Civilian Support Unit Member (Volunteer)

Carmine Marceno State of Florida
Sheriff County of Lee

“Proud to Serve”

IMPORTANCE OF HONESTY STATEMENT

The Lee County Sheriff’s Office is seeking applicants who demonstrate certain characteristics. Honesty is the most
important characteristic you must demonstrate. It is extremely important that you are completely honest in all of your
answers. The importance of honesty as you complete paperwork and during all interviews cannot be
overemphasized. Failure to respond to any question truthfully, whether orally or in writing, will result in
disqualification. Many applicants have been disqualified for dishonesty. While filling out documents, you are
cautioned to take your time, to be thorough, and to be specific in all your answers. If you have any doubt in your mind
concerning a particular question or if you are unsure whether to include certain information, the answer is “Yes”;
include it.

You may think that something you have done will disqualify you from further consideration; it may or may not. What
will certainly disqualify you is lying or distorting the truth.

Applicant's interviews may be recorded.

Applicants should be aware that per Florida Administrative Code 11B-27.0011, titled “Moral Character” that falsifying
an employment application may result in the suspension or revocation of your Florida law enforcement certification,
thereby disqualifying you from employment as a law enforcement/correctional officer within the state of Florida.

COLLECTION AND USE OF SOCIAL SECURITY NUMBERS

Effective October 1, 2007, in accordance with FSS 119.071, the Lee County Sheriff’s Office may collect Social Security
numbers for the following purposes:


Application Process – for the purpose of collecting information related to background investigations, to include
fingerprints, NCIC/FCIC checks, verification of employment, local and state records checks, clarification for
duplicate names, verification of Military Service. 

Payroll – for reporting wages to Internal Revenue Service, Division of Retirement and New Hire Reporting.


Insurance – for medical, dental, flexible spending, life insurance policies, and long-term disability enrollment
and reporting. 

Medical Leave – for Worker’s Compensation reporting and medical purposes associated with Workers’
Compensation.

ACKNOWLEDGMENT:

I, ,
do solemnly attest that I have read and agree to the above information.

Applicant's Signature: x

Print Applicant’s Name: x

Date: X

“The Lee County Sheriff’s Office is an Equal Opportunity Employer”
14750 Six Mile Cypress Parkway  Fort Myers, Florida 33912-4406  (239) 477-1000

LEE COUNTY SHERIFF’S OFFICE Date Received: _________________
VOLUNTEER APPLICATION FORM Rev 11/19/2024 Office Use Only

The Sheriff’s Office is an Equal Employment Opportunity Employer. We consider applicants for all positions
without regard to race, national origin, sex (including gender identity and expression, sexual orientation, and

pregnancy), age, disability, marital status, religion or any other legally protected status.
This application shall become the property of the Sheriff's Office and the information received in the application

process are public record, pursuant to Florida State Statute 119.071

INSTRUCTIONS

Application must be handwritten legibly in ink or typed by the applicant. All questions must be answered
completely. If any sections are left incomplete your application will be rejected. If space provided is not
sufficient for complete answers or if you wish to furnish additional information, please utilize page 4.

Volunteer Position Desired: Civilian Support Unit Chaplain Internship
1. Full Name (Last, First, Middle, Suffix):

2. Social Security Number:

3. Date of Birth: Place of Birth: Country:

4. Aliases: List all other names you have used including circumstances and time periods you used them

(for example: maiden name, former names, aliases, or nicknames):

5. Are you a U.S. citizen? Yes No Naturalization Date: Permanent Resident Card:

6. Current Address:

Full Time Part Time Approximate Number Months in Florida: From/To:

Phone Number(s)

Email Address:

Marital Status: Married Divorced Single

7. Spouse’s Name:

Current Address:

Phone Number(s):

Email Address:

8. Driver's License Number State Date Expires Restrictions

9. Do you hold or have you ever held a driver’s license in another state? Yes No

Please list license number (if known), state, name used, approximate date:

10. Have you ever been denied issuance of a driver’s license or have you ever had a license suspended or

revoked? Yes No Details:

Lee County Sheriff's Office Volunteer Application Page 1 of 4 Pages

11. College/University, Trade, Vocational, Business or Military Education (Include school, address, dates
attended, if you graduated, and type of diploma):

12. Current Employer:

Address:

Phone(s):

Dates Worked: From: To:

Title/Position: Supervisor Name:
13. Have you ever been a volunteer in any capacity for a law enforcement agency, i.e. Explorer, Auxiliary,

Internship? Yes No If yes, please provide Agency name, year(s), and position held:

14. Have you ever been a volunteer in any capacity for an organization other than a law enforcement agency?

Yes No If yes, please provide the organization's name, year(s) and position held:

15. Have you ever enlisted for active or reserve duty in the Armed Forces of the United States? Yes No

Branch Rank From To Discharge Type Active?

16. Do you currently possess a concealed carry permit in any state? Yes No List state(s):

17. Have you ever received a ticket or been charged with a traffic violation (excluding parking tickets)?
Yes No Give details, including ticket date, city, department, charge/offense, and disposition/result:

18. Have you ever been arrested, charged or received a notice or summons to appear for any criminal
violation, regardless if the record was sealed or expunged? Yes No Details:

19. Have you ever been fingerprinted for any reason (arrest, job application, military, etc.)? Yes No
Details:

Lee County Sheriff's Office Volunteer Application Page 2 of 4 Pages

20. In the past ten (10) years, have you EVER used what you knew or believed to be, an illegal
substance/drug, including synthetic drugs OR medical marijuana? Yes No
If you answered yes, please list all drugs and check ALL yes or no boxes.

First Used Last Used
Drug Month/Year Month/Year # of Times Used

21. In the past ten (10) years, have you EVER possessed, bought, sold, delivered, made/grown,

packaged/weighed what you knew, or believed to be, an illegal substance/drug including synthetic
drugs? Yes No If you answered yes, please list all drugs and check ALL yes or no boxes.

Made/
First Last Weighed/

Occurred Occurred Bought Sold Delivered Grown Packaged
Month/ Month/ # of Yes No Yes No Yes No Yes No Yes No

Drug Year Year Times

22. In the past ten (10) years, have you EVER used what you knew or believed to be, prescription drugs for

non-medical purposes, including another individual’s medical marijuana? Yes No
If you answered yes, please list all drugs and check ALL yes or no boxes.

First Used Last Used
Drug Month/Year Month/Year # of Times Used

23. In the past ten (10) years, have you EVER possessed, bought, sold, delivered, packaged/weighed what

you knew, or believed to be, prescription drugs for non-medical purposes? Yes No
If you answered yes, please list all drugs and check ALL yes or no boxes.

Made/
First Last Weighed/

Occurred Occurred Bought Sold Delivered Grown Packaged
Month/ Month/ # of Yes No Yes No Yes No Yes No Yes No

Drug Year Year Times

Lee County Sheriff's Office Volunteer Application Page 3 of 4 Pages

I understand that the submission of this application does not constitute acceptance of employment or
appointment with the Lee County Sheriff's Office.

Applicant Signature: Date:
Q # Additional Information

Lee County Sheriff's Office Volunteer Application Page 4 of 4 Pages