Fort Walton Beach Council agenda — 10-26-11 special attorney — reading text

you have any relatives currently employed by the City? YES FrNO cc M1 EE O Are you under the age of 18? YES O' NO N S'EP 2011 uu nn LRLR Are you legally authorized to work in the U. S.? DYES NO N ai RECfiVEe WaRnn Sear ii QQ W pg lflorkation rizat Res to our woil IPoCOnStates offer of employment is made, you will be required ro provitle identification and proof of citizenship United states. 8! _ TheThe CityCity ofof FortFort WaltonWalton BeachBeach isis aa DrugDrug - - FreeFree WorkplaceWorkplace EmployerEmployer andand requiresrequires applicantsapplicants andand employeesemployees toto submitsubmit toto DrugDrug Testing,Testing, TheThe CityCity isis anan EqualEqual EmploymentEmployment Opportunity Opportunity EmployerEmployer andand wil wil considerconsider allall applicantsapplicants forfor allall positionspositions withoutwithout regardregard toto race,race, color,color, religion,religion, creed,creed, gender,gender, nationalnational origin,origin, age,age, disability,disability, maritalmarital oror veteranveteran status,status, oror anyany otherother legallylegally protectedprotected status.status. IndividualsIndividuals whowho requirerequire accommodationsaccommodations inin orderorder toto completecomplete thethe employmentemployment applicationapplication processprocess shouldshould contactcontact thethe Administrative Administrative Services Services DirectorDirector atat thethe phonephone number,number, e-e- mailmail oror mailingmailing addressaddress listedlisted above.above. HowHow diddid youyou hearhear aboutabout thisthis position?position? NewspaperNewspaper 11 WebsiteWebsite 7171 EmployeelFriend EmployeelFriend JobJob FairFair  Please list any knowledge, skills, and abilities you possess and believe relevant to the position you seek, such as operating equipment (specific types), computer skills ( specific programs), typing wpm, dictation, etc. D.& a'- a atR Please list three persons, other than relatives who have knowledge of your work experience and /or education. HIGH SCHOOL COLLEGE UNIVERSITY OR PROFESSIONAL SCHOOL Select highest grade completed: 1 2 3 4 5 6 7 B 9 10 11 [ X 12 2 3 lY 4 Graduate School: 1 2 3 4 Z College: 1 Received Diploma? [ E' YES NO QI Highest Degree Attained: i Year Received: Name of School City State Degree, Major or Type of Course r jt- Z, Ly JOB RELATED TRAINING AND COURSE WORK (Please provide institution name, location and dates) of attendance) 1'-w. L'.Q e.¢ JLPP -E h1J C- - c > t2.- 0. Have you ever ban discharged from employment because your work or conduct as not snisfnevi. DYES [ VJNO Have you ever been convicled ora criminal Drug of Alcohol Offense? YES ltd NO ryes, please give duties and explanation: Have ymu ever been convicted ofa felony? YES 2/ NO Ifyes, pleaselisteachofifica : An affirmative answer will not automatically disqualify you from being considered as a candidate for en, loymot.  Please list all current and /or previous employment. Begin with your current or most recent position and list all previous positions in chronological order. If additional space is needed please submit supplemental sheets, resumes may be included. May we contact this employero YES NO If No, explain: Employer Name: 1 Dates of Employment: Address: r I Phone Number: Puce - 4ce Supervisor' s Name: Salary ( Begin & Ending): Full Time Part Time Reason for Leaving: Position Held: Duties/ Responsibilities: Employer Name Dales of Employment of Address Phone Number: O i Supervisor' s Name rn Salary (Begin & Ending): Full Time Part Time Reason for Leaving: Position Held: Duties /Responsibilities: H 2 W Employer Name: Dates of Employment: Address: Phone Number: I O Supervisor' s Name. Salary ( Begin & Ending): Cl- Full Time Part Time Reason for Leaving Position Held: W Duties /Responsibilities: Employer Name Dates of Employment li Address Phone Number i Supervisors Name Salary ( Begin & Ending): Full Time 13 Part Time Reason for Leaving Position Held. Duties/Responsibilities: PacketPacket Pg.Pg. 66  Please include any additional STATEMENTS OF AFFIRMATION AND AUTHORIZATION c AFFIRMATION AUTHORIZATION I understand that any employment offer will be I authorize and consent to every person, firm, company, m"30 corporation, governmental agency, medical facility or c contingent upon the successful completion of a pre - placement medical examination and background practitioner, association, court, school, college, university or m investigation. As a part of the City' s requirement for a institution having control of any documents, records and other rn work force free from drugs, the pre -placement medical information pertaining to me, to furnish such information, upon examination will include a drug /alcohol test. request by The City of Fort Walton Beach. I do also authorize m 9 the National Personnel Records Center and /or Army /Navy/ To the best of my knowledge all information on this c Marine /Air Force /Coast Guard or their reserve components, [ o application is true and correct. I understand any false statements, representations, or failure to disclose release . information in their files about me to the City or its U