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HomeMy Public PortalAboutPRR 14-0673i V .t�- Your original request, dated February 18, 2014, is reproduced in the space below: From: Chris O'Hare [ mailto: chrisoharegulfstream @gmail.com] Sent: Tuesday, February 18, 201411:03 AM To: Bill Thrasher Subject: PUBLIC RECORDS REQUEST policeman application 2.18.14.b This is a PUBLIC RECORDS REQUEST policeman application 2.18.14.b Pursuant to Article 1, Section 24 of the Florida Constitution and Chapter 119.07 of the Florida Statutes I wish to make a public records request of your agency for the following records: All records of the application for employment submitted by the Town employee driving the police car labeled 750 (see attached photo) this morning in Place Au Soleil, removing political signs and depositing said signs in the rear seat of said car. If you contend that any of the records 1 am seeking, or any portion thereof, are exempt from inspection or disclosure please cite the specific exemption as required by 0119.07(1)(e) of the Florida Statutes and state in writing and with particularity the basis for your conclusions as required by O 1 I9.07(1)(t) of the Florida Statutes. Please take note of &119.07fc1 Florida Statues and your affirmative obligation to (1) promptly acknowledge receipt of this public records request and (2) make a good faith effort which "includes making reasonable efforts to determine from other officers or employees within the agency whether such a record exists and, ifso, the location at which the record can be accessed." I am, therefore, requesting that you notify every individual in possession of records that may be responsive to this public records request to preserve all such records on an immediate basis. If the public records being sought are maintained by your agency in an electronic format please produce the records in the original electronic format in which they were created or received. See 0119.01(2)(8. Florida Statutes. If you anticipate the production of these public records to exceed $1.00 please notify me in advance of their production with a written estimate of the total cost. Please be sure to itemize any estimates so as to indicate the total number of pages and/or records, as well as to distinguish the cost of labor and materials. All responses to this public records request should be made in writing to the following email address: ch riso h a reau Ifstrea m(a)gmaii.com TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered via e-mail April 21, 2015 Chris O'Hare [mail to: chrisoharegulfstream@gmail.com] Re: GS #673 (policeman application 2.18.14.b) All records of the application for employment submitted by the Town employee driving the police car labeled 750 (see attached photo) this morning in Place Au Soleil, removing political signs and depositing said signs in the rear seat of said car. Dear Chris O'Hare [mail to: chrisoharegulfstream@email.com], The Town of Gulf Stream has received your public records requests dated February 18, 2014. If your request was received in writing, then the requests can be found at the following links httv: / /www2.gulf- stream. ore/ WebLink8 /0 /doc /18119/Paeel.aspx. Please refer to the referenced number above with any future correspondence. Please note that pursuant to the public records laws, the duty of the Town of Gulf Stream is to provide access to or copies of public records at a reasonable time in reasonable conditions. The Town of Gulf Stream is not required to give out information from these records nor give information about these records. We consider this matter closed. Sincerely, Town Clerk, Custodian of the Records GULF STREAM POLICE DEPARTMENT E14P.LOYMENT APPLICATION 246 SEA ROAD GULF STREAM, FL. 33483 i v / j'c'L o�C Etz POSITION APPLIED FOR 1. 2. 3.HOW LONG HAVE YOU LIVED AT YOUR PRESENT ADDRESS? _ly Mvti-- 4. 5. - ROME TELfPHGIVE (AREA CODE) WORK TELEPHONE 6. - 7. P 2_410 - 4170 -62. -lye S SOCIAL SEC'11R:CTY NUMBER DRIVER LICENSE NUMEER oA. 8.MALE ( FEMALE 9.DATE OF BIRTH 9A. PLACE OF BIRTH _W C-14" _Fil//s► ticw yd,L�_ — 10.HAVE; YOU EVER HAD YOUR NAME LEGALLY CHANGED? YES _NO� 11.IF IOU RESPONDED POSITIVELY TO QUESTION ##10 INDICATE AS FOLLOWS. A. FREVIaUS NAME B. DATE AND LOCATION OF CHANGE C. F.EASON FOR CHANGE ( 2 ) 12. RAC.*VNATIONALITY WHITE BLACK _ - HISPANIC OTHER IF OTHER, PLEASE SPECIFY 13. HEIGHT -_�Q_- 14. WEIGHT Z3 O 15 . COLOR 0E' EYES _ BkowN 16. COLOR OF HAIR 17. DO YOU HAVE ANY SCARS MARKS OR TATTOOS? YES _ _ 140 IF SO, DESCRIBE EACH MARK OR TATTOO AND WHERE IT IS LOCATED ON YOUR BODY MARITAL STATUS 18. SI14GLE MARRIED �- ENGAGED SEPARATED DIVORCED 19.SPOUSE /FIANCEE *' 19A. MikIDEN NA14E OF WIFE 12%Z[ /J 6042i&7- 19B. DATE AND LOCATION OF MARRIAGE 19C. ARE YCU PRESENTLY LIVING WITH YOUR SPOUSE? YES NO IF NC, PROVIDE DETAILS ON A SEPARATE SHEET - 19D. EkVE YOU AND YOUR SPOUSE EVEYPARATED BECAUSE OF MARITA:: DIE?IC:ULTIES? YES NO :CF YES, PROVIDE DETAILS ON A SEPARATE SHEET (3) DIVORCES, ANNULMENT, WIDOWED (PREVIOUS MARITAL STATUS) 20. NA14E OE FORMER SPOUSE J4�SE/r< JOEUjj -E �'% LAST FIRST MIDDLE 20A. COMPLETE MAILING ADDRESS OF FORMER SPOUSE CITY AI4D STATE WHERE THE FORMER MARRIAGE WAS PERFORMED 20C. DATE OF FORMER MARRIAGE REASON FOR - DISSOLUTION OF THE M R GE WIDOWED ANNULLED DIVORCED " - - -- OR ANNULMENT 20D. WHO INSTITUTED SUIT? _ PeI ise lUzzey 20E. T':TLE A14D LOCATION OF COURT ISSUING IVORC OR �ANNN�UL�M�ENT (INDICATE DATE OR ANNULMENT WAS GRANTED) 20F. ARE THERE ANY CHILDREN BY THIS FORMER MARRIAGE,? YES -- NO _)< PLEASE INDICATE NUMBER 20G. ARE YOU RESPONSIBLE FOR CHILD SUPPORT PAYMENTS? YES —_ NO X IF YES, INDICATE HOW MUCH _ 20H. ARE YOU RESPONSIBLE FOR PAYING ALIMONY? YES_ _ NO 202. IF YOU ARE RESPONSIBLE FOR MAKING CHILD SUPPORT PAYMENTS OR PAYING ALIMONY, HAS LEGAL ACTION EVER BEEN TAKEN AGAINST' YOU FOR EITHER FAILING TO MAKE PAYMENT OR DELAYING PAYMENTS? YES NO - lF YES, EXPLAIN DETAILS ON SEPARATE SHEET YES NO x HAVE YOU EVER BEEN ACTION" CORRESPONDENT IN A DIVORCE CT IF YES, EXPLAIN DETAILS ON A SEPARATE SHEET 4 (4) RECORD OF PARENTHOOD 20K. LIST THE NAME, PLACE OF BIRTH, NAME OF CHILD, MOTHER OF CHILD, WHERE THE CHILD RESIDES AND WITH WHOM. EDUCATIONAL BACKGROUND 21, LIST ALL SCHOOLS AND COLLEGES YOU HAVE ATTENDED YEARS FROM -TO SCHOOL LOCATION GRADUATE? 1975- 76 w ' 'To �. i�`�) sci/a�L SAN 2w o 1976 -g �'� � �1 suh S4/JC3a�2n.� A)eV cu2K - ES 198q v:4Mes- i-���� Gc�/lll. Colle e Mrs �„ k NEw yc)a-rK 2TF`e. Ally OFFS f 0 • 'o e S c�liLC, dFF�GcRS � i 21A. WF:ILE IN ;iCHOO�,�FIERE YOU EVER SUSPENDED OR EXPELLED? YES NO �__ IF YES, EXPLAIN ON SEPARATE SHEET. **** kY : *'.t* * * * * * * * * * *Y(* * * ! * ** * *'k * ** (5) 22-CHRONOLOGICALLY LIST ALL PREVIOUS PLACES OF RESIDENCE SINCE LEAVING ELEMENTARY SCHOOL. FROM 110 MO. YR. MO. YR. ADDRESS, CITY AND STATR wwwwwwwwwwxrnw• xwwwwwwwwxwwxwwwwwwwwww�rwwwwwwwwwwwx rwwwwwwww 23.HAVE' YOU EVER CHANGED OR BEEN ASKED TO CHANGE YOUR OCCUPATION OR RESIDENCE BECAUSE OF YOUR HEALTH? YES NO IF YES, PROVIDE DETAILS ON A SEPARATE SHEET. 24.HAVE YOU EVER BEEN DECLINED FOR LIFE, ACCIDENT OR SICKNESS INSIURANCE? YES NO IF YES, ?ROVIDE DETAILS ON A SEPARATE SHEET. 25.HAVE YOU EVER RECEIVED ANY MEDICAL R ATMENT FOR A DRUG (INCLUDING ALCOHOL) HABIT? YES NO IF YES, PROVIDE DETAILS ON A SEPARATE SHEET. 26.HAVE YOU EVER USED ANY NARCOTIC' DRUG, BARBITURATES, AMPHETEMINL•'3, MARIJUANA, OR ANY HALLUCINOGENIC DRUGS? YES _ NO DISORDER? YOU EVER BEEN TREATED FOR A NERVOUS OP. MENTAL DISORDER? YI;S NO � � IF YES, IPIDICATE ON A SEPARATE SHEET (1) THE NAME OF THE PHYSICIAN, PSYC.- HIATRIST OR PSYCHOLOGIST. (2) THE ADDRESS OF THE PERSON .ADMINISTERING TREATMENT. wwww* wwwwwwt�wwwwii' wk}' yt* wwW1F: FwWwwwwwwwwwwxwwwwwwwww .wwwww•Fxk ( 6 ) 28.LIST ALL CLUBS, SOCIETIES, CIVIC OR FRATERNAL ORGANIZATIONS TO WHICH YOU ARE OR HAVE BEEN A MEMBER. NAME OI' DATE OF *ORGANIZATION *ACTIVE /NO LONGER A MEMBER ENTRY * WWWWW%'* WWkk% W' k* WYt** W***** W**** W * * * *W * * * * *W *%'%•WWWW *WWW * *k *W* MILITARY 29A. HAVE YOU EVER SERVED IN A,M�LITARY ORGANIZATION OF THE UNITED STATES? YES NO �� IF YES, GIVE PERIODS OF ACTIVE MILITARY SERVICE AND OTHER DATES REQUESTED. FROM TO BRA14CH _ SERIAL NUMBER _ RANK AT DISCHARGE TYPE OI' DISCHARGE RECEIVED REASON FOR DISCHARGE 29B. WERE YOU EVER TRIED, PUNISHED, REPRIMANDED, OR REDU'ED IN RANI: FOR ANY INFRACTION OF MILITARY RULES AND REGULATIONS:? YES NO IF YES, INDICATE ON A SEPARATE SHEET OF PAPER THE #1. DATE(S) 42. CHARGE(S) #3. TYPE OF COURT MARTIAL OR OTHER DISCIPLINARY PROCEEDINGS AND 09. THE DISPOSITION OF CHARGES. 29C. HhS YOUR DISCHARGE OR SEPARATION EVER BEEN CHANGED? YES NO IF YES INDICATE DETAILS BELOW CHANGE FROM AUTHORITY EMPLOYMENT /UNEMPLOYMENT RECORD SOCIAL SECURITY NUMBER (7) 30. LIST ALL EMPLOYMENTS, IIICLUDII4G PART -TIME EMPLOYMENT AND PE�IODS OF UNEMPLOYMENT OVER 20 DAYS. FROM -TO MO -YR NAI4E AND MAILING ADDRESS OF EMPLOYER OR UNEMPLOYMENT INDICATE POSITION REASON FOR OFFICE IJHERE YOU FILED BENEFIT HELD LEAVING /O 2 �l SA4A+%E2 SG 7T, 1W, S4,ud,2,6 A Jy, _' )F&^ cl 1 c)kin/ 6F u � S !�i N ir- . ! 37 OFE 20, /.� i3Tcv`i ,V�r / /cj(icL OFFi Z o OW (jE lsx9 8 q - y1 k) -P . -W- /C,,A -7 ,C J9 cc 13Sd , NEwPb2T c6j72 A2, a(Ll0, (/69uy CGka CJ(�Er2ATo2 ecutiT 54 ecv 2 `SAIL, /J'ftiA� EycN cal N (te Aug. Df3c��l tG - Z -I oe NAD k ,M P�ACes /�p_C or4 uw( �tO fia (IF MORE SPACE IS NEEDED, USE A SEPARATE SHEET) 6e cwAc%�O, 30A. IF' ANY OF THE EMPLOYER: YOU HAVE LISTED ARE RELATIVES, INDICATE WHICH ONES. 30B. WERE YOU EVER DISCHARGED OR FORCED TO RESIGN BE E OF MISCONDUCT, OR UNSATISFACTORY :SERVICE? YES NO IF YES, LISP THOSE EMPLOYERS WHO EITHER $1. DISCIPLINED YOU #2. DISSCHARGED YOU #3. OR REQUESTED YOU TO RESIGN EMPLOYER'S NAME IDATE NAME OF SUPERVISOR INVOLVED (It' MUEE SPACE IS NEEDED, USE A SEPARATE SHEET) (8) 30C. DO YOU OEJESJi YES NO TO YOUR PRESENT EMPLOYER BEING CONTACTED? 30D�_,, HAVE YOU EVER APPLIED F R A POSITION WITH ANY LAW NN RCEMENT AGENCY? YES NO IF YES, INDICATE ON A SEPARATE SHEET OF PAPER 41. THE POLICE DEPARTMENT TO WHICH YOU MADE APPLICATION ##2. THE DATE WHICH YOU APPLIED 43. WHETHER YOU WERE REJECTED OR ACCEPTED "44. IF REJECTED, THE REASON FOR REJECTION ,#5. IF ACCEPTED WHY YOU REFUSED EMPLOYMENT. ****** K******: t• k************• K*** * *k * ** * * ** * * * * * * * * *K * *'.r ** * *:Y 31. HAS THE LICENCE OR PERMIT (EXCLUDE DRIVER'S LICENCE OR LEARNER'S PERMIT) ISSUED BY ANY CITY, COUNTY, STATE OR FEDERAL AGENCY EVER BEEN DENIED YOU OR TO ANY CORPORA`"ION OR PARTNERSHIP OF WHICH YOU WERE AN OFFICER, DIRECTOR OR PARTNER? YES NO )_ IF YES, PROVIDE DETAILS ON A SEPARATE SHEET. 32. HAS ANY SUCH LICENSE E.T BEEN REVOKED, CANCELED, OR SUSPENDED? YES - NO 33. HAVE YOU Eyp FILED A CLAIM FOR WORKMEN'S COMPENSATION ^: YES _ NO IF YES, PROVIDE DETAILS ON A SEPARATE SHEET. 34. HAVE YOU EVER HAD ANY EXTENDED ABSENCES FROM WORK OR SCHOOL BECAUSE OF PERSONAL INJURY? YES NO i� IF YES, PROVIDE DETAILS ON SEPARATE SHEET. 34A. APPROXIMATELY HOW MANY DAYS HAVE YOU LOST FROi4 SCHOOL OR ,WORK DUE TO ILLNESS DURI14G THE PAST FIVE YEARS' ^ - 1�4E- 'rE� I eSS 35. ARE YOU NOW ON ANY ELIGIEILITY LIST? YES NO IF YES, WHERE, AND FOR WHAT POSITION? 36. HAVE YOU, YOUR SPOUSE R EX- SPOUSE EVER HAD YOUR WAGES ATTACHED? YES NO 37. DO YOU, YOUR SPOUSE, OR EX- SPOUSE HAVE ANY IMM DIATE CIVIL ACTION PENDING AGAINST YOU? YES NO 38- HAVE YOU, YOUR SPOUSE OR EX- SPOUSE EVER HAD A JUDGEMENT RENDERED AGAINST YOU? YES � NO c�: P&M /I /�y .. J � (9) 38A. HAVE YOU, YOUR SPOUSE, OR EX- SPOUSE EVER FIL17D ZF BANKRUPTCY OR BEEN DECLARED BANKRUPT? YES _ NO 39. HAVE YOU EVER BEEN REFUSED A LIFE, A OMOBILE. HEALTH OR OTHER INSURANCE POLICY? YES NO 40. HAVE YOU EVER HAD A LIFE, AUTOMOBILE, HE TH, OR OTHER INSURANCE POLICY CANCELLED? YES NO 41. HAVE YOU EVER BEEN REFUSED CREDIT? YES 42. HAVE YOU, YOUR SPOUSE, OR EX- SPOUSFy EVER HAD ANY PROPERTY REPOSSESSED? YES _ NO i� 4''3�� HEAVE YOU EVER BEEN BONDED? YES NO %�44/ IF EMPLOYED BY THIS POLICE DEPARTMENT, DO Y U ANTICIPATE I� Y INCOME OTHER THAN YOUR POLICE SALARY? YES NO _ W*' kWWWWW** r. W• k* W** WW**%%% W** W* x *WW * * *% % % * * * * * * * * * * % *x *k %x * > *% CRIMINAL AND JUVENILE RECORD 45. HAVE YOU EVER BEEN ARRESTED OR DIET INED BY ANY LAW ENFORCEMENT OFFICER? YES _ NO IF YES, INDICF.TE ON A SEPARATE SHEET #1. THE POLICE AGENCY #2• THE CHARGE #3. THE FINAL DISPOSITION 44. THE DATE #5. DETAILS 01' CANE. THIS QUESTIC.N ALSO INCLUDES THOSE INSTANCES IN WHICH YOU MAY HAVE BEEN JUDGED A JUVENILE DELINQUENT, YOUTHFUL OFFENDER, OR WAYWARD MINOR. 45A. HAVE YOU _EVER BEEN REPOR'['ED TiS A MISSING• PERt�ON? YES NO �_ IF YES, INDICATE ON A SEPARATE SHEET #1. COMPLETE DETAILSS #2. INCLUDING JURISDICTION DATES ;;3. AND FINAL DI;3POSITION. MOTOR VEHICLE OPERATOR RECORD 46. DO YOU POSSESS A VALID DRIVER'S LICENSE? YES2�-NO 46A. DRIVER'S LICENSE TYPE- CHAUFFEUR'S X-�UASS D. OPERATOR'S LICE14SE NUMBER ZLIO -4{%0 - 62Iqq:fXPIRATION DATE 0 Ll DATE OF ISSUANCE Q,S - J - (in) 46B. HAS YOUR DRIVER'S LICEN E EVER BEEN REVOKED OR SUSPENDED? YES -_ NO IF YES, INDICATE ON A SEPARATE SHEET 41. THE STATE #2. DATE AND #3. ALL DETAILS 46C. I= YES, 14AS YOU LICENSE RESTORED? YES NO IF SO, WHEN? - - -- 46D Hi�VE YOU EVER BEEN INVOLVED IN A MOTOR VEHICLE ACHDENT? YES X NO IF YES, INDICATE ON A SEPARATE; SHEET #1. THE DATE #2, LOCATION, #3. INJURIES, #4. CHARGES, #5. FINAL DISPOSITION OF ANY POLICE CHARGES OR CIVIL LIABILITY. 46E. HAVE YOU EVER BEEN REFUSED A DRIVER'S LICENCE BY ANY STATE? YES NO X 46F. IF YES, INDICATE ON A SEPARATE SHEET THE REASONS FOR THIS REFUSAL. 4�w6 HAVE YOU EVER RECEIVED A TRAFFIC CITATION - PARKING)? YES x NO IF YES. INDICATE ON A SEPARATE. SHEET #1. THE CITY, COUNTY AND STATE, 42. NAME OF AGENCY ISSUING THE CITATION, #3 DATE, #4. CHARGE AND #5. FINAL DISPOSITION. 46H. DO YOU NOW HAVE ANY UNPAID SUMMONSES OUTSTANDING AGAINST YOU FOR ANY PARKING VIOLATION? YES rip 3 / IF YES, HOW MANY AND WHERE (11) FAMILY BACKGROUND 47. LIST ALPHABETICALLY BY LASIT NAME FIRST, ALL MEMBERS OF YOUR IMMEDIATE FAMILY, SPOUSE INCLUDED AND ALL MEMBER:, OF YOUR SPOUSE'S IMMEDIATE FAMILY. IMMEDIATE FAMILY SHALL INCLUDE FATHER, STEP - FATHER, MOTHER, STEP - MOTHER, RROTHERS, SISTERS, GUARDIANS, AND /OR FOSTER PARENTS. THIS 111CLIIDES THOSE RELATIVES WHO ARE DECEASED. RELATION- SHIP NAME ADDRESS, STATE IF DECEASED OCCUPATION DATE OF BIRTH /�iQSE/E I{IJ Fq�7��2 ZI y LR '�cw file 3i/62- f} Cc)kvS`pwct• j4eAa�y C-0r A 6-(1-35 MO-771 L'2 fiASE1E ZIz-I G¢rCVrcw ��c . 1-pfI✓�NA q 6 Et�ro2., L- ' f bGse /enE� -7-1-3S IN F� ( �� lUu(ZSC Z- l3- 6c n ��-� NT I E�/ 73 WaS7 i �L 3A Mo-rNE2 J&) - I��i �Q�-rJie� i fJ law _rL' q � 4-= (3E2T1} M; f\l ix 73 we$-r PAlh • LazTIf L 33y�7 �eS T 1� � 6 33 � . S4ks cleG -IC SRI�SM 4ti 5' - N -:ZS 3 - - p P 1! M i N X 100 Z- Qg tir AijuiTIONAL SPACE IS NEEDED, USE A SEPARATE SHEET) ***' k******* rt' kY.' kk*: C******* W 'k * *kk* *rt * *�I' * * *Yt #kW'k'k * *k•k Xi[ *Y,krt kkk (12) REFERENCES 48. FILL IN BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU AND NOT FORMER EMPLOYERS, WHO HAVE KNOWN YOU FOR AT LEAST FIVE (5) YEARS. ALL PERSONS TO WHOM YOU REFER 14AY BE ASKED TO APPRAISE YOUR CHARACTER, ABILITY, EXPERIENCE, PERSONALITY AND OTHER QUALITIES. NAME _ HOME; ADDRESS / 17�L/II�cAJ� mow, __. -_ RESIDENCE PHONE � BUSINESS, C,CCU ATION OR PROFESSION -1�n YEARS KNOWN ? NAME OF FUSINESS _ CiJJ cam✓ BUSINESS ADDRESS — PHONE kj- W*#**** #' * ** * *'k * * * * *W * * *'k * *k #' # *W'k* NAME BUSINESS, OC(fUPA YEARS KNOWN BUSINESS ADDRESS HOME, ADDRESS ,RESIDENCE PH ROFESSION C OF BUSINESS k*X -, p213 AME �� d1;oe HOME ADDRESS _ RESIDENCE HON iC BUSINESS, CICCI P/ATION OR PROFESSION !S� YEARS KNOWN J � NAME OF BUSINESS BUSINESS AI)DRGSS - —PHONE ACQUAINTANCES 49. FILL IN BELOW THE NAME OF TWO PERSONS NOT RELATED TO YOU, AND NOT FORMER EMPLOYERS OR REFERENCES WHO ARE FRIENDS, FELLOW STUDENTS, OR FELLOW WORKERS, NAMES LISTED SHOULD EE THOSE OF PERSONS WHO HAVE SEEN YOU FREQUENTLY DURING THE PAST YEAR. NAME .PL._�p CpNE�j ADDRE "S kz RESIDENCE FH0I4E - Ub wU - - -- - - - - -• USINESS, OCC'UPA'PION OR PROFESSION -% BUSINESS ADDRESS L -- fz -- - -- ac clrc�le yE p' *:k WSW * * * * /jy#:�k NRME� % ADDRESS _i AL{%?L ._cl RESIDENCE F'HOdE ( —j� _ BUSINESS, OCCUPATION OR 33yaE PROFESSION BUSINESS ADDRESS �� tC � C;W, Ti,�fi41Tr �- - 3 q — 49A. IN WHAT CAPACITY ARE THE ABOVE ACQUAINTANCES KNOWN TO YOU? -- _lsLiS CEO FAJli - -- (I3) POLYGRAPH EXAMIINATION 50. ARE YOU WILLING TO TAKE A POLYGRAPH EXAMINATION TO VERIFY ALL INFORMATION SUPPLIED IN THIS APPLICATION AND ALL OTHE» ]' FORHATION SUPPLIED BY YOU TO THIS DEPARTMENT? YES NO IF NO, STATE; YOUR REASON(S) I AFFIRM THAT THIS APPLICATION CONTAINS NO MISREPRESENT- ATIONS OR FALSIFICATIONS, OMISSIONS, OR CONCEALMENT OF' MATERIEL FA:' ^.', AND THAT INFORMATION GIVEN BY ME IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. 1 AM AWARE THAT S7'ATEId31I7S MADE BY ME ON THIS APPLICATION ARE SUE JECT TO LATER IIJJESTIGATION. I AM FURTHER AWARE THAT SHOULD ANY INVESTIGATION DISCLOSE ANY SUCH MISREPRESENTATION, FALSIFICATION, OMISSION OR CONCEALMENT OF MATERIAL FACT, MY APPLICATION MAY BE REJECTED AND MY NAME REMOVED FR'iM THE ELIGIBLE LISTS. IF ALREADY APPOINTED, I MAY BE DIr';MISSED. 9GL S ATURE APPLICAN STATE CF FLORIDA CITY /CCU TY q SWOIj TO I FORE ME THIS �3 DAY OF ��lQ� A.D., lg huraar Yl "G1C .1 L: ,.L�� kls -soy-b-5 'C S11"I 7 F10iitRd: N E37 JfP y 4, 114 teasµ tRA, Ui3., (14) FORMS WHICH MUST ACC- 014PANY THIS POLICE APPLICATION 1. BIRTH CERTIFICATE 2. COPY OF HIGH SCHOOL DIPLOMA OR _z EQUIVALENCY CERTIFICATE (CED GRADE !;['ORES NOT ACCEPTABLE) 3. COPY 017 DD214, IF APPLICABLE 4. COPY OF CURRENT DRIVER'S LICENSE 5. COPY OF SOCIAL SECURITY CARD p IF CERj'IFIED POLICE OFFICER, COPY 01' CERTIFICATE AND PPOOF OF MANDATORY RETRAINING (IF APPLICABLE). PLEASE CHECK OFF THE FORMS ATTACHED, INDICATE N/A IF NOT APPLICABLE IN YOUR CASE. OTHER FORM: A'T'TACHED HERETO -- COLLEGE DEGREES, CERTIFICATES, ETC. PLEASE LIS`1' PkASC See R.Csomc , IF YOU DO NOT HAVE THE ABOVE TZEQUIRED FORMS ATTACHED, PLEASE LIST WHE14 VIE CAN EXPECT TO HAVE THEM IN. Plclas 8c- Aou;seo , : 6cjlw4e--lk) roe oe"Ft"0,4�- GXIP�5eS 4T Ph(M /3EAGW 6'r Pzcp -rCA J G�27i F�`� i .� /�S2 %!iA % GoC�rZS� di•J 713c>192'-, /}S SO��% �S I o�7Ai%J !/ate CQ2Ti F 'c/17�5. ��rJ 40/ Police De t. x`30 D Dept. Date Disposition lantana 6191 ;pplication on file. I,antana 6111192 pplication on file, attended oral board interview on 7/2/92. Still ��% iting notifica- tion as to eligibility. alantis 6191 pplication on file. it Ialce Clark Shores 6/91 =:pplicatior_ on file. Re. IT Springs 6191 application on file. Royal Palm Death 6191 .pplication on file. Traffic accidents. 1 46 D Date aprox. 12/87 ! ?inor accident, no injuries; no police or civil action. ( Fender bender ,Insurance claim aprox.*500.00 ) Date ,i prop_ . 1978 Traffic Tickets 146 G Mazara Falls N.Y., Issued by ?.Y. State Police. Speeding 69- 557.P.H. zone on �vN state thruway Disposition - Drivin. school E_ ,,x,20.00 fine. Amended TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered via e-mail June 7, 2015 Chris O'Hare [mail to: chrisoharegulfstream @gmail.com], Re: GS #673 (policeman application 2.18.14.b) All records of the application for employment submitted by the Town employee driving the police car labeled 750 (see attached photo) this morning in Place Au Soleil, removing political signs and depositing said signs in the rear seat ofsaid car. Dear Chris O'Hare [mail to: chrisohareeulfstream agrnail.coml, The Town of Gulf Stream received your public records requests on February 18, 2014. You should be able to view your original requests at the following link htty://www2.gulf- stream.ore/weblink/0 /doc /18119 /Pagel.aVx. In future correspondence, please refer to this public records request by the above referenced numbers. The responsive document can be found at the same above link. We consider this matter closed. Sincerely, Town Clerk, Custodian of the Records CORRECTED RESPONSIVE PAGES TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered via e-mail June 22, 2015 Chris O'Hare [mail to: chrisoharegulfstream @gmail.com] Re: GS #673 (policeman application 2.18.14.b) All records of the application for employment submitted by the Town employee driving the police car labeled 750 (see attached photo) this morning in Place Au Soleil, removing political signs and depositing said signs in the rear seat ofsaid car. Dear Chris O'Hare [mail to: chrisoharegulfstream (a wnail.coml, The Town of Gulf Stream received your public records requests on February 18, 2014. You should be able to view your original requests at the following link http://www2.gulf- stream.ore/weblink/0 /doc /18119 /Paeel.aWxx. In future correspondence, please refer to this public records request by the above referenced numbers. The same responsive documents can be found at the same above link. We consider this matter closed. Sincerely, Town Clerk, Custodian of the Records