Fillable Employment Application 2017

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Employment Application 2017

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The Employment Application 2017 form is 4 pages long and contains:

  • 1 signature
  • 68 check-boxes
  • 140 other fields

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Applicant: Please retain the 2-page Applicant Brochure
Applicants Social Security #
___ ___ ___ - ___ ___ - ___ ___ ___ ___
Revised 05/2017 1
GENERAL INSTRUCTIONS:
• Print this application;
submit by fax, email, or in
person.
• Applications MUST be
legible and signed.
• Only one application is
required if applying for
more than one position at
a time.
• Answer all questions
which apply to you.
• For questions that do not
apply to you, insert “N/A”.
• If you need additional
space, put the information
on a separate sheet and
return it with the
completed application. Be
sure to reference the
appropriate Item Number.
• A detailed resume and
current picture may be
submitted, but is not
required.
• Address or telephone
number changes should
be reported promptly.
• Applications will remain
current for six months
from date of notification.
I. INDIVIDUAL DATA
Date of Application ________ / ________ / ________
(mo) (day) (year)
1. Name
___________________________________________________________________________________
(Last) (First) (Middle or Nickname)
2. Address __________________________________________________________________________________
Actual Place (Number) (Street)
of Residence
_________________________________________________________________________________
(City) (State) (Zip Code)
3. Mail
ing Address __________________________________________________________________________
(If different (Number) (Street) (City) (State) (Zip Code)
from above)
4. Home phone ( ________ ) ________________ Cell Phone ( ________ ) _______________________
(ext.)
5. Full Time: (40 hours) Part Time: (20 to 30 hours) Temporary:
□ Customer Service □ Customer Service □ Seasonal
□ Greeter □ Greeter
□ Mail Courier □ Driver License Examiner
6. If a j
ob requirement, are you willing to work overtime? □ Yes □ No
II. EDUCATION & TRAINING
7. Are you a High School Graduate? ___ Yes ___ No Have you obtained a GED? ___ Yes ___ No
8. Have you ever been a member of the Armed Services?
___ Yes ___ No
If yes: Branch ____________________________________ Discharge Date ____________________________________
9. Comments/Remarks (if any): ______________________________________________________________________________________
Are you
seeking Veterans Preference for your application?
___ Yes ___ No
Colleges, Universities, Junior/Community Colleges attended or attending:
10. Name 11. City/State
___________________________________________ ____________________________
___________________________________________ ____________________________
12. Dates
Attended
(From/To)
_________
_________
13. Credit
Hrs
Earned
(Qtr/Sem)
_________
_________
14. Type
of Degree
_________
_________
15. Year
Obtained
_________
_________
16. Major/
Minor
_________
_________
*To receive credit for college coursework it is necessary that you supply Quarter/Semester hours earned in addition to dates attended.
Business, Technical, or Vocational Schools attended or attending
(Correspondence Courses):
17. Name 18. City/
State
___________________________________________ ____________________________
___________________________________________ ____________________________
19. Dates
Attended
(From/To)
__________
__________
20. Actual
Duration
(Hrs/Days
/Mos/Yrs)
_________
_________
21.
Credits
Earned
_________
_________
22. Type
of Cert. or
Diploma
_________
_________
23.
Courses
Taken/
Complete
_________
_________
*If Correspondence Course, please identify as such.
24. Do you possess a valid* driver license?
___ Yes ___ No *Valid: An issued license which has not expired nor has, within
If yes, answer the following. If no, explain in item #42 the past three years, been denied, restricted, revoked, or
suspended.
State: _________________________________________
DL #: _
________________________________________ Date of Birth: __________________________________
25. Do you have a source of transportation to work?
___ Yes ___ No
Seminole County Tax Collector
Attn: Cynthia Torres
1101 E First Street * Sanford, FL 32771
(An EEO [M F V H] Employer)
APPLICATION FOR EMPLOYMENT
Fax: 407-665-7654
Email: Cynthia.Torres@SeminoleCounty.tax
Mail: PO Box 630, Sanford, FL 32772-0630
You may submit a photo if you choose
II. EDUCATION & TRAINING (CONT’D)
27. Do you speak any foreign languages? Please list:
PLEASE CHECK THE APPROPRIATE BOX INDICATING THE LEVEL OF COMPETENCY OR EXPERIENCE
YOU HAVE IN EACH AREA.
28.
TYPING/KEYBOARD SKILLS
___
Tested wpm ________
Date Last Tested _ _
/_ _
/_ _
Typing/Keyboard skills are required.
It is acceptable to utilize any free typing test available on the Internet for
current rating.
29.
SPECIAL AREAS:
30.
COMPUTER SOFTWARE:
31.
List any other skills attained useful to the position for which you are applying
____________________________________________________________________________________________________________
32.
List any Technical or Professional licenses or certificates held
____________________________________________________________________________________________________________
III. MISCELLANEOUS
Answer the following questions by placing an “X” under “YES” or “NO”.
YES
NO
33. Have you ever been ticketed for any moving traffic violations (including speeding tickets)?
*
34. Have you ever been convicted of any criminal violation of law, or ever had adjudication in a felony
case?**
*
35. Have you ever been discharged for misconduct or unsatisfactory service from any job? If so, which
company(s)?
*
36. Have you had an on-the-job illness or injury in the past seven (7) years? If yes, indicate date(s), type(s)
of injury,
and if you received any worker’s compensation for this injury?
*
37. Do you have or have you had any physical or mental handicap, injury, illness, limitations, or other
disability
which would interfere with your work assignment? If yes, explain.
*
38. Have you ever filed an application for employment with any Seminole County governmental office?
*
39. Have you ever been employed by a Seminole County government office? If yes, indicate date(s) of
employment, Department(s)/Division(s), position(s), and reason for leaving.
*
40. Are any members of your family or relatives (by blood or marriage) employed by the Office of the
Seminole
County Tax Collector?
*
41. DO YOU UNDERSTAND THAT BY MAKING APPLICATION FOR EMPLOYMENT THE
APPLICATION
BECOMES AVAILABLE FOR PUBLIC INSPECTION IF SUBSTANTIATED TO BE
NECESSARY?
* If you responded with a “YES” answer, please explain in the space provided under item 42, of this application.
** NOTE: A conviction does not automatically mean you cannot be appointed. Give all the facts so that a decision can be made.
42. Space for detailed answers, indicate item number to which answers apply.
ITEM NO.
(If additional space is needed, attach additional sheets and reference item number.)
Revised 05/2017 2
Customer Service Face-to-Face
No Experience
Less than 3 years
3 years or more
Customer Service by Phone
No Experience
Less than 3 years
3 years or more
Cash Handling
No Experience
Less than 3 years
3 years or more
Calculator Use
No Experience
Less than 3 years
3 years or more
Balancing Cash Drawer
No Experience
Less than 3 years
3 years or more
Computer Imaging
None
Beginning
Advanced
Microsoft Word
None
Beginning
Advanced
Microsoft Excel
None
Beginning
Advanced
Other
None
Beginning
Advanced
IV. WORK HISTORY
List your most recent employer first. We encourage you to be specific, include a resume or additional pages, if desired, which will help clarify your work
experience. However, you MUST complete the employment history below. If resume is attached, be sure that month/day/year for each employment
experience is reflected on the resume. Include voluntary unpaid work experience as well as military service, if any.
Note: If your name at your previous employer was different than your current name, please indicate in the appropriate section below.*
43. Present employer: ___________________________________________________________
(Company/Agency Name)
Empl
oyer’s Address: _____________________________________________________________
(Number) (Street)
______________________________________________________________
(City) (State) (Zip)
Empl
oyer’s Phone Number: ( ________ ) ____________________________
Job Title: _______________________________________________________
May We Contact Employer? ___ Yes ___ No Supervisor’s Name: _____________________________ *Employed Name: __________________________
Duties in Detail: _______________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Reason for Leaving: __________________________________________________________________________________________________________________________
44. Previous employer: ___________________________________________________________
(Company/Agency Name)
Empl
oyer’s Address: _____________________________________________________________
(Number) (Street)
______________________________________________________________
(City) (State) (Zip)
Empl
oyer’s Phone Number: ( ________ ) ____________________________
Job Title: _______________________________________________________
May We Contact Employer? ___ Yes ___ No Supervisor’s Name: _____________________________ *Employed Name: __________________________
Duties in Detail: _______________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Reason for Leaving: _____________________________________________________________________________________________________________
_____________
45. Previous employer: ___________________________________________________________
(Company/Agency Name)
Empl
oyer’s Address: _____________________________________________________________
(Number) (Street)
______________________________________________________________
(City) (State) (Zip)
Empl
oyer’s Phone Number: ( ________ ) ____________________________
Job Title: _______________________________________________________
May We Contact Employer? ___ Yes ___ No Supervisor’s Name: _____________________________ *Employed Name: __________________________
Duties in Detail: _______________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Reason for Leaving: __________________________________________________________________________________________________________________________
46. An additional work history form is available. Resume attached: ___ Yes ___ No
Revised 05/2017 3
From: ______________________________________
(Month) (Day) (Year)
To: _________________________________________
(Month) (Day) (Year)
___ Full Time ___ Part Time
Number of Hours per Week: ___________________
Starting Salary: $_____________________________
Last Salary: $_________________________________
From: ______________________________________
(Month) (Day) (Year)
To: _________________________________________
(Month) (Day) (Year)
___ Full Time ___ Part Time
Number of Hours per Week: ___________________
Starting Salary: $_____________________________
Last Salary: $_________________________________
From: ______________________________________
(Month) (Day) (Year)
To: _________________________________________
(Month) (Day) (Year)
___ Full Time ___ Part Time
Number of Hours per Week: ___________________
Starting Salary: $_____________________________
Last Salary: $_________________________________
47. How did you learn about the vacancy for which you are applying? (Check appropriate space.)
□ Walk-in / Counter Sign □ Web Page (www.seminolecounty.tax)
□ Registration Renewal Insert □ Web Page (other: _______________________________________)
□ Employee ___________________________________
APPLICANT CERTIFICATION AND AGREEMENT
Please Read Carefully
I unde
rstand that any false answers or statements made by me on my employment application or any
supplement thereto, or any false statements made to any representative of the Seminole County Tax Collector’s
Office during the interview process, will be sufficient grounds for immediate discharge, no matter when
discovered.
I unde
rstand and agree that when hired by the Tax Collector, my appointment is for no definite period and
may, regardless of the date of payment of my wages and salary, be terminated at any time without previous
notice or cause. I understand that no supervisor or other representative of the Seminole County Tax Collector’s
Office, except the Tax Collector, has the authority to enter into any agreement for appointment for any
specified period of time. If I enter into any such agreement with the Tax Collector, such agreement must be in
writing.
I unde
rstand that the Seminole County Tax Collector may make a thorough investigation of my character,
reputation, past employment, and medical history. I authorize the giving and receiving of any such information
requested by the Tax Collector (including financial and credit records) and hereby relieve and release all former
employers and their agents of any liability for any information they may give to the Tax Collector. I hereby
waive any rights or claims I may have, whether presently fully developed or not, against the Seminole County
Tax Collector or his agents or deputies arising out of, or resulting from the release, authorized or unauthorized,
of the information received pursuant to or in connection with my employment application with the Seminole
County Tax Collector’s Office.
I understand that once employed by the Seminole County Tax Collector’s Office, some potential future employer
may contact Tax Collector representatives concerning my work record and my work performance at the Tax
Collector’s Office. I hereby consent to and authorize persons employed by the Tax Collector’s Office to divulge
any and all information they consider relevant to any person representing themselves to be an employer or
potential employee of mine with respect to my work record and/or performance of my job at the Tax Collector’s
Office. I understand that all information I provided is public record and is subject to review upon request.
I agr
ee that as an employee of the Seminole County Tax Collector’s Office, if in a non-exempt position, I will be
eligible to receive compensatory time in lieu of the payment of overtime at the discretion of the Tax Collector.
I auth
orize a criminal background search, and I agree to a physical examination if requested, including
urinalysis and/or blood test for use of illegal drugs or substances. I understand that failure to meet any job
related medical and/or health requirement for the position could prevent my appointment or continued
appointment by the Tax Collector.
I her
eby acknowledge that the first ninety (90) days of appointment with the Tax Collector’s Office constitutes
an initial probationary period.
Sign
ature: ___________________________________________________________ Date: ______________________
Revised 05/2017 4
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Employment Application 2017

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Completed 22 July 2020

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