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APPLI EM P L O Y MENT N (The 15th Judicial Circuit of Florida)

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1
State
of Florida
EM
P
L
O
Y
MENT
APPLI
C
A
T
I
O
N
Equal Opportunity Employer/Affirmative Action
Employer
The State
of
Florida does not tolerate violence
in
the
workplace.
FOR OFFICIAL USE
ONLY

Agency Authorized
Signature Date
Class
Code
Status
POSITION APPLIED
FOR
Agency:
Title:
Where
to
Find Vacancy Information:
Position
Number:
Date
Available:
•
On the Internet:
http://www.15thcircuit.com
•
Jobs and Benefits Centers
-
Consult your local telephone directory
•
State Agency Personnel
Offices
Counties
of
Interest:
Minimum
Acceptable
Salary:
GENERAL INSTRUCTIONS
HOW DO WE CONTACT
YOU?
• Type or print in ink this application in its entirety.
• Specify the position for which you are applying.
(Note: A separate application must be submitted for each
vacancy. Photocopies are acceptable.)
• Submit your application to the office announcing the vacancy no
later than the close of business on the announced deadline date.
• Sign your name in the Certification Section (page 4). All
information you submit is subject to verification.
• Notify the agency's hiring authority in advance if you require
special disability accommodations to participate in the
employment process.
EDUCA
TION
Your
Name
Social Security
Number
Your Mailing
Address
City County State
Zip
Code
Home
Phone
Business
Phone
SUNCOM (State
Employees)
HIGH
SCHOOL:
NAME
/
LOCATION OF
SCHOOL RECEIVED: Diploma
Other
(specify) None
YOUR
NAME,
IF
DIFFERENT
WHILE
ATTENDING
SCHOOL:
COLLEGE, UNIVERSITY OR PROFESSIONAL
SCHOOL:
(TRANSCRIPTS MAY BE
REQUIRED)
NAME OF
SCHOOL
LOCATION
DATES
OF
ATTENDANCE
(MONTH
/
YEAR)
CREDIT
HOURS
EARNED
MAJOR
/
MINOR
COURSE OF
STUDY
TYPE
OF
DEGRE
E
EARNED
FROM
TO
QTR SEM



YOUR
NAME,
IF
DIFFERENT
WHILE
ATTENDING
SCHOOL:
JOB-RELATED TRAINING OR COURSE
WORK:
(VOCATIONAL, TRADE, GOVERNMENTAL, BUSINESS, ARMED FORCES,
ETC.)
NAME OF
SCHOOL
LOCATION
DATES
OF
ATTENDANCE
(MONTH/YEA
R)
CREDIT
HOURS
EARNED
COURSE
OF
STUDY
TRAINING
COMPLETED
?
FROM
TO
CLASS CLOCK
YES NO





YOUR
NAME,
IF
DIFFERENT
WHILE
ATTENDING
SCHOOL:
LICENSURE, REGISTRATION, CERTIFICATION
EXAMPLES:
Driver License, Teacher Certification, RN, LPN, PE, CPA,
etc.
LICENSE, REGISTRATION OR
CERTIFICATION:
Number
Date
Received
Expiration
Date
State Licensing
Agency


2
2
PERIODS OF
EMPLOYMENT
Describe your work experience
in
detail, beginning with your current
or
most recent job. Include military service (indicate rank) and job-related volunteer work,
if
applicable. Indicate number
of
employees supervised.
Use
a
separate block
to
describe each position
or
gap
in
employment.
If
needed, attach additional sheets, using the same format
as on
the application. All
information
in
this section
must
be
completed.
Resumes may be attached
to
provide additional
information.
1
Name
of
Present
or
Last
Employer:
Address:
Phone
No.:
(
)
Your
Job
Title:
Supervisor’s
Name:
FROM:
/
/
TO:
/
/
HOURS
PER
WEEK:
( )
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME
IF
DIFFERENT DURING
EMPLOYMENT
Duties
and
Responsibilities:
Reason
For
Leaving:
Name
of
Next
Previous
Employer:
Address:
Phone
No.:
(
)
Your
Job
Title:
Supervisor’s
Name:
FROM:
/
/
TO:
/
/
HOURS
PER
WEEK:
( )
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME
IF
DIFFERENT DURING
EMPLOYMENT
Duties
and
Responsibilities:
Reason
For
Leaving:
3
Name
of
Next
Previous
Employer:
Address:
Phone
No.:
(
)
Your
Job
Title:
Supervisor’s
Name:
FROM:
/
/
TO:
/
/
HOURS
PER
WEEK:
( )
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME
IF
DIFFERENT DURING
EMPLOYMENT
Duties
and
Responsibilities:
Reason
For
Leaving:
3
4
Name
of
Next
Previous
Employer:
Address:
Phone
No.:
(
)
Your
Job
Title:
Supervisor’s
Name:
FROM:
/
/
TO:
/
/
HOURS
PER
WEEK:
( )
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME
IF
DIFFERENT DURING
EMPLOYMENT
Duties
and
Responsibilities:
Reason
For
Leaving:
5
Name
of
Next
Previous
Employer:
Address:
Phone
No.:
(
)
Your
Job
Title:
Supervisor’s
Name:
FROM:
/
/
TO:
/
/
HOURS
PER
WEEK:
( )
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME
IF
DIFFERENT DURING
EMPLOYMENT
Duties
and
Responsibilities:
Reason
For
Leaving:
6
Name
of
Next
Previous
Employer:
Address:
Phone
No.:
(
)
Your
Job
Title:
Supervisor’s
Name:
FROM:
/
/
TO:
/
/
HOURS
PER
WEEK:
( )
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME
IF
DIFFERENT DURING
EMPLOYMENT
Duties
and
Responsibilities:
Reason
For
Leaving:
If
needed, attach additional sheets, using the same format
as on
the application.
Resumes may be attached
to
provide additional
information.
DP-E-16 Rev. 12/98
4
KNOWLEDGE / SKILLS / ABILITIES
(KSAs)
List KSAs you possess and believe
relevant
to
the position you seek
, such
as
operating heavy equipment, computer skills, fluency
in
language(s),
etc.
EXEMPTION FROM PUBLIC RECORDS DISCLOSURE
ARE YOU
A
CURRENT OR FORMER LAW ENFORCEMENT OFFICER, OTHER EMPLOYEE** OR THE SPOUSE
OR CHILD OF ONE, WHO
IS
EXEMPT FROM PUBLIC RECORDS DISCLOSURE
UNDER
§119.07,
F.S.? YES NO
**Other covered jobs include: correctional and correctional probation officers, firefighters, certain judges, assistant state attorneys, state attorneys, assistant
and
statewide prosecutors, personnel
of
the Department
of
Revenue
or
local governments whose responsibilities include revenue collection and enforcement
or child
support enforcement, and certain investigators
in
the Department
of
Children and Families [see §119.07,
F.S.].
BACKGROUND
INFORMATION
HAVE YOU EVER BEEN CONVICTED OF
A
FELONY OR
A
FIRST DEGREE
MISDEMEANOR? YES NO
If
“YES”,
what
charges?
Where
convicted?
Date
of
Conviction:
HAVE YOU EVER PLED NOLO CONTENDERE OR PLED GUILTY TO
A
CRIME WHICH
IS A
FELONY OR
A
FIRST DEGREE
MISDEMEANOR? YES NO
If
“YES”,
what
charges?
Where?
Date:
HAVE YOU EVER HAD THE ADJUDICATION OF GUILT WITHHELD FOR
A
CRIME WHICH
IS A
FELONY OR
A
FIRST DEGREE
MISDEMEANOR? YES NO
If
“YES”,
what
charges?
Where?
Date:
NOTE:
A
“YES” answer
to
these questions will not automatically bar you from employment. The nature, job-relatedness, severity and date
of
the offense
in
relation
to
the position for which you are applying are
considered.
CITIZENSHIP
The State
of
Florida hires only U.S. citizens and lawfully authorized alien workers.
If a
conditional offer
of
employment
is
made, you will
be
required
to provide
identification and proof
of
citizenship
or
authorization
to
work
in
the
U.S.
ARE YOU
A
U.S. CITIZEN OR ARE YOU LEGALLY AUTHORIZED TO WORK
IN
THE
U.S.? YES NO
RELATIVES

TO YOUR KNOWLEDGE, DO YOU HAVE ANY RELATIVES WORKING
IN
THIS
AGENCY? YES NO
SELECTIVE SERVICE SYSTEM
REGISTRATION

All
males between the ages
of 18
and
26
must
be
registered with the Selective Service System
or exempted.

IF
YOU ARE
A
MALE BETWEEN THE AGES OF
18
AND 26, DO YOU HAVE PROOF OF REGISTRATION
WITH THE SELECTIVE SERVICE SYSTEM OR EXEMPTION FROM SUCH
REGISTRATION? YES NO
CERTIFICATION
I am
aware
that any
omissions, falsifications, misstatements,
or
misrepresentations above
may
disqualify
me for
employment consideration
and, if I am
hired, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I consent to the release of
information
about
my
ability, employment history,
and
fitness
for
employment
by
employers, schools,
law
enforcement agencies,
and
other individuals
and
organizations
to
investigators, personnel staff, and other authorized employees of Florida state government for employment purposes. This consent shall continue to be effective
during
my employment
if I
am hired.
I
understand that applications submitted for state employment are public records except as exempted above.
I
certify that
to
the best
of
my knowledge and belief
all of
the statements contained herein and
on
any attachments are
true, correct, complete, and made
in
good
faith.
SIGNATURE:
DATE:
click to sign
signature
click to edit
✂
Employer, remove this section upon completion
of
the selection
process.
YOUR
NAME:
POSITION
TITLE
FOR
WHICH
YOU
ARE
APPLYING:
VETERANS’ PREFERENCE
INFORMATION
POSITION
NUMBER:
Completion
of
the Veterans’ Preference section below
is
made
on a
voluntary basis and kept confidential
in
accordance with the Americans with Disabilities Act.
Listed
below are the four Veterans’ Preference
categories.
1. A
veteran with
a
service-connected disability who
is
eligible
for or
receiving compensation, disability retirement,
or
pension under public laws administered
by the
U.S. Department
of
Veterans’ Affairs 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
by a
foreign power,
or
3. A
veteran
of
any war who has served
on
active duty for one day
or
more during
a
wartime period, excluding active duty for training, and who was discharged
under
honorable conditions from the Armed Forces
of
the United States
of
America,
or
4.
The unremarried widow
or
widower
of a
veteran who died
of a
service-connected
disability.
A
DD214
or
comparable document which serves
as a
certificate
of
release
or
discharge
must be furnished
at
the time
of
application
.
In
addition, applicants
claiming
categories
1, 2, or 4
above must furnish supporting documentation
in
accordance with the provisions
of
Rule 55A-7.013, F.A.C. Wartime periods are defined
in §1.01,
F.S. Veterans’ Preference shall expire after
an
eligible person has been employed
by
the state
or an
agency
of a
political subdivision
of
the state. Under Florida
law,
preference
in
appointment shall
be
given
by
the state
to
those persons
in
categories
1
and
2
and then those
in
categories
3
and
4.
Veterans’ Preference
is
only
available
to
Florida
residents.
If an
applicant claiming Veterans’ Preference for
a
vacant position
is
not selected, he/she may file
a
complaint with the Florida Department
of
Veterans’
Affairs,
P.O. Box 31003, St. Petersburg, Florida 33731-8903.
A
complaint must
be
filed within
21
days
of
the applicant receiving notice
of
the hiring decision made
by the
employing agency
or
within
3
months
of
the date the application
is
filed with the employer
if no
notice
is given.
VETERANS’ PREFERENCE
CLAIM
IF
ELIGIBLE, WHICH VETERANS’ PREFERENCE CATEGORY ARE YOU
CLAIMING?
(Please indicate number from Veterans’ Preference Information section
above.)
HAVE YOU EVER BEEN EMPLOYED BY ANY GOVERNMENTAL ENTITY WITHIN THE STATE OF
FLORIDA? YES NO
ARE YOU
A
RESIDENT OF THE STATE OF
FLORIDA? YES NO
NOTE:
If
you are claiming Veterans’ Preference you
must
meet the criteria and substantiate your claim
by
furnishing
a
DD 214 (Certificate
of
Release
or
Discharge
from
Active Duty) and any other required supporting documentation with your
application.
✂
Employer, remove this section prior
to
the selection
process.
EEO SURVEY
Although
the
following
information
is
not
mandatory,
it
is
requested
to
aid
the
State
of
Florida
in
its
commitment
to
Equal
Employment
Opportunity
and
Affirmative
Action.
Refusal
to answer will not result in adverse treatment of any applicant. Applicants who believe they have been discriminated against may file a complaint with the Florida
Commission
on
Human Relations, Building
F,
Suite 240, 325 John Knox Road, Tallahassee, Florida
32303.
POSITION
TITLE
FOR
WHICH
YOU
ARE
APPLYING:
POSITION NUMBER:
SEX:
MALE FEMALE
DATE OF BIRTH:
RACE
(Check Only
One):
WHITE
(Non-Hispanic)
BLACK
(Non-Hispanic) HISPANIC
ASIAN
or
PACIFIC
ISLANDER
NATIVE AMERICAN
OTHER
(Specify)
app
l
d
for
Employment with the State of Florida
The State
is a
major employer
in
Florida offering many challenging
and rewarding career
opportuni-
ties. Included among the
many
advantages
of
working for
the
State are the diverse
and
interesting job opportunities
as
well
as
competitive
salaries,
benefits, and career
mobility.
Most state jobs are
in
the
Career
Service
personnel system.
The
Career Service system
provides
uniform pay, job classification,
benefits,
and recruitment for the majority
of
non-management jobs within
state
agencies. Career Service employees
can
move between agencies without any
loss
of
state
benefits.
Non-Career Service jobs
include
upper
management and policy-making jobs
in the
Senior Management Service (SMS),
middle
management and professional positions such
as
physicians, attorneys, bureau chiefs
in the
Selected Exempt Service (SES),
and
temporary jobs funded
by
Other
Personal
Services (OPS). OPS employees receive
an
hourly wage but
no
benefits such
as insur-
ance, leave,
or retirement.
Non-Career Service agencies
are
agencies
in
which
all
positions are not
a
part
of the
Career Service system and their employment
procedures may differ. For example,
in most
cases, they may require different applications
and their job titles and salaries may not
be
comparable
to
the Career Service
system.
EMPLOYMENT
PROCESS
Individual state agencies are responsible
for
announcing their job vacancies,
accepting
ications, and making hiring
ecisions.
Generally,
agencies accept
job
applications
for adver-
tised vacancies
only.
In
some instances,
how-
ever, agencies
may
accept applications
on a
continuous basis
to
meet
Affirmative Action goals and
hard-to-fill vacancies. You
may obtain applications from
any
Career Service agency personnel office
or
any Florida Jobs and Benefits
Center
(formerly Job Service
of
Florida). A
legible
original
or
photocopy
of
the State
of Florida
employment application
is
normally required
for each job vacancy for which you apply.
It is
also possible
to
obtain
an
application
form
and
to
apply electronically via the Internet
for
many vacancies
at:
http://jobsdirect.state.fl.us
LOCATING
VACANT
POSITIONS
There are several ways for you
to
obtain
state job vacancy
information:
•
Vacancy information
is
available
on the
Internet
at:
http://jobsdirect.state.fl.us.
•
Contact individual Career Service agencies
directly
for
information regarding
their
employment
opportunities.
•
Contact
a
Florida Jobs and Benefits Center
for job vacancy information for
all Career
Service agencies, including jobs
in the
Selected Exempt and Senior Management
Services. Check your telephone
directory
under “Florida Jobs and Benefits
Center”
or
“Job Service
of
Florida”
to
locate the
office nearest
you.
Since agencies are not required
to
advertise
OPS
temporary jobs, you may wish
to
contact any
of
the state agencies
for OPS
employment
consideration.
JOB SEARCH
TIPS
Market yourself. Prior
to
completing
the
application, gather specific
information
relating
to
the position you seek
by
reviewing
the job opportunity announcement
or by
contacting the employing agency for
a
description
of
duties and relevant knowledge,
skills, and abilities. Use this information
to
assist you in preparing your application,
cover
letters, resumes and other support
materials.
COMPETING IN
THE
SELECTION PROCESS
The first step
an
employing agency takes
in
the selection process
is to
review
the
applications which have been received
to
determine who
is
eligible
to
compete
further
in
the selection process. The agency
then
uses job-related criteria
to
determine
those
applicants who will
be
asked
to
participate
in
additional assessment steps such
as an oral
interview,
a
work sample exercise,
or a
proficiency test. The job-related
information
gained during the selection process
will
assist the hiring official
in
making the
final
selection decision. Veterans’
preference
and Affirmative Action goals are also
considered
by
the agency
in the
decision-making
process.
If,
because
of a
disability, you require
a
special accommodation
to
participate
in the
application and selection process,
please
notify the hiring authority
in advance.
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APPLI EM P L O Y MENT N (The 15th Judicial Circuit of Florida)

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Completed 13 June 2021

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