Job Application

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CITY OF LAKE MARY 
100 N. COUNTRY CLUB RD 
MAILING ADDRESS: P. O. BOX 958445 
LAKE MARY, FL 32795-8445 
PHONE 407-585-1445 
 
EMPLOYMENT APPLICATION 
This City is an Equal Opportunity Employer in compliance with the laws prohibiting discrimination on the basis 
of race, color, sex, age, marital status, religion, national origin, disability or any other legally protected status. 
Applicant Data

Proof of citizenship or immigration will be required upon employment.

Additional Information

Have you ever had an offense against the law (misdemeanor/felony) where you were found guilty, where
charges are pending adjudication, where you pled guilty or nolo contendere, where adjudication was withheld,
or where you were placed on probation or a supervised program? You do not have to consider charges that
were dropped or of which you were found innocent. If yes, state court, case no., and year below.
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.

Education and Training
High School
College
Vocational/Certificate
Technical
Other
Professional Licenses/Certification(s)
Personal References

List three (3) references (not relatives, former or present employers, fellow employees, or school teachers).

Work History

YOU MUST COMPLETE THE WORK HISTORY SECTION OF THIS APPLICATION. LIST YOUR CURRENT OR MOST RECENT EMPLOYER FIRST. PLEASE INDICATE YOUR EMPLOYMENT HISTORY FOR THE PAST TEN (10) YEARS OR LAST FIVE (5) EMPLOYERS. INCLUDE VOLUNTARY UNPAID WORK EXPERIENCE AS WELL AS MILITARY SERVICE, IF ANY. IF DESIRED, INCLUDE A RESUME OR ADDITIONAL PAGES WHICH WILL HELP CLARIFY YOUR WORK EXPERIENCE.

Present Employer
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Previous Employer
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Previous Employer
$
$
Previous Employer
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$
Previous Employer
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Certification

The City of Lake Mary is authorized to verify any or all of the information contained on the application form. A false answer to any question(s) in this application may be grounds for non-selection or for termination after you begin work. All statements are subject to investigation, including a check of your training and experience statements. All information you give will be considered in reviewing your application and is subject to public inspection in accordance with the Florida Public Records Law, Chapter 119, Florida Statutes.

I hereby certify that all statements made in this application are true and I agree and understand that any
misstatement, misrepresentation, falsification or omission of facts shall cause forfeiture of all rights to employment with the City of Lake Mary. If accepted for employment I agree to abide by and comply with all rules, regulations,
policies and procedures of the City of Lake Mary. I further understand and agree that my employer has the right to terminate my employment during my initial probationary period. I understand that no representative of the employer has any authority to enter into any agreement with me contrary to the rules, regulations, policies and procedures of the City of Lake Mary.

I freely and voluntarily agree to submit to a drug/alcohol test as part of my application for and as a condition of
employment. I understand that either my refusal to submit to the drug/alcohol test or my failure to qualify according to the minimum standards established by the City of Lake Mary for this examination will disqualify me for further consideration for employment.