INSTRUCTIONS TO APPLICANTS

READ CAREFULLY

 

1. Type information.

2. Answer every question (Do not refer to your resume).

3. If a question is not applicable, mark it n/a.

4. All statements are subject to verification.

APPLICATION FOR EMPLOYMENT

City of North Lauderdale

701 S.W. 71st Avenue

North Lauderdale, Florida. 33068

(954) 724-7068

AN EQUAL OPPORTUNITY EMPLOYER

 

It is the policy of the City of North Lauderdale not to discriminate against employees or applicants for employment on the basis of sex, age, race, disability, religion, national origin or veteran status.
Position Applied For

INCOMPLETE APPLICATIONS WILL BE RETURNED
Last Name First Name Middle Initial
Address Apt # City /St Zip
Phone Number Cell Number Email
Driver's License Number D/L Type State Expiration Date
Date of Birth (Optional) Social Security Number
Your social security number is requested for the purpose of payroll eligibility verification, processing employment benefits, applicant and employee background checks, and income reporting, and will be used solely for these purposes.
U.S. Citizen? If no, alien registration H51# or, Refugee Status I94#
Minimum Acceptable Salary $ Can you work nights? Can you work weekends?
   
Have you ever been discharged or forced to resign? If yes, give date and details:
Have you ever been arrested and/or convicted of a crime? If yes, give date and details:
Active Military Service: Branch Rank Service Number
Date of Entry Date of Separation Type of Discharge To claim veteran preference points, please submit a copy of Form DD214 with your application
Have you ever been employed by the City of North Lauderdale? Are any relatives employed by the City of North Lauderdale?
If yes, when: If yes, who:
Emergency Contact Name: Phone Relationship Address City/State Zip
 
Reference Name #1 Phone Relationship Address City/State Zip Yrs Kwn
Reference Name #2 Phone Relationship Address City/State Zip Yrs Kwn
Reference Name #3 Phone Relationship Address City/State Zip Yrs Kwn

Education

Name Location

Dates Attended

 Did you Graduate?

Degree

Major Course of Study
High School
College or University
Post Graduate
Business or Trade
Other
Other
             
List any special qualifications/memberships/licenses/certificates

E M P L O Y M E N T    H I S T O R Y

Start with present or most recent employment and work back fifteen years, explaining gaps in employment of four (4) months or longer. Please complete this section  legibly. If you need more room, please use an additional application, filling in only your name and social security number as a reference.

Employer

 Nature of Business Phone
Address City State Zip
Supervisor Title From To Total Time Starting Salary $ Ending Salary $
Reason for Leaving Specific Duties
Employer Nature of Business Phone
Address City State Zip
Supervisor Title From To Total Time Starting Salary $ Ending Salary $
Reason for Leaving Specific Duties
Employer Nature of Business Phone
Address City State Zip
Supervisor Title From To Total Time Starting Salary $ Ending Salary $
Reason for Leaving Specific Duties
Employer Nature of Business Phone
Address City State Zip
Supervisor Title From To Total Time Starting Salary $ Ending Salary $
Reason for Leaving Specific Duties
May we contact the employers listed above regarding your records of employment?  
If no, indicate which one(s) you do not want contacted and why:
   
If offered a position, when would you be available to start?  
Please tell us how you heard about this position vacancy 
 

Drug Screening Authorization: I hereby agree to submit to a pre-employment drug screening test. I fully understand that failure to pass this portion of the employment selection process will disqualify me from further employment consideration. In addition, I release the City of North Lauderdale from any and all liability and hold the City harmless with reference to this drug screening test.

Waiver of Confidential Records: Permission is hereby granted to any agency of the government of the United States, any municipal or political subdivision of this state or any other state or agency or department thereof, and any other agency, person, firm or corporation holding records considered confidential concerning me, to furnish the City of North Lauderdale all information desired involving me in any way, upon request. Included in this grant of authority is my permission to former employers and other persons acquainted with me or in possession of information concerning me to supply such information to the City of North Lauderdale. Such records, I understand, may include reasons for termination of employment, reasons for discharge from military service, criminal history, on the job performance, complete history of injuries suffered, including disability remaining, educational records, or any other personal information which may be obtained about me will be obtained without prior agreement. I further understand some of the information that may be obtained about me will be obtained upon assurance of confidentiality by the City of North Lauderdale to the person or persons supplying such information. I understand that this information will become privileged to the City of North Lauderdale and will become part of the confidential records of the City of North Lauderdale, to which I will not have access.

In accordance with Section 504 of the Vocational Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, the City of North Lauderdale does not discriminate on the basis of disable status in the admission or access to, or treatment, or employment in , its programs and activities.

I hereby agree that I have read and understand the Drug Screening and Waiver of Confidentiality Sections of this application:

APPLICANTS CERTIFICATION AND AGREEMENT  I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that any incorrect, incomplete or false statements or information furnished by me may subject me to disqualification for consideration for employment or to dismissal if employed.