Do you request Veteran’s Preference consideration? No Yes
If Yes, A copy of your DD214 must accompany this application in compliance with Federal quidelines
Please designate the basis for your preference below.
As a Veteran with a compensable service-connected disability who is eligible for or receiving compensation, disability retirement
or pension under public laws administered by the U.S. Veterans Administration and the Department of Defense.
As the spouse of 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.
As a Veteran of any war who has served on active duty for 181 consecutive days or more, or who has served 180 consecutive
days or more since January 31, 1955, if any part of such active duty was performed during a wartime era. Active duty for
training is not allowable.
As the unremarried spouse of a Veteran killed in action, or who died of a service-connected disability.
Branch of Service____________________________________ Date of Entry_____________ Date of Discharge____________
Have you been employed through Veteran’s Preference since October 1, 1987? No Yes
NOTE: Any eligible applicant who believes he/she was not affor ded employment pr efer ence in accordance with FS 295.08 may
file a complaint with the THE DIVISION OF VETERAN’S AFFAIRS (P.O. Box 31003, St. Petersburg, FL 33731) within 21 calendar
days from the date of notice of hiring decision.
POLICE AND DRIVING RECORDS WILL BE CHECKED
Have you ever been arrested, received a notice to appear, charged, convicted, pled nolo contendere or pled guilty to any criminal violation,
regardless if the record was sealed or expunged? ________ If yes, describe the offense, date(s), charge(s), location(s), disposition(s), and
court(s). (Include jail or prison sentence(s), suspended sentence(s), probation(s) served, and conviction(s) incurred.)
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
____________________________________________________________________________
Information concerning convictions will not necessarily disqualify an applicant unless the conviction record indicates that the applicant
would not be suitable or desirable for employment in a particular position. An applicant who falsifies the application by failing to give
required information concerning convictions will, if employed, be subject to dismissal.
Have you ever been refused a Surety Bond?________
CERTIFICATION MUST BE SIGNED - PLEASE READ CAREFULLY
I certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers, and that the entries made
by me are true, complete and correct to the best of my knowledge and belief.
I hereby authorize the City of Tarpon Springs to verify all information contained herein, and I release all past employers and all references
from any and all liability for the release of information to the City of Tarpon Springs.
I further agree and consent in advance to being summarily discharged if any of the information provided by me contains any
misrepresentations or falsifications, or if any material information has been omitted.
Signature____________________________________________________ Date_____________________
The City of Tarpon Springs, Florida is an Equal Opportunity Employer. Qualified applicants are considered for emploment and treated
without regard to race, color, national origin, sex, sexual orientation, religion, disability, age, pregnancy, marital status or veteran status
(except if eligible for Veteran’s Preference) and all other protected characteristics. DRUGFREE WORKPLACE
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