Columbus Day News

APPLICATION FOR EMPLOYMENT AN EQUAL OPPORTUNITY EMPLOYER INDIAN RIVER SHORES PUBLIC SAFETY DEPARTMENT 1901 90TH AVENUE VERO BEACH, FL 32963 (772) 231-2700 INSTRUCTION: Please answer all questions completely. You must sign and date this application. A resume may be attached for additional information. However, the application must be completed. PERSONAL Name (Last, First, Middle Initial) Social Security Number Present Address How Long Have You Been at This Address? City State Zip Code Phone Number ( ) - E-Mail Address Are you legally eligible for employment in the U.S.? Yes No Have you ever been convicted of a felony? Yes No If yes, state when, where and nature of offense. Are you related to anyone now employed by the Town of Indian River Shores? Yes No If yes, state name and department. EDUCATION School City & State Number of Years Completed Diploma/Degree High School College Other List any special skills or training you have that are related to the position for which you are applying. EMPLOYMENT HISTORY List your employment history for the past ten (10) years, including summer or part-time employment. List your MOST RECENT employer first. You must complete this section even if you submit a resume. Explain any gaps in employment. Employer Dates Employed Address From To City State Zip Code Salary Starting: $ Ending: $ Phone Number ( ) - Position Held Supervisor Reason for Leaving Employer Dates Employed Address From To City State Zip Code Salary Starting: $ Ending: $ Phone Number ( ) - Position Held Supervisor Reason for Leaving Employer Dates Employed Address From To City State Zip Code Salary Starting: $ Ending: $ Phone Number ( ) - Position Held Supervisor Reason for Leaving REFERENCES Give the names of three (3) persons not related to you, who have knowledge of your qualifications for the position for which you are applying. Name Address Phone Number Years Known 1. 2. 3. DRIVING RECORD Do you have a valid Florida Driver’s License? Yes No Driver’s License Number State Has your driving privilege ever been suspended or revoked? Yes No If yes, give details: CRIMINAL CONVICTION Have you ever been arrested for or charged with any criminal offense, whether or not the charge resulted in a conviction? Yes No If yes, please explain even if the record has been sealed or expunged: AUTHORIZATION I certify that all of the information provided in this application is true and complete, and I understand that any false statement, misrepresentation, or omission may disqualify me from consideration for employment or result in dismissal. I authorize the Town of Indian River Shores to investigate all statements contained in this application as may be necessary in arriving at an employment decision. I authorize all individuals, schools, and employers named in this application to provide any information requested by you and release them from all liability for damage on account of furnishing such information. I understand that if I am employed, my employment is for no definite period of time and may, regardless of the date of payment of my salary and wages, be terminated at any time without any prior notice. I understand that a background investigation will be conducted, and that any offer of employment is contingent upon satisfactory results of the background investigation. Signature of Applicant Date