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Instructions for Completing the Florida Legislative Employment Application
The Application for Legislative Employment can be accessed online using any of the latest browsers, and may be typed or hand written.
We accept electronic signatures.
•
For best results, download and fill out the application and save it in Adobe Reader, as some browsers do not allow for electronic
signatures.
•
Select the hand tool
•
Position the pointer on a form line or inside a form box. The I-beam pointer allows you to type text. The arrow pointer allows you
to select a button or check box. Use your mouse or press Tab to move between form items.
•
“Fill in” text fields have character limits. If you need more space, please attach a resume to provide that information.
•
This PDF has been extended to enable users with Adobe Acrobat Reader version 11 and greater to save their data with the
form to their hard drives. Users with earlier versions of Acrobat Reader can still fill out the form online, but when the form is
closed, the information will be erased.
•
Either print by clicking the Acrobat Print button or prepare for electronic submission.
If you are completing the application within a browser, you may not be able to sign your name electronically. In this case, you can print
the application, sign manually and scan the completed application to the email shown below. The mailing address is provided below
should you choose to mail your application.
Addresses for Submission:
The Florida Legislature Office of Human Resources
Room 701 Claude Pepper Building 111 W. Madison St.
Tallahassee, FL 32399-1400
(850)488-6803
FAX (850) 488-0780
olshumanresources@leg.state.fl.us
Equal Opportunity Employer
If an accommodation is needed for disability, please notify the Office of Human Resources
THE FLORIDA LEGISLATURE
EMPLOYMENT APPLICATION
Human Resources
Suite 701, Claude Pepper Building
111 W. Madison Street Tallahassee, Florida 32399-1400
(850) 488-6803 FAX (850) 488-0780
olshumanresouces@leg.state.fl.us
APPLICANT INFORMATION
NAME (Last, First, Middle) (Prior)
HOME / CELLULAR
TELEPHONE
MAILING ADDRESS
BUSINESS
TELEPHONE
CITY, STATE, COUNTY, ZIP
EMAIL ADDRESS
POSITION APPLIED FOR:
DATE AVAILABLE: COUNTY PREFERENCE:
ACKNOWLEDGMENTS
Please initial each of the three statements below to acknowledge you have read and understand before submitting your application
for employment.
FRS RETIREES
The Florida Legislature is a participating employer in the Florida Retirement System (FRS). Applicants who previously retired or
have taken a distribution from the FRS may be reemployed by an FRS employer only after satisfying certain required waiting periods
connected with the Investment or Pension Plans. If you have previously retired or taken a distribution from the FRS, please contact
the FRS at [1-866-446-9377 (TRS 711)] regarding the waiting periods. _________
OUTSIDE EMPLOYMENT
A candidate hired by the Florida Legislature is required to obtain prior approval for outside employment. If your request for approval
is denied, you will have to resign from your outside employment in order to remain employed by the Legislature. ___________
EMPLOYMENT RESTRICTIONS
Employees of the Florida Legislature are subject to the provisions of Section 11.26, Florida Statutes. Certain positions within the
Legislature may also be subject to the post-employment prohibitions described in Section 112.313(9) which applies employment
restrictions for two years after Legislative employment. __________
SCHOOL
DID YOU
GRADUATE?
NAME AND ADDRESS
DEGREE
RECEIVED
MONTH/
YEAR
GRADUATED
IF NO
DEGREE,
# OF HRS.
EARNED
YES
NO
QTR
SEM
High School
College/
University
Graduate/
Professional
Other
LICENSES • CERTIFICATIONS • SPECIAL SKILLS
Please indicate typing, computer/word-processing skills, foreign language proficiency, professional or occupational licensure you
currently possess. Please provide a copy of certifications and licensures with the application.
Has any disciplinary action ever been taken against your certificate or license? YES ____ NO ____
EDUCATION
Pursuant to Joint Policy and to verify education, once employed you must submit an official college transcript
reflecting the highest level of education and/or coursework completed or conferment of degree to Human
Resources.
INDICATE highest grade completed:
1 2 3 4 5 6 7 8 9 10 11 12 GED College 1 2 3 4 5 Graduate School 1 2 3 4 5
EMPLOYMENT HISTORY
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. 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 but
completion of this form is required.**
Present or Most Recent Employer
If currently employed, may we contact your employer? Yes ____ No ____
Employer: Supervisor:
Address: Supervisor’s Title:
City, State, Zip: Phone number:
Employment Dates: / / to / /
MONTH DAY YEAR MONTH DAY YEAR
Hours per week: Check box if Volunteer work: Ending Salary:
Position Title:
Primary Duties:
Reason for leaving or seeking other employment:
Next Previous Employer
Employer: Supervisor: ___________________________
Address: Supervisor’s Title: ____________________
City, State, Zip: Phone number: ____________________
Employment Dates:
/ to
/ /
MONTH DAY YEAR MONTH DAY YEAR
Hours per week: Check box if Volunteer work: Ending Salary:
Position Title:
Primary Duties:
Reason for leaving or seeking other employment:
Next Previous Employer
Employer: Supervisor:
Address: Supervisor’s Title:
City, State, Zip: Phone number:
Employment Dates: / / to / /
MONTH DAY YEAR MONTH DAY YEAR
Hours per week: Check box if Volunteer work: Ending Salary:
Position Title:
Primary Duties:
Reason for leaving or seeking other employment:
/
Next Previous Employer
Employer: Supervisor:
Address: Supervisor’s Title:
City, State, Zip: Phone number:
Employment Dates: / / to / /
MONTH DAY YEAR MONTH DAY YEAR
Hours per week: Check box if Volunteer work: Ending Salary:
Position Title:
Primary Duties:
Reason for leaving or seeking other employment:
Next Previous Employer
Employer: Supervisor:
Address: Supervisor’s Title:
City, State, Zip: Phone number:
Employment Dates: / / to / /
MONTH DAY YEAR MONTH DAY YEAR
Hours per week: Check box if Volunteer work: Ending Salary:
Position Title:
Primary Duties:
Reason for leaving or seeking other employment:
Next Previous Employer
Employer: Supervisor:
Address: Supervisor’s Title:
City, State, Zip: Phone number:
Employment Dates: / / to / /
MONTH DAY YEAR MONTH DAY YEAR
Hours per week: Check box if Volunteer work: Ending Salary:
Position Title:
Primary Duties:
Reason for leaving or seeking other employment:
RELATIVES
Please list the names and relationships of relatives* who are a member of the Legislature, a legislative employee, a lobbyist, a
member of the Florida Cabinet or the Governor, a key Cabinet aide, the head of an executive branch department or an appointed
secretary or executive director.
Name: Relationship: Office:
Name: Relationship: Office:
*”Relative” is defined as: Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife,
father-in-law, mother- in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson,
stepdaughter, stepbrother, stepsister, half-brother, or half-sister.
LEGAL HISTORY
A criminal history record check will be conducted prior to hiring.
HAVE YOU EVER BEEN CONVICTED OR PLED NOLO CONTENDERE TO A FELONY OR A FIRST DEGREE
MISDEMEANOR? A conviction includes a plea of guilty, a guilty verdict, or finding of guilt, regardless of whether the sentence is
imposed or adjudication is withheld. YES ____ NO ____
If “YES”, what were the charges?
Where were you convicted (city and state)?
Date of Conviction:
A “YES” answer to this question 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 [see §112.011, F.S.].
REFERENCES
Please list three references excluding relatives and former employers. Include the name, phone number, and email address.
Name
Phone
Email
1.
2.
3.
EMPLOYMENT ELIGIBILITY
The Florida Legislature hires only U.S. citizens and lawfully authorized alien workers. If hired you will be required to provide identifi-
cation and either proof of citizenship or proof of authorization to work in the U.S.
Are you legally eligible to work in the United States? YES ____ NO ____
EXEMPTION FROM PUBLIC RECORDS DISCLOSURE
Are you a current or former law enforcement officer, other covered employee**, or the spouse or child of one, whose information
is exempt from public records disclosure under section 119.071(4)(d), Florida Statutes ? YES ____ NO ____
**Other covered jobs include but are not limited to: 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 inves ti-
gators in the Department of Children and Families [see§ 119.071.F.S.].
SELECTIVE SERVICE
Section 110,1128, Florida Statutes, prohibits employment by the State (including re-hire after a break in service) of any male born
after October 1, 1962, who failed to register with the Selective Service System, under the provisions of the U.S. Military Selective
Service Act, during the person’s period of eligibility (ages 18 through 25). Additionally, if currently employed by the State, this law
prohibits the promotion of such person.
IF YOU ARE A MALE BORN AFTER OCTOBER 1, 1962, HAVE YOU REGISTERED WITH THE SELECTIVE SERVICE OR DO
YOU HAVE PROOF OF AN EXEMPTION FROM THIS REQUIREMENT (DOCUMENTATION MAY BE REQUIRED)?
YES ____ NO ____ Not Applicable ____
AUTHORIZATION AND CERTIFICATION
I hereby authorize the Florida Legislature to verify all information contained in this application and supplement hereto. I consent to the
release of any information regarding my eligibility for legislative employment by employers, educational institutions, law enforcement
agencies, personal references or other organizations.
I certify that the above statements are true and complete to the best of my knowledge. I further understand that any
misrepresentations or false statements made by me on this application, or any supplement hereto, may be grounds for immediate
discharge and/or rejection from consideration for further employment. If employed, I understand that my employment and
compensation can be terminated with or without cause and with or without notice at any time at the option of either the Legislature
or myself.
Signature: Date:
Manual or electronic signatures are accepted.
All employment applications, pursuant to legislative policy, are available for review by the public.
Rev 4/2021
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