City of New Smyrna Beach 210 Sams Avenue
New Smyrna Beach, Florida 32168
(Verification of eligibility will be confirmed upon employment)
If yes, provide name, relationship and department where they work:
In addition to federal law requirements, The City of New Smyrna Beach complies with applicable state and local laws governing nondiscrimination in employment in every location in which the City has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
The City of New Smyrna Beach expressly prohibits any forms of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, nation origin, age, genetic information, disability, or veteran status.
List each job held for the last ten (10) years. Start with your PRESENT or MOST RECENT job. Include military service assignments and volunteer activities. (Exclude groups which indicate race, color, religion, sex or national origin). Are there any employers listed below you WOULD NOT like contacted for employment reference checks?
FILL IN THE NAMES OF SIX (6) PERSONS NOT RELATED TO YOU, NOT FORMER EMPLOYERS, WHO HAVE KNOWN YOU INTIMATELY FOR A SUBSTANTIAL PERIOD, PREFERABLY MORE THAN FIVE (5) YEARS.
*If you currently reside in an apartment or rental home, list landlord information below:
PLEASE ANSWER THE FOLLOWING QUESTIONS COMPLETELY AND ACCURATELY. ANY FALSIFICATION OR MISSTATEMENT OF FACTS WILL BE SUFFICIENT TO DISQUALIFY YOU.
If you mark "No" and Public Records indicate otherwise, you may be disqualified.
you must provide a full explanation on a separate sheet of paper. Conviction of a crime alone typically will not disqualify you from being considered for employment. Upon review factors taken into consideration may include nature of infraction, remoteness in time and rehabilitation.
APPLICANT’S CERTIFICATION and AGREEMENT – THIS FORMS MUST BE NOTARIZED
I understand that previous employers will be contacted for references. I hereby authorize former employers to furnish any and all records of my service with them. I also release my former employers from any liability for any damage in providing this information. I also authorize educational institutions to furnish any records of education-related information they may have concerning me.
I understand that positions regarded as part-time and/or temporary are paid for actual hours worked and are not entitled to benefits offered to full time positions, with the exception of FICA and Worker’s Compensation.
I understand that if hired, my position with the City of New Smyrna Beach is temporary during the established initial probationary period. My employment may be ended before the expiration of that period for any reason, without recourse.
to take and pass a physical examination after an offer of employment is made and employment is contingent on the results of that examination in accordance with the Americans With Disabilities Act (ADA). I also understand that the post-offer physical, I will receive a copy of the City’s Drug-free Workplace Program. Any illegal or controlled substance that shows in my test results will cause my immediate disqualification for employment with the City of New Smyrna Beach.
Pursuant to Florida Statute 119, the Public Records Act, documents made or received by the City of New Smyrna Beach may be public record and open for inspection by the public. Some records, such as social security numbers, examination questions and answers and medical documentation are not public records and may not be disclosed.
I understand that this application must be completed in full. Incomplete applications may be rejected. I agree that any false or misleading information provided by me will be cause for canceling the application process. If hired by the City of New Smyrna Beach, after my hire date, it may cause my dismissal from City service. I have answered all the questions on this form completely and truthfully. I certify that the facts set forth in this employment application are true and complete to the best of my knowledge. If hired, I agree to accept conditions of employment and abide by rules, procedures and policies of the City of New Smyrna Beach.
By signing below you hereby authorize and give consent for the City of New Smyrna Beach to obtain information pertaining to possible criminal history on myself. This includes the following: Criminal Background Records/Information Sex Offender Registry Information, Addresses and Social Security Number Verification. I hereby release from liability and promise to hold harmless under any and all possible claims or causes of action (i) any and all persons or entities who shall furnish such information to the District, its officers, agents or employees, and (ii) the District, its officers, agents or employees for any statements, acts or omissions in the course of obtaining said information. Furthermore, I understand that this release is signed, free from duress, and with the full knowledge and understanding that any information obtained will be used in assessing my relative fitness for employment with the City of New Smyrna Beach.
This form must be completed if you wish to apply with Veteran's Preference
Under Florida law, preference in appointment and employment shall be given, by the State and its political divisions, to those persons with compensable service related disability eligible to or is receiving compensation, disability retirement, or pension under public laws administered by the U.S. Veteran’s Administration and the Department of Defense. Preference in employment, reemployment, promotion, and retention shall be given to an eligible veteran pursuant to ss. 295.07, 295.08, 295.085, and 295.09 as long as the veteran meets the minimum eligibility requirements and has the knowledge, skills, and abilities required for the particular position. If any applicant claiming Veteran’s Preference for a vacant position is not selected for the position, they may file a complaint with the Division of Veterans Affairs, P.O. Box 1437, St. Petersburg, FL 33731-1437. A complaint shall be filed within 21 days after notice of a hiring decision. If a notice of a hiring decision is not given, a complaint may be filed within three months of the date of application.
Applicants claiming preference is responsible for providing the required documentation (DD214, Member letter) at the time of making an application for a vacant position.
This field is not part of the form submission.
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