Agreement Release Information
In accordance with section 119.071(5)(a)2 Florida Statutes (2021), your social security number is being collected for verification purposes and completion of a background investigation. This collection is imperative for the performance of this agency’s duties and responsibilities as prescribed by law. Information submitted on the application must be verified prior to appointment. Inclusion of the social security number will save staff time and result in the position being filled with prompt efficiency. The Department will not use the social security number collected for any purpose other than the purpose provided above.
I do hereby agree to the release of any and all information (excluding records deemed confidential under ADA) pertaining to me by any person to whom this authorization may be presented, in consideration of the fact that all such obtained information shall be used only in relation to my application for employment with the Florida Department of Corrections. I understand that if I am employed by the Florida Department of Corrections, any documents obtained pursuant to this release will be placed in my personnel file and be public records pursuant to Chapter 119, Florida Statutes.
I acknowledge that a fingerprint-based record check will be conducted for all individuals seeking employment with the Florida Department of Corrections. The purpose of the records check is to conduct a search of any Florida and National criminal history records that may pertain to the applicant/employee. By submitting fingerprints, I am authorizing the dissemination of any state and national criminal history record that may pertain to me to the Florida Department of Corrections. The fingerprints submitted are retained by the Florida Department of Law Enforcement (FDLE) and the Federal Bureau of Investigation (FBI). The fingerprints will be retained with the agency until such time as employment separation occurs. In the event of subsequent arrests, FDLE and the FBI will notify the agency of a records hit based on those retained fingerprints.
If I believe that the criminal history record is incomplete or inaccurate, I may conduct a personal review as provided in s. 943.056, F.S., and Florida Administrative Code Rule 11C-8.001 by calling FDLE at (850) 410-7898. If I believe the national information is in error, I may contact the FBI at (304) 625-2000. I can receive any national criminal history record that may pertain to me directly from the FBI, pursuant to 28 CFR Sections 16.30-16.34. I have the right to a reasonable amount of time to obtain a determination as to the validity of my challenge before a final decision is made about my status as an employee.
Attestation and Submission
By submission of this electronic form, I hereby certify there are no misrepresentations, omissions, or falsification in the foregoing responses. I am aware that should an investigation disclose any misrepresentations, omissions, or falsifications, my application may be rejected, and I may be disqualified for employment with the Florida Department of Corrections or, if after my acceptance for employment, subsequent investigation should disclose misrepresentations, omissions, or falsifications, it may be just cause for my immediate dismissal.