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3614 S. Ocean Boulevard Highland Beach, Florida 33487

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3614 S. Ocean Boulevard
Highland Beach,
Florida 33487
Phone: (561) 278-4548
Fax: (561) 265-3582
EMPLOYMENT APPLICATION FORM
Thank you for considering the Town of Highland Beach as a prospective place of
employment.
The attached Employment Application is to be used when applying for posted
employment positions within the Town of Highland Beach. The Town of Highland
Beach can only accept applications for posted positions. You may include your resume
with an Employment Application, but not in place of it.
For information about current job openings, please log on to
www.highlandbeach.us and click Employment Opportunities with the Town of
Highland Beach.
Should you have any questions or require any assistance in accessing the Town’s
website or application form, please feel free to contact the Town of Highland Beach at
(561) 278-4548, Monday – Friday, between 8:30 a.m. and 4:30 p.m.
We appreciate your interest in employment with the Town of Highland Beach.
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3614
S. OCEAN BOULEVARD
H
IGHLAND BEACH, FLORIDA 33487
The TOWN OF HIGHLAND BEACH (“the TOWN”) is an equal opportunity employer and does not discriminate
on the basis of race, color, religion, sex, national origin, age, disability, marital or other protected status.
Page 2 of 7
TOWN OF HIGHLAND BEACH
APPLICATION FOR EMPLOYMENT
PLEASE ANSWER ALL QUESTIONS ACCURATELY AND COMPLETELY.
PLEASE PRINT. Print "N/A" in any space that does not apply to you. INCOMPLETE
APPLICATIONS ARE CONSIDERED INVALID AND WILL NOT BE CONSIDERED.
Position applied for __________________________________________________Date ______________
Last Name____________________________ First _______________________________M.I. ________
Current How
Address __________________________ City ______________State ______Zip ______ Long?_______
Previous How
Address __________________________ City _____________ State ______Zip ______ Long?_______
Home Phone # _________________________
Cell Phone # __________________________ E-mail ________________________________________
Are you 18 years of age or older? Yes No
Are you legally authorized to work in the US on a full-time basis for any employer? Yes No
Proof of eligibility and identity will be required upon employment.
Are y
ou available for full time employment? Yes No
Have you ever applied with the TOWN? Yes No
If yes, when? _________________________________________________________________________
For which job(s) did you apply?___________________________________________________________
Have you been previously employed by the TOWN? Yes No
If yes, when?_________________________________________________________________________
In which job(s) were you employed? _______________________________________________________
Give names and positions of any relatives, including in-laws, who work for the TOWN:______________
_____________________________________________________________________________________________________________
Please indicate hours and shifts or days you are not available to work:_____________________________
____________________________________________________________________________
What are your salary requirements?____________________________ Hourly Annually
List any job related skills or qualifications that support your application:
Page 3 of 7
Do you smoke or use other tobacco-related products? Yes No
Have you ever been discharged or requested to resign from a position? Yes No
If so, explain:
Have you ever been convicted of, or plead guilty or nolo contendere to a crime? Yes No
Are you currently awaiting trial, sentencing or other disposition of a criminal charge? Yes No
If the answer to either question is yes, please explain (state the date, type of crime, place of occurrence,
disposition:
Conviction of a crime will not necessarily disqualify you for employment. Each conviction will be judged on its own
merit with respect to time and job relatedness. However, false statements or omissions of convictions shall be just cause
for disqualification.
EDUCATION
Level Name & Address Major
Check Highest
Grade
Completed
Degree/
Diploma/GED
High School
9 10
11 12
College
1 2
3 4
Other
1 2
3 4
Do you have any special computer or technical skills and training?
Professional License(s):
Page 4 of 7
EMPLOYMENT
List all employment since high school, the most recent job first. Attach additional sheets if necessary.
Include periods of unemployment, self-employment and military service.
Employer Name and Address:
P
ay: ____________
P
er:_____________
Position Title:
Ski
lls and Duties:
S
tart date:
____/ ____
End date:
____/ _____
Reason for Leaving:
Supervisor: Telephone:
May we contact this employer? Yes No
Employer Name and Address:
P
ay: ____________
P
er:_____________
Position Title:
Ski
lls and Duties:
S
tart date:
____/ _____
End date:
____/ ____
Reason for Leaving:
Supervisor: Telephone:
May we contact this employer? Yes No
Employer Name and Address:
P
ay: ____________
P
er:_____________
Position Title:
Ski
lls and Duties:
S
tart date:
____/ _____
End date:
____/ ____
Reason for Leaving:
Supervisor: Telephone:
May we contact this employer? Yes No
Employer Name and Address:
P
ay: ____________
P
er:_____________
Position Title:
Ski
lls and Duties:
Start date:
____/ _____
End date:
____/ ____
Reason for Leaving:
Supervisor: Telephone:
May we contact this employer? Yes No
If you answered “No” to contacting your present or previous employer, please explain:
Page 5 of 7
Are you currently on “Lay-off” status and subject to recall? Yes No
PERSONAL REFERENCES
Do not list relatives or previous employers
Name Address Phone # Occupation
Years
Known
1.
2.
3.
4.
Is additional information relative to a change of name or your use of an assumed or different name or
nickname necessary to enable the Town to check your work or education records? Yes No
If answered yes, please explain:
Page 6 of 7
APPLICANT ACKNOWLEDGEMENT & AUTHORIZATION
I hereby certify that the answers to the foregoing are true and correct to the best of my knowledge. I understand
that the TOWN OF HIGHLAND BEACH (“the TOWN”) will attempt to verify statements made on my
application.
I understand that the TOWN requires certain information about me to evaluate my qualifications for
employment and to conduct its business if I become an employee. I understand that false, incomplete or
misleading statements or omissions on this application or any other pre- or post-employment form, or in any
interview or other oral communication, may be considered sufficient cause for dismissal, if and when discovered.
The use of this application does not indicate there are positions open and does not in any way obligate the TOWN.
I authorize personal references, as well as professional references, other persons, companies, corporations,
schools, and law enforcement agencies identified in this application to furnish to the TOWN and/or its
representatives any information they have concerning me.
I understand that I may be required to submit to drug testing now or at any time in the future and I agree to such
testing. Moreover, I understand that my failure or refusal to undergo such testing will result in the withdrawal of
my employment application.
I will be able, if hired, to certify that I am authorized to work in the United States of America. The
Immigration Reform and Control Act of 1986 requires that, upon hiring, employers verify the authorization to
work and identity of all new employees. An offer of employment is contingent upon the TOWN’s ability to verify
this necessary information.
I understand that if I am hired, confidential information regarding the TOWN, and/or its customers and
employees may be available to me and that this information must not be disseminated or used except for the
TOWN’s benefit. If employed, I agree to keep all information about the TOWN, including such information
regarding its business methods, protocols, customers and employees, confidential and shall not disclose this
information to any unauthorized personnel whether within or without the TOWN.
I understand that this application or subsequent employment does not create a contract of employment nor
does it guarantee employment for any definite period of time. Should I be hired, I understand that my employment
is at-will and my employment may be terminated at any time with or without cause, and with or without notice.
_______________________________________________________
Complete Signature of Applicant Date
Thank you for completing this application form and for your interest in employment with the Town of
Highland Beach. Due to the volume of applications received, we may not interview every applicant. In the event
you are selected for interview, we will contact you.
Applications will not be considered active after 90 days from date of application unless renewed, in writing, by
the applicant.
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
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signature
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Page 7 of 7
NOTICE & CONSENT FORM
DISCLOSURE TO APPLICANT AND CONSENT TO REQUEST
CONSUMER REPORT INFORMATION
I understand that the Town of Highland Beach (“the Town”) will utilize the services of a consumer
reporting agency as part of the procedure for processing my application for employment. I also
understand if my application for employment is granted, the Town may obtain further information
through subsequent investigations by a consumer reporting agency so as to update, renew or extend my
employment.
I understand
a consumer reporting agency’s investigation may include obtaining information covering
up to the last seven (7) years regarding my credit background, references, character, past employment,
work habits, education, general reputation, personal characteristics, mode of living, judgment, liens,
and criminal background.
I
understand such information may be obtained by direct or indirect contact with former employers,
schools, financial institutions, landlords and public agencies or other persons who may have such
knowledge.
I also understand that before I am denied employment based, in whole or part, on information obtained
in the report, I will be provided a copy of the report and a description in writing of my rights under the
Fair Credit Reporting Act.
I understand if
I disagree with the accuracy of any information in the report, I must notify the Town
within two days of my receipt of the report. If I notify the Town within two days of the receipt of the
report that I am challenging information in the report, the Town, will not make a final decision on my
employment status until after I have had a reasonable opportunity to address the information contained
in the report.
I hereby consent to this investigation and authorize the Town to procure a report on my background as
stated above from a consumer reporting agency.
DATED this _______
day of _________________, 20___.
Signature
: __________________________________
Print Name: __________________________________
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signature
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Page 8 of 8
VETERANS’ PREFERENCE
Check appropriate item to claim Veterans' Preference. Documentation substantiating your claim
MUST be furnished at the time of application or your claim for veterans' preference will be
invalid.
1. A Veteran who has served duty in any branch of the Armed Forces who has a presently
existing service-connected disability 30% or more compensable under public laws administered
by the Veterans' Administration; or who is receiving compensation, disability retirement benefits,
or pension by reason of public laws administered by the Veterans' Administration and the
Department of Defense; or
2. The spouse of a veteran who cannot qualify for employment because of a total and
permanent disability, or the spouse of a veteran missing in action, captured or forcibly detained
or interned in line of duty by a foreign government of power; or
3. A veteran of any war who has served on active duty for at least one (l) day during the
wartime era, including but not limited to the following:
(a) Spanish-American War: April 21, l898 to July 4, l902;
(b) Mexican Border Period: May 9, l9l6 to April 5, l9l7;
(c) World War I: April 6, l9l7 to November 11, l9l8; extended to April l, l920, for
those veterans who served in Russia; also, extended through July l, l92l, for those
veterans who served after November 11, l9l8, and before July 2, l92l, provided
such veterans had at least 1 day of service between April 5, l9l7, and November l2,
l9l8;
(d) World War II: December 7, l94l, to December 3l, l946;
(e) Korean Conflict: June 27, l950, to January 3l, l955;
(f) Vietnam Era: February 28, 1961, to May 7, l975;
(g) Persian Gulf War: August 2, l990 and ending on the date thereafter prescribed by
Presidential proclamation or by law; or
4. The unmarried widow or widower of a veteran who died of a service-connected disability.
Have you claimed and been employed through Veterans' Preference since October l, l987? Yes
No If yes, give name of Employer:
Note: Under Florida law, preference in appointment and employment shall be given, by the State
and its political subdivisions, first to those persons included in #l and #2 above, and second to
those persons included under #3 and #4 above. If any applicant claiming a veterans' 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 l437, St. Petersburg, Florida 3373l. A complaint shall be filed
within 2l days after notice of a hiring decision. If notice of a hiring decision is not given, a complaint
may be filed at any time.
Applicant's Full Name
(Please Print)
BRANCH OF SERVICE
DATE OF ENTRY
DATE OF DISCHARGE
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3614 S. Ocean Boulevard Highland Beach, Florida 33487

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Completed 26 December 2022

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