HOME
|
ABOUT US
|
NEWS
|
CALENDAR
|
FAQs
|
HELP CENTER
|
OFFICE DIRECTORY
Fidelity Bond Request Form
Career Center Information
*
Local Board Name
--None--
LWDB 1 - CareerSource Escarosa
LWDB 2 - CareerSource Okaloosa Walton
LWDB 3 - CareerSource Chipola
LWDB 4 - CareerSource GulfCoast
LWDB 5 - CareerSource Capital Region
LWDB 6 - CareerSource North Florida
LWDB 7 - CareerSource Florida Crown
LWDB 8 - CareerSource Northeast Florida
LWDB 9 - CareerSource North Central Florida
LWDB 10 - CareerSource Citrus Levy Marion
LWDB 11 - CareerSource Flagler Volusia
LWDB 12 - CareerSource Central Florida
LWDB 13 - CareerSource Brevard
LWDB 14 - CareerSource Pinellas
LWDB 15 - CareerSource Tampa Bay
LWDB 16 - CareerSource Pasco Hernando
LWDB 17 - CareerSource Polk
LWDB 18 - CareerSource Suncoast
LWDB 19 - CareerSource Heartland
LWDB 20 - CareerSource Research Coast
LWDB 21 - CareerSource Palm Beach County
LWDB 22 - CareerSource Broward
LWDB 23 - CareerSource South Florida
LWDB 24 - CareerSource Southwest Florida
*
Career Center Address
*
Staff First Name
*
Career Center City
*
Staff Last Name
*
Career Center State
FL
*
Staff Email
*
Career Center Zip
*
Staff Phone Number
Employer Receiving Bond
*
Company / Agency Name
*
Employer Address
*
Employer Industry
--None--
Administrative and Support Services
Agriculture, Forestry, Fishing, and Hunting
Arts, Entertainment, and Recreation
Construction
Educational Services
Finance and Insurance
Government
Grocery
Healthcare and Social Assistance
Hotels and Hospitality
Information Technology
Janitorial
Landscaping
Management and Consulting
Manufacturing
Mechanics
Mining, Quarrying, Oil and Gas Extraction
Nonprofit
Other Services (Except Public Administration)
Professional, Scientific, and Technical Services
Real Estate, Rental, and Leasing
Restaurant and Food Services
Retail
Transportation
Utilities
Warehousing
*
Employer City
*
Contact First Name
*
Employer State
--None--
AL
AK
AS
AZ
AR
CA
CO
CT
DE
FL
GA
GU
HI
ID
IN
IA
KS
KY
IL
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
VI
UT
VT
VA
WA
WV
WI
WY
*
Contact Last Name
*
Employer Zip
Number of Employees
Employer Type
--None--
For Profit
Not For Profit
Government Agency
Employee Covered by Bond
*
Employee First Name
*
Employ Florida State ID
*
Employee Last Name
*
Bond Effective Date
[
2/25/2021
]
*
Bond Amount Requested
--None--
$5,000
$10,000
$15,000
$20,000
$25,000
*
Bond Request Type
--None--
New
Renewal
*
Employee Status
--None--
Justice Involved
Non-Justice Involved
*
Employee Occupational Code
--None--
Architecture and Engineering Occupation
Arts, Design, Entertainment, Sports/Media Occupation
Building and Grounds Cleaning and Maintenance Occupation
Business and Financial Operations Occupation
Community and Social Service Occupation
Computer and Mathematical Occupation
Construction and Extraction Occupation
Educational Instruction and Library Occupation
Farming, Fishing, and Forestry Occupation
Food Preparation and Serving Occupation
Healthcare Practitioner and Technical Occupation
Healthcare Support Occupation
Installation, Maintenance, and Repair Occupation
Legal Occupation
Life, Physical, and Social Science Occupation
Management Occupation
Military Specific Occupation
Office and Administrative Support Occupation
Personal Care and Service Occupation
Production Occupation
Protective Service Occupation
Sales and Related Occupation
Transportation and Material Moving Occupation
*
Employee Address
Employee Hourly Wage
*
Employee City
Employee Hours of Work Per Week
*
Employee State
--None--
AL
AK
AS
AZ
AR
CA
CO
CT
DE
FL
GA
GU
HI
ID
IN
IA
KS
KY
IL
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
VI
UT
VT
VA
WA
WV
WI
WY
Employee Ethnicity
--None--
White
Hispanic
Black or African-American
Asian
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Other
Optional
*
Employee Zip
January
February
March
April
May
June
July
August
September
October
November
December
2020
2021
2022
2023
2024
2025
2026
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Today