Requesting Secondary Employer (Name)

Polk County Sheriff’s Office

Application for Extra-Duty Detail/Secondary Employment As provided for in Florida Statute 30.2905 Requesting Secondary Employer (Name): Street Address: City: State: Zip: Contact Person: Telephone #: ( ) - or ( ) - Date(s) Needed: to Time(s) Needed: to E-mail Address: Fax: Number of Deputies Requested Total Hours Requested for all Deputies for Extra-Duty Detail: Does the extra-duty detail require the use of an agency vehicle? Yes No

Note: Extra-Duty Detail/Secondary Employment contracts for large public events must provide for a sufficient number of deputies to ensure safe and efficient coverage. The need for six (6) or more deputies requires the employment of an off-duty deputy of supervisory rank.

1. One (1) sergeant shall be required for each assignment requiring six (6) to ten (10) deputies. 2. Two (2) sergeants shall be required for groups of eleven (11) to twenty (20) deputies. 3. Three (3) sergeants shall be required for groups of twenty-one (21) to thirty (30) deputies. 4. One (1) lieutenant shall be required whenever an extra-duty detail requires two (2) to five (5) sergeants. 5. One (1) captain shall be required whenever an extra-duty detail requires two (2) or more lieutenants.

Rate of Payment: Lieutenant $34.00 per hour, per Lieutenant Sergeant $32.00 per hour, per Sergeant Deputy $30.00 per hour, per Deputy

Administration Fee: $2.00 per hour, per Deputy

Fuel Surcharge Fee : $2.00 per hour, per Deputy (Fuel Surcharge Fee is for any Extra-Duty Detail requiring the use of an agency vehicle.)

Location of extra-duty detail:

Nature of extra-duty detail and duties: Special directions, notations, and/or additional information:

PCSO FORM 109 (REV 12/13/16) Page 1 of 2 Polk County Sheriff’s Office

Application for Extra-Duty Detail/Secondary Employment As provided for in Florida Statute 30.2905

Notice to Customers

The extra-duty employment deputies are at all times subject to the policies, rules and regulations governing employees of the Polk County Sheriff’s Office (PCSO). A customer has no authority over PCSO personnel and is restricted to providing only a general assignment of duties to be performed by the extra-duty employment deputy. Those rules never supersede PCSO policy or procedures and employers of the extra-duty employment deputies should be so advised. Extra-duty employment deputies remain under the exclusive control of the PCSO and are accountable for strict adherence to PCSO rules and regulations. Any conflicting rules of employers of extra-duty employment deputies will be disregarded. The extra-duty employment deputy shall refuse to perform any duties deemed to be in conflict with the guidelines established by the PCSO. As determined by the PCSO, extra-duty employment deputies may be recalled to on-duty status at any time for emergency operations.

The Polk County Sheriff’s Office is not obligated to provide extra-duty employment services.

The Polk County Sheriff’s Office extra-duty employment deputies are not permitted to receive cash from customers for any reason.

The Polk County Sheriff's Office reserves the right to require a minimum number of extra-duty employment deputies for assignment to certain extra-duty details.

There shall be a minimum assessment of four (4) hours on all assignments requiring less than that amount of time.

Customers who wish to cancel an extra-duty employment request are required to give a minimum of twenty-four (24) hours’ notification of cancellation to the Extra Duty Coordinator during normal business hours. Customers failing to give the required notification of cancellation of the extra-duty employment deputy shall be charged a minimum of four (4) hours at the standard hourly rate.

The undersigned customer agrees, individually and on behalf of the named applicant, to promptly pay for the extra- duty employment services rendered. Further, the undersigned agrees, individually and on behalf of the named applicant to pay all costs, expenses and attorney fees incurred in the collection on any sums due hereunder.

Payment is due within two (2) weeks of services rendered. Please make two (2) separate checks; one payable to the individual extra-duty employment deputy and a separate check for administration/vehicle fuel surcharge fees, payable to the Polk County Sheriff’s Office. Checks are to be mailed to the listed address:

All checks shall be mailed to: Polk County Sheriff’s Office Attn: Special Operations Division/Extra-Duty Employment 1891 Jim Keene Blvd. Winter Haven, FL 33880

[email protected] Telephone: (863) 298-6231 Fax: (863) 298-6420

I have read and understand the Extra-Duty Employment conditions and Notice to Customers.

Signature (Customer – Individually and as Authorized Representative) Date

Reviewed by: (Sheriff Grady Judd or designee) Member # Date Approved Disapproved

PCSO FORM 109 (REV 12/13/16) Page 2 of 2