~ It b important that you answer an questions on thb application fully and truthfully, as fan1n'e to do 80 may dejay comderation for employment or result in loss of employment opportunities. If an item does not apply to you, write NA (not applicable). PLEASE TYPE OR PRINr IN ~ Human Resources 16000 Cmlmberlin Parkway, Suite 8671 Fort Myers, Florida 33913-8899 Phone: (239) 768-4974 Fax: (239) 768-4939 PERSONAL APPUCAll0N FOR ~OYlvlENT YOU MUST SHOW ORIGINAL SOOAL SECURnY CARD PRIOR TO EMP[.O'VMHNT Equal Opportunity/Affirmative Action Bmployer/Drug-Free WorkpJace Lee County Port Authority co~lies with local, state and federal equal employment opportunity guidelines which prohibit discrimination based on race, religion, sex, color, national origin, disability, age and manta! status. If}Uu need assistance or accommodation ill the applicant process, please contact Human Resources at the number listed above, Lee County Port Authority is an At Will I:mployer. Social Security No.: Last Name: First: Middle: Home Phone: Street : City, State, Zip Code: Work Phone: Message Phone: no I Have you ever worked for us before? List any relatives working for us Ii yes, when?, "Ever had a driver's license revoked? /:1 yes /:1 no If yes, explain: FOR OFFICE USE ONLY
4. 5. EDUCAllON Circle highest grade completed: Grade School 1,2,3,4,5,6,7,8 High School 9,10,11,12 College 1, ~~, 3, 4, Graduate 1,2,3,4 If you received a GED, indicate issuing authority: School Name & Location Graduate? Major Subject Degree::~~~~ High School College a yes a no a yes a no Vocation/ Business Q yes Q no Other Q yes Q no Certifications :MILlT AR Y Have you ever served in the armed forces? Q yes a no If yes, what Branch? Tours of Duty roo day yr mo day yr VE'IERANS' PREFERENCE (Complete this section ~ if you are claiming Veterans' Preference.) Have you entered into covered employment by a covered employer after having claimed preference since October 1, 1987? Q yes Q no. If yes, give name of employer: If you claim Veterans' Preference~ check the type below. Attach copies of the required documents to your application to support your claim. (Documents will not be returned.) 1. 0 Veteran of a wartime era -Requires (A) 00214 or other document showing dates of service and type of discharge. 2. a Disabled Veteran -Requires (A) and (8) letter of service-connected disability from the V.A. 3. a Veteran's Widow -Requires (A) and marriage and death certificates, and statement saying not remarried. Q Disabled Veteran's Spouse -Requires (A) and (B), evidence of marriage to the veteran, a statement that the spouse is still married at the time of application, and proof that the disabled veteran cannot qualify for employment because of disability. Q Permanently Disabled Veteran -Requires (A) indicating veteran is permanently disabled, or (A) and letter from V.A. indicating that the veteran is permanently disabled. Veterans' Preference documentation must be submitted at the time of initial application. If any preference-eligible applicant claiming Veterans' Preference for a vacant position is not selected for the position, they have the right to an investigation by the Division of Veterans' Affairs if a non-preference-eligible applicant is appointed to a position. In order to commence the investigation, the applicant must file a written complaint addressed to the Division of Veterans' Affairs, P.O. Box 1437, St. Petersburg, FL 33731. A complaint shall be filed within 21 days after notice of a hiring decision. If a notice of a hiring decision is not given, :it is the responsibility of the veteran to contact the employer within two months of the application to determine if the position has been filled. For further information, contact the Department of Veterans' Affairs. NOTE: Veterans' Preference pertains to all positions, except the following: 1. Department Heads 6. Positions filled internally by means of promotion, 2. P~r~o.nal S~cretary of each. such of~ice or ~~pointee demotion or reassignment 3. DIVIsIon DIrectors and Policy-making positions 7. Elected Officials 4. On-call and temporary position...8. Board and Commission members 5. Temporary employee for the purpose of conducting special studies
EMPLOYMENT nns SECl'ION MUST BE CO~TED, REGARDLESS OF WHE'nIER OR NOT A RFSllJMB IS ATTAaIED. Beginning with your PRESENT or most recent employment, list in REVERSE ORDER ALL periods of employment. Each time you changed jobs or your title changed should be listed as a separate period. Be sure to describe your military experience, if any. Describe in detail your specific duties, beginning with your primary duties. (Attach additional sheets, if necel.sary.) 1. Employer FROM TO Total Month Year Month Year Months If part-time, Beginning Salary hours per week- $ per $ per 2. Employer Describe your duties in detail; Your Official Job Tille! I (Phone number ' Month FROM Year Month TO Year Months Total If ~t-time, I Beglnmng.. Salary hours per week- $ per $ per This section is continued on the back of the application.
Employer Your Official Job Tide FROM Month Year TO Month Year Beginning Salary $, per S per 5. Empl~r FROM TO Months Olal If ~-time, Month Year Month Year Beginning Salary hours per week- $ per $ per Why do you feel you are qualified for this position? APPliCANT'S CERTIFlCA1l0N AND AGREElvfEN1' Pursuant to Chapter 119, Fla. Statutes, and the procedure adopted by the Lee County Port Authority, personnel re,cords and job applications shall be open for a personal inspection by any person.agrbhmbnfs: PROBA:fION PERIOD -It is understood that I shall be considered a probationary employee for no less than six months but no longer than 1 year from date of hire. I may be discharged or laid off before the expiration of that period without recourse, in accordance with Lee County Port Authority Policies and Procedures. (ARFF -1 Year Probationary Period).AT wn.l STA~ -I understand the'~ County Port Authority is an At Will employer, meaning that I am free to end the employment relationship at any time, with or without cause, and that the Lee County Port Authority is entitled to do the same. STATF1.mNT BY APPUCANr -I Ieeby authorize my former employers to furnish their records of any service, my reason for leaving their employ, together with all empkjymeni-re1atal inrt.'j1nation they may have concerning me. I also authorize educational institutions to furnish their records of education-related information they may have oork'emiilg me. It is Bgn!ed that any misrepresentations by me in this application, including omission of information, will be sufficient cause for its cancellation or for dismissal from the Port Authority's e:vice, if I am empklyed. I hereby certify the facts set forth in the above employment application are true and complete to the best of my kno\idedge. List previous last names Signature of Applicant Date M4.! Thank you for completing this application form and for your interest in employment with Lee County Port Authority.
Pursuant to Chapter 119, Florida Statutes, job applications, employment files & records are considered public documents open to inspection. Please Read Carefully Before Signing APPLICANT'S CERTIFICATION AND AGREEMENT I UNDERSTAND AND AGREE that, except as specifically prohibited by law, ordinance or regulation, Lee County Port Authority policies and procedures do not create or imply any property rights in employment; and that employrnent may be terminated "at will" by either the employee or the Lee County Port Authority with or without cause. I CERTIFY that all information on this employment application, in related documents and in all interviews is true and correct. I understand that Lee County Port Authority may make a thorough investigation of my character, reputation, past employment and other relevant history. I authorize the giving and receiving of any such information requested by Lee County Port Authority and hereby relieve and release all former employers and their agents of any liability for any information they may give to Lee County Port Authority. I hereby waive any rights or claims I may have whether present fully developed 01; not against Lee County Port Authority or its agents or employees arising out of or resulting from the release, authorized or unauthorized, of information received pursuant to or in connection with Lee County Port Authority's handling, processing, investigation, etc., of my application for employment with Lee County Port Authority. I UNDERSTAND that if hired, I will be placed on a 6-month probationary period. (ARFF -1-year probationary period) I further understand that if in accordance with the Florida Statutes, Section 443.131(3)(a)(2), I am terminated for unsatisfactory work performance within three months, Lee County Port Authority shall not be charged for any unemployment benefits paid to me. I AGREE that if the Lee County Port Authority employs me, a future potential employer may contact the Lee County Port Authority or its representatives concerning my work record and my work performance at the Lee County Port Authority. I understand that all information provided in my personnel file is subject to public inspection pursuant to Chapter 119, Florida Statutes, unless a specific statutory exemption exists. I AGREE to submit to any appropriate testing, including to determine the presence of alcohol or illegal controlled substances in my body, under whatever policies or procedures Lee County Port Authority has in effect at the time testing is required. I AGREE to pre-employment testing if requested and understand that failure to meet any job-related medical and/or health requirements for the positions may prevent employment by Lee County Port Authority. I UNDERSTAND that all employees who do not have a written employment contract with a limited and specified duration are employed at the will of Lee County Port Authority and that all offers of employment are contingent upon successful completion of all background investigations and acceptable driving records (if driving is required as a function of the position); which may include, but are not limited to, employer and non employer references and, where applicable, pre-employment testing. I UNDERSTAND that Lee County Port Authority will not tolerate sexual and any other form of unlawful harassment. I understand that I have the affirmative obligation to report incidents and participate in any investigation as requested. I also understand that unlawful harassment is grounds for disciplinary action up to and including immediate dismissal. I UNDERSTAND that falsification of any information so given or other information that, either singly or cumulatively, would tend to negatively impact the hiring decision discovered as a result of any background check or investigation may be grounds for not hiring an applicant or may subject me to immediate dismissal if employed. I AGREE that if hired by Lee County Port Authority, upon termination of employment, shall returl1 all Port Authority property. Applicant Name (PRINT CLEARLY): Previous rlame(s): Signature: Date: