home Phone: () Work Phone: () _________

Cell Phone: () _ Personal Email: @

Social Security Number: ____-_-_____ Date of Birth: /_/_____ (MM/DD/YR)

Driver License Number: __________ State: _ Sex: Male Female

Height: _ Weight: Color of Eyes (Natural): _____

a) Name: ____________________________ Dates: _ (From/To)

b) Name: ____________________________ Dates: _ (From/To)

c) Name: ____________________________ Dates: _ (From/To)

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

School: _____________ Dates Attended (From/To): _

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //

Employer: ______________________ Work : _

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //

Employer: ______________________ Work : _

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //

Employer: ______________________ Work Phone: _

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //

Employer: ______________________ Work Phone:

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //

Employer: ______________________ Work Phone: _

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //

Employer: ______________________ Work Phone: _

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //

Employer: ______________________ Work Phone: _

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //

Employer: ______________________ Work Phone: _

Street Address: __________________ City: State: Zip: _

Position Held: ______________ Salary per month:

Employment Dates: From: _// To: //