An Equal Opportunity Employer

The City of Atlantic Beach is an equal employment opportunity employer. The City, in its employment practices, does not discriminate on the basis of race, color, age, creed, religion, sex, national origin, disability, marital status or other classification prohibited by State or Federal Law. No information should be given in this application which would violate State or Federal Law. The city supports a drug free work place. Drug testing is conducted.

Position Information

Position applying for:*

Date of Application:*

General Information

Name:*

Nickname:

Street Address:*

City:*

State:*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip:*

Home Phone Number:*

Email Address:

Have you ever been employed by Atlantic Beach?*

Yes

No

If yes, give dates and positions:

Are you eligible to work in the United States? (Verifications will be required before employment)*

Yes

No

Are you over the age of eighteen?*

Yes

No

Have you ever been convicted of a crime?*

Yes

No

If yes, please describe the type of crime, date of conviction, and penalty:

Have you ever been defended, or convicted, in a civil case for intentional wrongdoing?*

Yes

No

If yes, please explain the nature of wrongdoing and the outcome of the case:

If selected for employment, when would you be available to start work?*

Do you have any relatives working for Atlantic Beach?*

Yes

No

If yes, give name(s) and relationship(s):

If position requires driving, please provide your driver license number:

Driver's License State of Issue:

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Do you use or have you used tobacco products within the past twelve months:*

Yes

No

Employment History

List your employment for past ten (10) years, starting with the most current.

Current Employment

Present Employer:*

Date of Employment:

From:*

To:*

Title/Position Held:*

Pay Rate:*

Address:*

Telephone Number:*

Supervisor's Name:*

Summarize the nature of work performed and job responsibilities:*

May we contact?*

Yes

No

Reason for leaving:*

Prior Employment

Prior Employer:*

Date of Employment:

From:*

To:*

Title/Position Held:*

Pay Rate:*

Address:*

Telephone Number:*

Supervisor's Name:*

Summarize the nature of work performed and job responsibilities:*

May we contact?*

Yes

No

Reason for leaving:*

Prior Employment

Prior Employer:*

Date of Employment:

From:*

To:*

Title/Position Held:*

Pay Rate:*

Address:*

Telephone Number:*

Supervisor's Name:*

Summarize the nature of work performed and job responsibilities:*

May we contact?*

Yes

No

Reason for leaving:*

Prior Employment

Prior Employer:*

Date of Employment:

From:*

To:*

Title/Position Held:*

Pay Rate:*

Address:*

Telephone Number:*

Supervisor's Name:*

Summarize the nature of work performed and job responsibilities:*

May we contact?*

Yes

No

Reason for leaving:*

Education

Select last year of school completed:*

Select One 9 10 11 12 13 14 15 16 17 18 18+

Highest degree obtained:*

Name of school or GED authority:*

Address of school:*

Other formal training:*

Professional licenses, certifications, and/or equipment you can operate:*

References (No family or former employers)

Name:*

Title/Business:*

Telephone Number:*

Address:*

Reference 2

Name:*

Title/Business:*

Telephone Number:*

Address:*

Reference 3

Name:*

Title/Business:*

Telephone Number:*

Address:*

Military Service

Have you served in the U.S. Armed Services:*

Yes

No

Branch:*

Type of discharge:*

Do you claim Veteran's Preference under Florida Statute 295.085 for Item 3 Service?*

Yes

No

Job Description

Note: Answer the following questions only if you have read the job description of the position for which you are applying (job description is available upon request.)

Are you able to perform all the essential job functions as listed on the job description?*

Yes

No

If no, list those that you are unable to perform:*

Are there any accommodations that could be made which would allow you to perform the essential functions listed above?*

Yes

No

If yes, please indicate:*

Applicant's Statement

I certify that the foregoing answers are true and correct to the best of my knowledge. I hereby authorize the investigation of all statements contained in this application, to interview the references and previous employers listed in this application, to conduct a record check on my background to include but not be limited to the following: criminal and driving check, employment and performance records and education records, and the release of all, and any, records or other information requested by the City of Atlantic Beach or its authorized representative.

I authorize the references, previous employers, any school or other educational institution, or public agency to give the City all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise, and I hereby release all such parties from any liability which may allegedly arise from furnishing such information to the City, including, but not limited to, any liability for defamation or invasion of privacy. I understand that any false or misleading information or omission of facts requested in this application or interview may remove me from further consideration for employment. In addition, if employed, any false or misleading statement or omission of facts called for in this application may be cause for subsequent dismissal at any time without any previous notice.

I understand that this application is completed for the position indicated at the beginning and that it will be necessary to reapply for other positions when they become available.

I understand that no supervisor or other representative of the City other than the City Manager has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement.

I understand and voluntarily agree as a condition of employment, or continued employment, that I may be requested by the City to submit o a urinalysis or other drug screen test and that my failure to take such test(s) when requested to do so or unsatisfactory test results will disqualify me from consideration for employment, or if I am then employed, may result in my immediate dismissal.

If employed by the City of Atlantic Beach, I agree to abide by its policies, rules and regulations. I understand and agree that my employment is at-will, and therefore, my employment and compensation can terminate with or without cause, at any time, at my option or the option of the City of Atlantic Beach.

I further understand and agree that this at-will employment relationship will remain in effect throughout my employment with the City of Atlantic Beach, unless it is modified by a specific written employment contract for a special duration which is signed by the city Manager and me. This at-will employment relationship may not be modified by any oral or implied agreement.

I certify that I have read, understand, and agree with the above.

EEO Survey (Optional)

Completion of this form is OPTIONAL. The following information will be used for Equal Employment Statistical Information and identification purposes only. This form will be detached and not processed/provided with application form. It would be helpful if you provided the following information.

Name:

Position applied for:

Ethnic Background:

Select One White Black Hispanic Asian/Pacific Islander American Indian/Alaskan Native Other

If other, please specify:

Sex:

Male

Female

Date of Birth:

Marital status:

Select one Married Single Divorced

Do you have a disabling or handicapping condition?

Yes

No

Referral Source

Please indicate how you became aware of this job.

Please select a referral source:

Select one Florida Times Union Newspaper City of Atlantic Beach Web Page Florida Times Union Web Atlantic Beach City Employee Shorelines Newspaper Beaches Leader Newspaper Walk-in Other

If other, please specify: