DEPARTMENT OF CORRECT: NS PERSONNEL FI ae CONFIDENTIAL FILE CHECK-LIST vn Oya — Me "his fori does not reflect a filing format or sequence: for additional information’ instructions regarding personnel files/mediesl ‘confidential files refer to Procedure #208.012, Social Security # PERSONNEL FILE SECTION! —_+Feranal Action Reqzst ee Widder Cina dons en earner = eats Bacon ent teete SRTION | _pechcancs Apr wd bid senor Cree Se Lili ices SECTION I HesltiCne Selecta Poo dcrionm Acceptance/Refusal ___ State Life — Acceptance __ Physical Examination documents o! and information reflecting medical DC Group Life — Acceptance status —_ Pre-Tax Premium Waiver ‘Trauma Debriefing Participation ‘Mise Deduction Authorization Forms Information py of W-4 Form Family Medical Leave Act documents Copy of Social Security Card Physician's statements __ SMSISES Group Disability-Acceptance/Refusal ___DC Group Disability Insurance-Acceptance Beneficiary Designation Form, BEN-001 (Optional) ___Pre-Tax Benefits Acknowledgment Form __ Request for Conversion of Annual Leave (DC2-682) ___ Flexible Work Schedule Request (DC2-655) SECTIONIV Employment Application Resume, including SECTION IV Supplemental Application, Willingness __ American with Dsailties Request westionare and Reference Check west for Accommodation Exployment Eligibility Verifiation (49) Release form AGN for employes hie ater 1/880) __ Miscellaneous medical documents ip or Ras, Proved. & Pol(DC2-8108) es of Appointment “W sleeve Service Regisuation Form Workforce Reduction Documentation SECTION VY —__Fingerprim Card epee opps) ILE/CISTC Documentation oe aling Documents for Health Services [Profesional Liens and al ote lense() information Pplicant Release of Information (DC2-607), if applicable SECTION VI___Use of Force Reports (DC2-802) (If Notice of Injury Form is attached, file in Medical Confidential file) __ Copy of all Disciplinary Actions ‘Charges of Discrimination (EEOC form) anc! letters of Determination Byvab~ Coimpleted by Sérvicing Personnel Staif Member Opie Date “Uf applicable. REVERSE SIDE OF THIS FORM TO BE COMPLETED ONLY FOR THE CERTIFIED OFFICER, 1BC2-452 (Revised 11-00)x EMPLOYEE ACKNOWLEDGEMENT ~ SIGNED oe NEW EMPLOYEE INSURANCE ACKNOWLEDGEMENT ~ SIGNED o~ PERSONNEL FILE/MEDICAL CONFIDENTIAL FILE CHECKLIST a DIRECT DEPOSIT AUTHORIZATION ~ SIGNED, VOIDED CHECK PROVIDED (ONLY IF SIGNING UP TODAY) aa W-4— SIGNED. EMPLOYMENT ELIGIBILITY VERIFICATION ~ SIGNED OATH OF LOYALTY ~ SIGNED a RECEIPT FOR RULES, PROCEDURES, OR POLICIES - SIGNED ~~ DRIVER'S LICENSE REQUIREMENT AND MANDATORY SAFETY RESTRAINT USE ~ SIGNED ~~" ACKNOWLEDGEMENT OF RESPONSIBILITY TO MAINTAIN CONFIDENTIALITY OF MEDICAL INFORMATION ~ SIGNED we MEDICAL CONFIDENTIAL FILE STANDARD RELEASE ~ SIGNED ESSENTIAL STAFF FAMILY EMERGENCY PREPAREDNESS PLAN SIGNED @/_ OATH OF ALLEGIANCE/CODE OF CONDUCT - SIGNED OMNIBUS/DOMESTIC VIOLENCE FORM (NON-CORRECTIONAL OFFICERS ONLY) ~ SIGNED CERTIFIED OFFICER TRAINEE RELEASE OF INFORMATION (NON- CERTIFIED CORRECTIONAL OFFICERS ONLY) - SIGNED ON NAME; SIGNATURE: ssFLORIDA DEPARTMENT OF CORRECTIONS Oath of Allegiance: do solemnly swear or affirm that | will uphold the Constitutions of the United States and the State of Florida, that | will obey the lawful orders of those appointed over me, and that | will perform my duties faithfully and in accordance with my mission to ensure the public safety, the support and protection of my co-workers, and the care and supervision of those in my charge, so help me God, "In the Oath of Allegiance, employees may strike through the phrase "so help me God" when the employee affirms rather than swears Code of Conduct: |. Lwill never forget that | am a public official sworn to uphold the Constitutions of the United States and the State of Florida, ll. | am a professional committed to the public safety, the support and protection of my fellow officers, and co-workers, and the supervision and care of those in my charge. | am prepared to go in harm’s way in fulfillment of these missions, Il. As a professional, | am skilled in the performance of my duties and governed by a code of ethics that demands integrity in word and deed, fidelity to the lawful orders of those appointed over me, and, above all, allegiance to my oath of office and the laws that govern our nation, IV. | will seek neither personal favor nor advantage in the performance of my duties. | will reat all with whom | come in contact with civility and respect. | will lead by example and conduct myself in a disciplined manner at all times. V. Lam proud to selflessly serve my fellow citizens as a member of the Florida Department of Corrections. Omor_Mateen en Aide Employee's Printed Name Employee's Signature \o\3olQ ~ Date NII-075 (5/06)DEPARTMENT OF CORRECTIONS Medical Confidential File Standard Release EMPLOYEE'S PRINTED NAME: Om Cr (\ \eheon SOCIAL SECURITY NUMBER hm! I understand the Americans with Disabilities Act (ADA) provides that medical-related information shall be kept confidential except the following may be provided without my consent: 1. Supervisors and managers may be informed about necessary restrictions on my work or duties and necessary accommodations; 2. First aid and safety personnel may be informed, when appropriate, if I have a disability that might require emergency treatment or if any specific procedures are needed in the case of fire or other evacuations; 3. Government officials investigating compliance with the ADA and other federal and state laws prohibiting discrimination on the basis of a disability or handicap may be provided relevant information upon request; and 4, Relevant information may be provided to state and federal agencies and persons baving the legal authority to obtain such information. No other disclosure of medical information from my file will be made without my written consent, OC \9 EMPLOYEE'S SIGNATURE DATE NOTE: In the event you refuse to sign this form, you must note “refused to sign” and the date of your refusal on the applicable signature line and return the form to your personnel office immediately. FORM TO BE FILED IN EMPLOYEE’S MEDICAL CONFIDENTIAL FILEoMs 0, Li s.0136 ity Verification Employment Please read instructions carefully before completing this form. The Instructions must be available during completion of this form, ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible individuals. Employers CANNOT specify which document(s) they will accept from an employee, The refusal to hire an individual because of a future expiration date may also constitute illegal discrimination. ‘Section 1, Employee Information and Verification, To be completes end agres by employee "Hada ome completion of this for; Alien # or Admission #) — Enea Seratte — 4 | basa Franiveayheay | > alz7] ec Preparer and/or Translator Certification. (To be campated and gre ¥ Section 1 prapared by @perzon lather than the employee) attest, under pansy of perry, that have assisted i te compation cf this form ance tthe bast of my knovelad th Information stra and corer Prepwe?a/Traraator's Signeture ] Pri Tame Ravens (iret Ni Date Gronthvanylyea) Section 2. Employer Review and Verification. To be complatas and signee by enplayer Examine ane Gocumen fom st AOR ‘xamine ore document for List Bard one fom List C, a2 ted onthe reverse ofthis frm, and resord tne te, numba tnd eepation dat, ary, of the samen TRA OR Tse8 AND Tae cocumen Drivers ‘ieense Social Securit Cerd came a , fle OS Explation Dace (any: —!—!— Expication Date (any) __1__j__ ‘CERTIFICATION - | attest, under penalty of perlury, that | have examined the document) presented by the abovewnamed employee, that the above-listed document(s) appear to be genuine and to relate to the employee nemed, that the ployee began employment on. (montnésy/yeer) 10/3 O© and that 10 te best of my Koowhedge the amployee cme is eighle to work in the United States. (State employment agencies may emi the date the employee Dogan smplyment)| Ce a Te n ce PSS ete imanenvanyiven) Lolarlow Arass (Street Name anc Number, Cy. Ste, Zp Cece) Laueieirciala, FL 33309 ‘Business or Orgenzation Nathe 5610 NW 9th Avenue, Ft. ‘Section 3. Updating and Reverification. To be campisted and signed by empayer ‘A New Name i anpieesi) Data of rare (manthayiyear) UF apaiebie) “Ge apgegen savor at WN Gaon Is WSFOE BAT Wd HFSTGOIN HBF BT UT BORDON Euro POE cea oecman Ts Ta andar ay of pen tht se ba of ny roa, apo sccumntsh the samen hate examined peer iota gona te ve wi el Signature of Employer or Authorized Representative Ra GTN Pg Decument # Exptation Date (rang): _/__ ‘igiie to work othe United States, and W Uw employes peenied 7 [Date tontouo os DY OP ep: Gy v Ea Ps —~£ | wal BER HAS BEENTRANSMISSION TINE Ra. ANAM DURATION FASE RESULT MODE Pigase eave this er2a hank STATE OF FLORIDA Direct Deposit AUTHORIZATION Tom Gallagher, Chief Financial Officer a LEASE TYPE OR PRINT CLEARLY ( Yaurgocr secur ariber Lest Wame (@) Change @) Stop. (4) Narye Change Oni... (Retiree Employee ‘Action Requested (Cheek Ony One) ‘ie yous slate empoyse, tetime or bath? IFICATION REPCRT 2 10/39/2006 10: Pe 19:29 DePasrr PLEASE READ AND CAREFULLY FOLLOW INSTRUCTIONS! For a Start or Change all boxes must be completed; ‘do not leave information blank! "his form will start, change, oF stop divest deposit forall | payments received by you from the State of Florida. You may Hot have direct deposit to more than ono aceount at one time. ast | ' Name: Please be sure your last name on this form matches | name on your W-¢ on file with your personnel office. Your direct | 1p rtser'f tet same batch yeu sh ‘etrinmsunegngou Me you ako mo sang sane 1a spot uma) fxs ogy ofan, reve! Wale 1 fame elo nak fe ge {Direct Deposit Action Requested: Phen Star yu one cre epost an wish 12 Chex Sahai you hve det epost and wih o tange 12 Str lions yar acer er = 1 type (Checking or Sevings). Your current direct deposit is 1 stopped when a change request is received. While the change is {being processed, you wil be paid by warrant (check). ' 3. Cheek Btop sfyou wish to stop your direct deposit. Stops are proceed the day they are received 114. Check Name Change Only if you are 1° Jame to cerrapondf your W-s, Complte th fp potion of anging only yo ' ' 1 ' ' i { \ heerm and apnand de ' | account Number: lage make sore the acountmumbe ten Vets fm sores. ityoure nt so, PLEASE CONTACT | {YOUR FINANCIAL INSTITUTION i ' Transit Routing Number: This is the nine-di 1 ‘identifies your fiaancialinstiution (Benk, Savings and Lom or | ' ' ' ' ' ' ' ! ' ' ' ' ' ' Credit Union). It is found in the bottom left-hand comer of your "penn neck s AGREEMENT Thereby authorize and request the State of Florida to initiate credit entries and, Fnezessary, a debit entry in accordance with NACHA rules reversing a credit entry mads in ero, to my : ' ' 1 Secount othe fencal nation named Ths dies: depos st 1 femal in eet ntl than by) mein wring wh ' 1 1 sufficient notice o the State to allow adequate time to effect ternination; (b) my death of legal incapacity; () the finan institation or (d) the State of Florida. It will purge approxima ement payment. It will six (6) months after my last wage or retSTATE OF FLORIDA DiREcT DEPosiT AUTHORIZATION Tom Gallagher, Chief Financial Officer PLEASE TYPE OR PRINT CLEARLY Your Socal Security Nuriber Feephone (Work, cel 6c) (9) Start (2) Change. 9) Stop (4) Name Change Oniy () Retree (2) Employes. (@) Bon (1) Checking Savings. iat leave unused spaces blank Direct ‘tion Requestes {Check Only One) Ou a state employes, retiree or beth? (Chock One ‘Account Tipe (Check Oniy Ore) Your Acsoun Nurber of Vous nancial nation pana ( Washiaaton Mata | Telephone numberof Your Francial sttuton Cu) Dale PLEASE READ AND CAREFULLY FOLLOW INSTRUCTIONS! Fora Start or Change all boxes must be completed; do not leave information blank! | This form wil start, change, or stop direct deposit for all ts received by you from the State of Florida, Y¢ paym {not have direct deposit to mare than one account at one time, ' Name: Please be sure your last name on this form matches the last 4 name on your W-4on file with your personne office. Your sir deposit wil not star ifthe last names do not match, IF you change your lastname on your W-4, you also must change your lastname fl { direct deposit. You may fax a copy of signed, revised W-4 tothe { number below to make the change | Direct Deposit Action Requested: Check Start if you don'thave direct deposit and wish to. Check Change if you have diret deposit and wish o change {your financial insttstion of just your account number or account! ‘ype (Checking or Savings). Your current cirect deposit is stopped when a change request i received, While tne change is being processed, you will be paid by warrant (check). ‘Check Stop if you wish to stop your direct deposit. Stops are processed the day they are received. Check Name Change Only if you are changing only your rate wo corespond to your W-4, Complete he op portion of 4 the fom and sigh and date i { Account Number: Please make sure the assount number writen {on his form is somect. if you rent sure, PLEASE CONTAC? YOUR FINANCIAL INSTITUTION ' Transit Routing Number: This is the nine-digit number that | identifies your financial institution (Bank, Savings and Loan or ' Credit Union}. It is found in the bottom left-hand comer of your ¥ personal chek 1 AGREEMENT Thereby authorize and request the State of Florida to inte Credit ties and, necessary, a debit en in aoordance with 1 1 1 NACHA rules reversing a credit entry made in eror, to my account atthe financial instirution named. This direct deposit is to 1 1 ' 1 ' i remain in effect until withdrawn by: (a) me in writing with sufficient notice tothe State to allow adequate time to effect termination; (6) my desth or legal incapacity; () the fina institution or (é) the State of Florida. It will purge approximate six (6) months afler my last wage or retirement payment. It will remain in effect if start receiving FRS benefits within 6 months | of the final wage payment 1 Special Note: Please make sure your direct deposit has stopped 1 before closing your account. Otherwise, the funds will be retumed to | I the state and cause a seven to ten day delay before you receive your 1 1 retirement payment in the mail 1 | To find out the status of your direct depositor the amount of the 1 1 deposit, please call our automated response system at (850) 413-72621 Forms with deposit slips attached will be rejected; the banking codes are not correct. Tape a voided personal check here for verification. savings account, please verify accout formation with your financial institution, 1 1 ' 1 1 ' 1 1 co — a [ae | This FORM MUST BE SIGNED AND DATED BY PAYEE Slgratue above eignfes acceptance of he terns and conditions in AGREEMENT to the right. State employees may view salary payments and expense reimbursements at https:/ffiair.dbf.state.fl.us (850) 410.9376 Direct Deposit Section SunCom 210-9376 | Department of Financial Services Ifyou fax your form, retain | 101 E. Gaines St, Room 414 riginal, do not mail it. | _ Tallahassee, FL 32399-0354 [Telephone (850) 410-9466, SunCom 210-9466 Please allow 3t0 4 weeks for your direct deposit to begin. DFS-AA2ES, Rev, Oct:2001 1 ' | FAX to: ‘Or mail to: ]OATH OF LOYALTY 1_OMaC Mott acitizntesiden of the State of Florida and of it fic the United States of America, and being employed by or an officer of the Department of Corrections and a recipient of public funds as such employee, do hereby solemnly swear of affirm that I will support the Constitution of the United States and of the State of Florida, Signature State of Florida County of _yeSso ‘The fore going instrument was acknowledged before me this_O71*> day of Our Woeby_ Omer Motton ‘who has produced De as identification and who did take an oath. an ‘Notary Public eae Anars\ an (WD wwanes rint Notary Public Name Volog My Commission Expires:STATE OF FLORIDA DEPARTMENT OF CORRECTIONS CERTIFIED OFFICER TRAINEE RELEASE OF INFORMATION ATTENTION: CISTC Certification Examination Florida Department of Law Enforcement Division of Criminal Justice Standards and Training Post Office Box 1489 Tallahassee, Florida 32302-1489 te ae EVV _ request my EDLE Officer Certification Examintifon rests be released to my employer, the Depertment of Corrections, Please mail my examination results to: Department of Corrections Servicing Personnel Office A copy of this form shall be considered as an original. Ce _jolza|a Sigkatare Diste STATE OF FLORIDA, COUNTY OF seSoko The foregoing instrument was acknowledged before me this NSFW’ Gate) by Onur Mecteend who is personally known to me ot who has produced (type of identification) as identification and who did (did not) take an oath Notary's Signeture Nun \ yn dwing me Notary'sName — &, PK Notary's Title ot Rank DDYIS 7B Serial Number, ifany DC2-846 (Revised 9-00)STATE OF FLORIDA DEPARTMENT OF CORRECTIONS ESSENTIAL STAFF FAMILY EMERGENCY PREPAREDNESS PLAN ‘The next time that a disaster strikes the State of Florida, you will have two areas of responsibility. The first is to ensure that your family is safe and is able to effectively deal with the emergency. The next is your responsibility to the Department If your position is of such a critical nature that you are needed to prepare and implement the Department's disaster response you will be required to report to work at your scheduled shift. You may be required to report to work on your days off or even come in and work other shifts and perform other duties as required, If you have special circumstances that you believe may cause difficulty with your compliance with these requirements, you must notify the Department. ONCE YOU HAVE REVIEWED THE STATE OF FLORIDA ~ FAMILY PREPAREDNESS GUIDE AND EVALUATED YOUR FAMILY’S NEEDS, REVIEW AND CHECK ONE OF THE FOLLOWING STATEMENTS: T understand that I am required to report for duty in the event of a disaster. I have analyzed my family situation and have prepared a plan of action to meet my family’s needs in the event 6f my absence due to duty requirements. (1 understand that I am required to report for duty in the event of a disaster. I have analyzed my family situation and have identified a need for special care that I have not been able to resolve should I be required to report for duty. I request an appointment to discuss this matter with my Director/Warden/Circuit Administrator (or designee). sential Stal) ae essen 2h on A Rn eee [J Tunderstand that even though I am not essential staff I have completed a personal preparedness plan. I understand that if my circumstances change, I shall to provide an updated Essential Family Emergency Preparedness. Plan. Form to. my Director/Warden/Circuit Administrator/Deputy Circuit Administrator (or designee). Name(prin’): \ ee * Tithe: CD com = ‘DC6-2026 (Revised 10/04)ACKNOWLEDGMENT OF RESPONSIBILITY TO MAINTAIN CONFIDENTIALITY OF MEDICAL INFORMATION By virtue of your employment or volunteer capacity with the Florida Department of Corrections, you may need to know and, therefore, may be informed of certain medical/mental health information pertaining to individual inmates necessary to perform your assigned duties and/or to classify and transfer inmates to faciliies appropriate for delivery of the required health care services for diagnosed medicalimental health conditions. State law, and in some instances, federal law, mandates that medical/mental health information be kept confidential unless specific written authorization is given by the patient or unless compelled by court order or subpoena when certain conditions are met for release of the medica/mental health information. By signing this form, you acknowledge that you must maintain as confidential all medical/mental health information regarding any inmate which you obtain in conjunction with your duties and responsipliities and you further acknowledge that you may not disseminate this medical/mental health information to or discuss the medical/mental health condition of an inmate with any person except those persons directly necessary to the performance of your duties and responsibilities. If you have been designated as a member of the department's Healthcare Transfer Team, you may not disseminate inmate medical information to or discuss the medical condition of an inmate with any person except other members of the Healthcare Transfer Team, medical staff, upper level management at the institutional/facility level, regional level, and cantral office level, or department attomeys. The dissemination or discussion of inmate medical information with the team members or persons enumerated herein shall only be to the extent necessary for the provision of health care to the inmate; the health and safety of others; law enforcement purposes; the administration and maintenance of safety, security and good order of the institution; and other purposes as authorized by law. Breach of this confidentiality may result in monetary liability and/or civil or criminal penalties imposed by law, and shall subject you to discipline, up to and including dismissal, for violation of department rules. & 7 Lid Cer Make A ‘Sighature of Employde/Volunteer Employee’s/Volunteer’s Printed Name Ole Date Social Security Number DC2-813 (Revised 2/06)Department of Corrections DRIVER'S LICENSE REQUIREMENT AND. MANDATORY SAFETY RESTRAINT USE L understand that when acting as a passenger or operator of a state-owned, leased, or privately-owned vehicle in the official conduct of state business, failure to use seat belts or occupant restraint systems shall be considered improper use of such vehicle. Failure to use safety equipment may result in disciplinary action as outlined in Department of Corrections Rule 33-208 and/or possible reduction in worker's compensation benefits in accordance with Florida Statutes 440.09(5). J understand a valid driver's license is required in order to operate a department- owned vehicle, or to operate my personal vehicle for department business, I further understand that operation of a department-owned vehicle or operation of my personal vehicle for department business without possession of a valid driver's license may result in disciplinary action as outlined in Department of Corrections Rule 33-208 and/or civil or criminal penalties in accordance with Chapter 322, Florida Statutes. LUNDERSTAND THAT THIS IS A DEPARTMENT POLICY, AND IDO AGREE TO COMPLY, CG We —lo\t1 | ee Employee's Signature Date Social Security Number DC2-8I (Revised 8-01)FLORIDA DEPARTMENT OF CORRECTIONS Oath of Allegiance: | do solemnly swear or affirm that | will uphold the Constitutions of the United States and the State of Florida, that | will obey the lawful orders of those appointed over me, and that | will perform my duties faithfully and in accordance with my mission to ensure the public safety, the support and protection of my co-workers, and the care and supervision of those in my charge, so help me God. “In the Oath of Allegiance, employees may strike through the phrase ‘so help me God” when the employee affirms rather than swears, Code of Conduct: |. will never forget that | am a public official sworn to uphold the Constitutions of the United States and the State of Florida I, Lam a professional committed to the public safety, the support and protection of my fellow officers, and co-workers, and the supervision and care of those in my charge. | am prepared to go in harm’s way in fulfilment of these missions. lll, As @ professional, | am skilled in the performance of my duties and governed by a code of ethics that demands integrity in word and deed, fidelity to the lawful orders of those appointed over me, and, above all, allegiance to my oath of office and the laws that govern aur nation, IV. Iwill seek neither personal favor nor advantage in the performance of my duties, | will treat all with whom | come in contact with civility and respect. | will lead by example and conduct myself in a disciplined manner at all times. V. 1am proud to selflessly serve my fellow citizens as a member of the Florida Department of Corrections. Oynar [dee @ Te Employee's Printed Name Employee's Signature ai etDepartmem of Corrections RECEIPT FOR RULES, PROCEDURES, OR POLICIES, NEW EMPLOYEE, 1) hereby acknowledge that today I have been furnished a copy of the rules, procedures, or policies of the Department of Coztections as indicated below. 2) Tunderstand that Iam responsible for immediately reading and complying with the rules, procedures. or policies. 3) understand that I am responsible for reading and becoming familiar with Chapter 33, Rules of the Florida Department of Corrections, prior to assuming the duties of my position. A copy of the Rules is available for loan at each department institotion, service center, all community facilities, and probation and parole offices. ‘They can also be found on the Department's Intemet site at: http://www de.statefl.ushighlite.himl. It is also my responsibility to maintain familiarity with Chapter 33, Rules of the Florida Department of Corrections, 4) T understand that it is my responsibility to obtain clarification from the servicing personnel officer or my supervisor regarding any part of these rules, and any other rule, policy, directive, or instruction which is not clear to me. 5) understand that itis my responsibility to read and become familiar with all revised rules, policies, or procedures below and newly developed rules, policies, or procedures that are maintained through the department's Intranet site at; htp:deweby. (X) Mission Statement €X) Chapter 33-208, Personnel, Rules of the Department of Corrections (X) Driver License Requirement and Mandstory Safety Restraint Use Form DC2-811 (X) Hostage Statement (X)Stafi/lnmate/Offender Relationships Statement (X) Weapons on Institution Property Statement ©) Use of Force in the Workplace Statement (X) Acknowledgment of Responsibility to Maintain Confidentiality of Medical Information Form DC2-813 (X)—_Anti-Harassment Statement and the pamphlet “Sexual Harassment, Your Rights and Responsibilities” ©) Department of Corrections Equal Employment Opportunity (EEO) Statement (%)__Domestie Violence Procedure (Excluding Appendices) (® Drug-Free Workplace Statement of Random Drug Testing Requirements for Employees (X) Medical Confidential File Standard Release Form DC2-812 X)—_ LD. Card and Procedure 604.002, Employee Identification Cards X)— Security Awareness Pamphlet (X) Dual Employment and Compensation Guideline (60L-32.003) X) Procedure 208.013 Outside Employment (X) _Employce Relationships with Regulated Entities (601 36,003) (X) Post Trauma Staff Support Program Brochure ©) Employee Assistance Program Brochure ©) Onmnibus Consolidated Appropriations Act Of 1997A fidavit fs Bamaie antes bust Sets ecouuimeaconee €}. Chyter3300 Patron sa unl onde Rese ne Deparment of Caneons 6 Florida Statute 943, Tuition Reimbursement Agreement Pp Garber an Rumsey iforate Sea as 04 Conmercl Diver cone Dag & Ale Teng Prog Practae £ sete Wa ner Soplons Shoal Eeoy hee troy Koes ©) Pampuce Wha Every Eup Shoal sow About Alctol Rise tt feet £} Deccan Oates hacativastrcudastenics Omer Neceen Q_ Ue Ethos amend imine telly Social Security Number Date DC2-810B (Revised 4/06)