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Fort Walton Beach Council agenda — 02-28-06 (workshop) — reading text
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Application
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Present Address ( Street. City, State, Zip Code)
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Telephone No. ( Work. Other) ( Home) - E- mail Address
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Valid Driver' s License [ r....
rYES [ ] NO CDL [ ] please specify class
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Position for Which Yon are Applying
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L i s t Only One Position Per Application)
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Are you seeking [ t-
1Full Time [ ] Part Time [ ] Seasonal
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Are you able to work the hours required by the position? ~~ ES [ ] NO
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Have you ever filed an application with the City before? [ YES [ 1,fNO If Yes. give date( s) / f/! 1
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Have you ever been employed with the City before? [] YES [~ O If Yes, give date( s) / l/ Il
J; Do you have any relatives currently employed by the City? [ ] YES F-1'
No If Yes, give name( s) / V! f
0 Are you under the age of 18? [ YES [ t,
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1' If Yes, give date of birth / f," t/f
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Are you legally authorized to work in the U. S.? U-1'[ ]
YES NO
W If a conditional offer of employment is made, you will be required to provide identification and proof of citizenship or authorization to
work in the United States.
The City of Fort Walton Beach is a Drug- Free Workplace Employer and requires applicants and employees to submit to Drug
Testing. The City is an Equal Employment Opportunity Employer and will consider all applicants for all positions without regard
to race. color, religion, creed, gender, national origin. age. disability. marital or veteran status. or any other legally protected status.
Individuals who require accommodations in order to complete the employment application process should contact the Human
Resources Director at the phone number, e- mail or mailing address listed above.
How did you hear about this position?
LJI Jobline ~ paper B Website lJI Employe /Friend [ Other
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en Please list any knowledge, skills, and abilities you possess and believe relevant to the position you seek, such as
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I operating equipment (specific types), computer skills ( specific programs), typing wpm, dictation, etc.
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en Please list three persons, other than relatives who have knowledge of your work experience and/ or education.
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NAME & ADDRESS 0\'("',>1 ~ ,} C.fV'/.{
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DCCUPATlON PHONE NUMBER
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