EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION
Wesley Davis, Indian River County Property Appraiser

1800 27th Street

Vero Beach, Florida 32960

772.226.1469

It is the policy of Indian River County Property Appraiser to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability, martial status, genetic information, or veteran status.
Applicant Information
Applicant First, Middle, and Last Name*
Address*

Permanent Home Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Number of years at this address*
Daytime Phone*
Mobile Phone*
Social Security Number*
Driver's License (State/Number)*
Emergency Contact
Who should be contacted if you are involved in an emergency?
Contact Name*
Relationship to you*
Address*

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Daytime Phone*
.
Mobile Phone*
Job Position Applied For: Full or Part Time?
Job Position Applied For*
Full or Part Time?*
Salary Desired*
per*
Who referred you to our company?*
Do you have any friends or relatives who work here? If yes, please list here:*
Have you applied to our company previously? If yes, when, for what position, and were you hired. If not hired, please give reason, if you know?*

YesNo
Reason*
Are you at least 18 years old?*

YesNo
How will you get to work?*
If applicable, are you available to work overtime?*

YesNo
If you are offered employment, when would you be available to begin work?*
If hired, are you able to submit proof that you are legally eligible for employment in the United States?*

YesNo
Have you ever been convicted of a felony or misdemeanor?*

YesNo
Convicted of*
Date*

MonthDayYear
Date
Convicted City*
Convicted State*
Disposition *
Have you ever been charged with a crime and either been placed on a court ordered probation, had adjudication withheld, or entered a pre-trial intervention program?*

YesNo
If yes, give details*
Date*

MonthDayYear
Date
Deposition City*
Deposition State*
Disposition*
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.
Applicant Employment History
List your current or most recent employment first. Please list all jobs (including self- employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.
Employer Name*
Supervisor Name*
Address*

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Job Duties*
Salary*
Reason for Leaving*
Dates of Employment (Month/Year)*

MonthDayYear
Date
Employer Name*
Supervisor Name*
Address*

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Job Duties*
Salary*
Reason for Leaving*
Dates of Employment (Month/Year)*

MonthDayYear
Date
Employer Name*
Supervisor Name*
Address*
City/State/ZIP*
Job Duties*
Salary*
Reason for Leaving*
Dates of Employment (Month/Year)*

MonthDayYear
Date
Did you work for any of these employers under a different name?*

YesNo
If yes, which employer(s) and under what name(s)?*
Please explain any gaps in your employment history*
Have you received any written reprimands or disciplinary suspensions during any previous employment?*

YesNo
Education and Training
High School/GED Name and Address*
College/University Name and Address*
Trade, Business, or Correspondence School Name and Address*
Other (including Graduate School)*
Did you receive a degree?*

YesNo
If yes, degree(s) received:*
Please indicate any current professional licenses or certifications you hold:*
Awards, Honors, Special Achievements:*
Military Service*

YesNo
If Yes, please provide the years of service, branch of service, military occupational specialty, and the highest rank achieved:*
Specialized Training*
Employment in this office will require a copy of DD-214.
DD-214 Upload

Cancelof
Veteran's Preference

Complete this section only if you are claiming Veteran's Preference
Have you entered covered employment by a covered employer after having claimed preference since October 1, 1987?*

YesNo
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. Veteran of a wartime era - Requires (A) DD214 or other document showing dates of service and type of discharge.

2.Disabled Veteran - Requires (A) and (B) letter of service-connected disability from the V.A.

3.Veterans' Widow - Requires (A) and marriage and death certificates, and statement saying not remarried.

4. Disabled Veterans' 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 disable veteran cannot qualify for employment because of disability.

5.Permanently Disabled Veteran - Requires (A) indicating veteran is permanently disabled, or (A) and letter from V.A., indicating the veteran is permanently disabled.

6. Receipt of any Armed Forces Expeditionary Metal - Requires (A) DD214.

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 compliant addressed to the Division of Veterans' Affairs, POB 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 (2) 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. Elected Officials

2. Board and Commission Members

3. Department Heads

4. Personal secretary of each such office or appointee

5. Temporary employee for the purpose of conducting special studies

6. Positions filled internally by means of promotion, demotion or reassignment
References

List any three (3) persons not related to you, whom you have known at least one (1) year:
Name*
Address*

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Relationship*
Name*
Address*

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Relationship*
Name*
Address*

Address

Street Address Line 2

City/State/ZIPState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Relationship*
Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer*
Background Check Information
Driving Record: Do you have a valid driver's license?*

YesNo
What class of license do you possess?*
List driver's license number and state*
Have you had a suspension or probation of your license within the last five (5) years?*

YesNo
How many speeding or other moving violations have you received in the last three (3) years?*
List below all traffic violations (except parking) on your record for the last five (5) years and all motor vehicle accidents in which you were involved (use additional page if necessary)
Date*

MonthDayYear
Date
Location*
Description*
Result*
Date*

MonthDayYear
Date
Location*
Description*
Result*
Date*

MonthDayYear
Date
Location*
Description*
Result*
I certify that the information provided on this application is truthful and accurate.I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Indian River County Property Appraiser to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate relevant information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Property Appraiser, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Indian River County Property Appraiser, except in a specific written contract of employment signed on behalf of the organization by its Property Appraiser, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
APPLICANT SIGNATURE*

Clear
DATE*

MonthDayYear
Date
Email*
example@example.com
Should be Empty:

EMPLOYMENT APPLICATION

Applicant Information

Emergency Contact

Applicant Employment History

Education and Training

Veteran's Preference

References

Background Check Information