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  1. This City is an Equal Opportunity Employer in compliance with the laws prohibiting discrimination on the basis of race, color, gender, age, marital status, religion, national origin, disability, genetic information, Veteran status or any other legally protected status.

  2. Applicant Data
  3. Are you claiming Veterans' Preference?
  4. Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?*

    Proof of citizenship or immigration will be required upon employment.

  5. Additional Information
  6. Are you 18 years of age or older?*
  7. Have you ever been discharged from any job for any reason including but not limited to misconduct or unsatisfactory service? If yes, explain*
  8. Have you ever resigned to avoid discharge for any reason including but not limited to misconduct or unsatisfactory service? If yes, explain*
  9. Have you ever worked under a different name? If yes, explain*
  10. Have you ever filed an application for employment with the City of Lake Mary? If yes, indicate approximate date(s)*
  11. Have you ever been employed by the City of Lake Mary? If yes, indicate date(s) of employment, position(s), and reason for leaving*
  12. Are any members of your family or relatives (by blood or marriage) employed by the City of Lake Mary? If yes, indicate their name(s), position, and relationship*
  13. Have you ever had an offense against the law?*

    Have you ever been convicted 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.

  14. Have you received a ticket or been charged with any traffic violation(s) during the past seven years? If yes, explain*
  15. Education & Training
  16. Did you complete high school*
  17. High School
  18. Did you Graduate?
  19. College
  20. Did you Graduate?
  21. Vocational/Certificate
  22. Did you Graduate?
  23. Technical
  24. Did you Graduate?
  25. Other
  26. Did you Graduate?
  27. Professional Licenses/Certification(s)
  28. Do you possess a valid driver's license?*
  29. Specific Skills (related to position applied for)
  30. Personal References

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

  31. 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 years or the last five 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.

  32. Present Employer
  33. May we contact employer?
  34. Full Time or Part Time
  35. Previous Employer
  36. May we contact employer?
  37. Full Time or Part Time
  38. Previous Employer
  39. May we contact employer?
  40. Full Time or Part Time
  41. Previous Employer
  42. May we contact employer?
  43. Full Time or Part Time
  44. Previous Employer
  45. May we contact employer?
  46. Full Time or Part Time
  47. Veterans' Preference Certification

    Section 295.07(1), Florida Statutes, provides for Veterans’ Preference in employment appointment and retention, if qualified under one of the following categories, and not exempt under Section 295.07(4), Florida Statutes. Section 295.09, Florida Statutes, also provides Veterans’ Preference for reinstatement, reemployment, and promotion. If you seek Veterans’ Preference, please “check” the appropriate box, and provide this form and documentation of your status with your employment application.

  48. I certify that I am qualified to claim Veterans' Preference.
  49. I certify that I am qualified to claim Veterans’ Preference under the category checked
  50. 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.

  51. Leave This Blank:

  52. This field is not part of the form submission.