Columbus Day News

INDIAN RIVER SHORES PUBLIC SAFETY DEPARTMENT 6001 HIGHWAY A1A INDIAN RIVER SHORES, FL 32963 APPLICATION FOR EMPLOYMENT AN EQUAL OPPORTUNITY EMPLOYER PERSONAL Last Name First Name Middle Initial Date Present Address Street City State Zip Permanent Address Street City State Zip Telephone Number Social Security Number Email Address Position Applied For Date Available Salary Desired How Did You Learn About Our Organization? Advertisement Friend Relative Walk-In Other EDUCATION School Name of School Location Course of Study No. of Years Completed Diploma/ Degree Elementary High School College Other EMPLOYMENT EXPERIENCE List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military assignments. Explain any gaps in employment in the space provided below. Employer Dates of Employment Position Held Reason for Leaving Address From To Telephone Number Starting Salary Ending Salary Supervisor May we contact? Employer Dates of Employment Position Held Reason for Leaving Address From To Telephone Number Starting Salary Ending Salary Supervisor May we contact? Employer Dates of Employment Position Held Reason for Leaving Address From To Telephone Number Starting Salary Ending Salary Supervisor May we contact? Employer Dates of Employment Position Held Reason for Leaving Address From To Telephone Number Starting Salary Ending Salary Supervisor May we contact? Explain gaps in employment: REFERENCES List three (3) persons not related to you, whom you have known for at least one year. Name Complete Address Telephone Number Occupation 1. 2. 3. Have you ever been convicted of a criminal offense (felony or misdemeanor)?  Yes  No If yes, state the nature of the offense(s), the date(s) of conviction(s) and the court(s) in which you were convicted. (A conviction will not necessarily disqualify an applicant for employment.) Are you now under charges for any criminal offense?  Yes  No If yes, state the nature of the offense(s) and the court(s) in which the charges are pending. (An affirmative answer will not necessarily disqualify an applicant for employment.) Do you possess a valid Florida Driver’s License?  Yes  No Number State Have you ever had your Driver’s License suspended or revoked?  Yes  No If yes, give date(s) and reason(s): I certify that the facts set forth in this application are true and complete to the best of my knowledge. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice. Signature of Applicant Date