City of New Smyrna Beach
210 Sams Avenue
New Smyrna Beach, Florida 32168
Work History: List each job held. Start with your present or most recent job. Include military service assignments and volunteer activities for employment reference checks. Please place a check mark in the correct box by the employer's name if you would like to be contacted for reference checks.
List three (3) persons not related to you who have knowledge of your character
Statement of Application: I understand that previous employers may 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 volunteer/internship and will not be paid for actual hours worked and not entitled to benefits offered to full time positions.
I understand that accepted as a volunteer/intern, my position with the City of New Smyrna Beach is temporary during the established initial probationary period. My assignment may be ended before the expiration of that period for any reason, without recourse.
I am aware that the City of New Smyrna Beach is a “Drug-free Workplace”. I understand that I may be required to take and pass a physical examination after volunteer/intership application is accepted and 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 participation as a volunteer/ intern 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.
The City of New Smyrna Beach provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. 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.
This field is not part of the form submission.
* indicates a required field