Type or Print Clearly In Ink
11. Will accept position as follows: Full-time Part-time
Temporary On-Call
12. Minimum Salary Requirement
13. Present or previous Palm Beach County Board of County Commissioners’ employee? Yes No IF YES, give dates: From:
14. Related to current Palm Beach County employee? Yes No
IF YES, give name, relationship & Dept./Div. employed: ________________________________________________________________________
15. Complete if position requires driving: Commercial Non-Commercial
Do you have a valid Florida Driver’s license?
Yes
Has your license ever been suspended or revoked? Yes
No
No
B
If Yes, please provide dates and explain: __________________ _________________ C
_____________________________________________________________________ Endorsements: __________________________________
16. Military Service
Do you claim Veterans’ Preference (in accordance with Chapter 55 A-7, Florida Administrative Code, and Chapter 295, Florida Statutes)? *
Preference eligibility no longer expires upon appointment of the eligible person to a position with the state or any political subdivision in the state.
Persons who were previously ineligible for preference because they held or are currently holding a job with a public employer are now eligible to use
their Veterans’ Preference again with all employers covered by law. Persons who were previously ineligible for preference because they did not
serve during an eligible wartime period may now be eligible for Veterans’ Preference if they served during Operation Enduring Freedom (beginning
October 7, 2001 – present) or Operation Iraqi Freedom (beginning March 19, 2003 – present). Operation Iraqi Freedom was renamed Operation
New Dawn effective September 1, 2010. If you are claiming Veterans’ Preference, check the applicable box.
a.
Disabled veterans who have served on active duty in any branch of the United States Armed Forces and who:
b. The spouse of any person:
c. A wartime veteran as defined in Section 1.01(14), F.S., who has served in active duty during a specified wartime period for at least 1 day
in a campaign or expedition for which a campaign badge has been authorized, including any armed forces expeditionary medal or the
global war on terrorism medal, or during one of the specified periods of wartime service; however, active duty for training is not allowed
for eligibility.
d. The un-remarried widow or widower of a veteran who died of a service-connected disability.
e. The mother, father, legal guardian, or un-remarried widow or widower of a member of the United States Armed Forces who died in the line
of duty under combat-related conditions, as verified by the United States Department of Defense.
f. A veteran as defined in Section 1.01(14), F.S., who has served in active duty as specified; however, active duty for training is not allowed for
eligibility.
g. A current member of any reserve component of the United States Armed Forces or the Florida National Guard.
Note: There have been recent additions to eligible wartime periods.
* It is the applicant’s responsibility to submit current and complete documentation with this
application.
Documentation for all applicants shall include a Veterans’ Preference Certification, FDVA form VP-1, incorporated by reference and found at
http://www.flrules.org/Gateway/reference.asp?No=Ref-06983 . Veterans, disabled veterans, and spouses of disabled veterans shall furnish a
Department of Defense document, commonly known as form DD-214 or military discharge papers, or equivalent certification from the DVA, listing
military status, dates of service and discharge type. All documents must clearly indicate that they are copies of originals. A Veterans’
Preference statement of documentation/eligibility is posted in the Human Resources Office; a copy is available upon request. If applicants
claiming Veterans’ Preference for vacant position(s) are not selected for the position(s), he or she may file a written complaint requesting an
investigation to the Florida Department of Veterans’ Affairs, Division of Benefits and Assistance, 9500 Bay Pines Blvd., Room 214, St.
Petersburg, Florida 33708, within 60 calendar days after receiving notice of hiring decision. Prior to filing a complaint, it is the responsibility of
the preference-eligible applicant to contact the designated Human Resources or other contact person at least one time after 45 days have
passed from the final date for submitting an application or the interview date, whichever is later in time, if the applicant has not received notice of
a hiring decision.
Have a presently existing service-connected disability which is compensable under public laws administered by the DVA; or
Are receiving compensation, disability retirement benefits, or pension by reason of public laws administered by the DVA and the
Department of Defense.
1.
2.
Who has a total and permanent service-connected disability and who, because of this disability, cannot qualify for employment; or
Who is missing in action, captured in line of duty by a hostile force, or forcibly detained or interned in line of duty by a foreign
government or power.
1.
2.
