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

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 vv To the best of my knowledge all information on this the National Personnel Records Center and /or Army /Navy/ application is true and correct. I understand any false Marine/Air Force /Coast Guard or their reserve components, to OmOm statements, representations, or failure to disclose release information in their files about me to the City or its pertinent information is sufficient cause for dismissal from authorized agents. 0N the City' s employment if hired. This Authorization will serve as a release of any and all I understand that an offer of employment is not an information and for this purpose a photo copy shall be e0 employment contract and that either the City or I may considered an original and valid . terminate the employment relationship at any time. I have read and fully understand the contents of this uu statement of "Authorization ". Qaw3m Applicant' s Signature: William D. Wells Applicant' s Signature: William D. Wells Date: September 29, 20 11 1 Date: September 29, 2011 If eligible, which Veteran' s Preference category are you claiming? ee Please Indicate number from Veteran' s Preference Category form) N0 FOR OFFICE USE ONLY —APPLICANT PLEASE DO NOT WRITE IN SECTIONS BELOW Human Resources Department Hiring Department cmcEumL Date Application Entered: 09- 2c)- 11 Date Application Interviewed: 66 Applicant' s Status ( please check appropriate box) Log Book Postcard Receipt S Applicant selected Entered by ( initials): N Did not show for interview I Insufficient applicable experience Forward to: AA r-, All PQr n 5 Q Does not meet minimum qualifications M Better matched candidate was chosen Department: P 0-1 I N AAA i ctq cr R lob was offered but rejected B Not best qualified Dale Returned: Comments: Filed By: Interviewer' s Initials: PacketPacket Pg.Pg. 1818  City Council of Fort Walton Beach 0 To: CITY MANAGER MEMORANDUM Robert T. Meams, City Manager From: Carole Jones, Executive Assistant Date: October 26, 2011 Subject: Discussion by Mayor /Council 611 W V:Cy 117134C0Ik E Attorney Applicant Vote Summary ( PDF) SIGNATURE BLOCK: Carole Jones Completed 10119/ 20114:08 PM Carole Jones Completed 10/ 19/ 20114: 08 PM City Manager Completed 10/ 20/20112: 39 PM City Council Pending Packet Pg. 19 OZ' Bd laH ed F- M o p m D D n a m m y 3 F F3 D 31 uy o d o FD m w x x x x x 3 N O NO N X X X X O w X x x X X 10O3N x x mm0N OO6f 0Zw0 x m 0 a x x x x pnF ti Dr e