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Recruit Application Fire Academy Applicant Name: Street Address: Daytime telephone: Desired Class: firefighter I & II Notification of Social Security Number Collection and Usage In compliance

Additionally, you should not reveal your Social Security number to anyone unless you are an approved TCC member. Your Social Security number should not be disclosed to a governmental entity for any purpose, including without limitation, any law enforcement agency, a tax authority, a credit bureau, the Department of Defense or Federal Public Safety Broad Agency Information Sharing Networks (PERSON) (a component element of the Defense Department), the Department of Justice, the U.S. Federal Bureau of Investigation, the Federal Bureau of Prisons (BOP), or any other entity of any government. Your Social Security number may not be used in connection with the distribution of any advertising copy of any TCC publication, without your prior written authorization. The College may release your Social Security number to the law enforcement unit of any local, state, or Federal law enforcement officer (or a person authorized by law to receive this information) in an emergency or emergency situation, if the law enforcement officer has a bona fide, sworn (or properly authenticated) warrant authorized the disclosure of personal information of the applicant and to prevent the loss of life or physical injury to anyone. To verify the identity and eligibility of all applicants and members, an on-line information search is available at. For those students with active student status a photocopy of your Student Health Record or Student Aid Report (AIR's) is authorized. If you are not currently enrolled at TCC, a copy of your last student ID or federal issued non-driver identification card is also authorized. If you would like to verify the information contained on your SRA or ARE report, you would be asked to sign a “Statement of Identification of Information Received, Verification of Information, and Request of Corrections” (Form SAI-1A). TCC will provide this form electronically when it is sent. Please be advised that, as a requirement of the Florida Health Care Cost Containment (Fiasco) Act, all individuals who submit an SRA or ARE report must also sign the FHC ACC Form 1232A, Statement of Information Regarding Health Care Coverage Under the Fiasco Act. If you would like to verify the information contained on your SRA or ARE report, and you are not a current or former TCC Student, please complete Section 14 of the Student Information Act.

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