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2. We consider applicants for all positions, without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.
4. Position(s) Applied For:*
5. Date of Application:*
7. Last Name:*
9. First Name:*
10. Middle Name:
12. Street Address:*
14. City:*
15. State:*
16. Zip:*
18. Contact Number:*
19. Email Address:
21. How did you learn about the opening?
23. Best time to contact you at the telephone number above?
25. If under 18 years of age, can you provide required proof of your eligibility to work?

    1. Yes

    1. No
26. (Proof of citizenship or immigration status will be required upon employment)
28. Have you ever filed an application with us before?

    1. Yes

    1. No
29. If Yes, give date:
31. Have you ever been employed with us before?*

    1. Yes

    1. No
32. If Yes, give date:
34. Are you currently employed?*

    1. Yes

    1. No
35. Do any of your friends or relatives, other than spouse, work here?*

    1. Yes

    1. No
37. May we contact your present employer?*

    1. Yes

    1. No
38. Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*

    1. Yes

    1. No
40. Have you ever been convicted of a felony?*

    1. Yes

    1. No
42. Date Available for work:*
43. Desired salary range:*
45. Are you currently on "lay off" status and subject to recall?

    1. Yes

    1. No
46. Can you travel if a job requires it?

    1. Yes

    1. No
48. When are you available to work? (Check all that apply)*

    1. Full-Time
    2. 1st Shift
    3. 2nd Shift
    4. 3rd Shift
    5. Temporary (list availability below)
    6. Part-Time
    7. Mornings
    8. Afternoon
    9. Evenings
49. Date(s) Available to Work:
    If temporary position desired, list dates available; else enter first day you are available for work
53. Work Experience
55. Employer Name:*
56. Employment Dates:
58. Address:
60. Starting Salary:
61. Ending Salary:
63. Job Title:
65. Supervisor:
66. Phone Number:
68. Reason for Leaving:
69. Work Performed:
73. Employer Name:
74. Employment Dates:
76. Address:
78. Starting Salary:
79. Ending Salary:
81. Job Title:
83. Supervisor:
84. Phone Number:
86. Reason for Leaving:
87. Work Performed:
91. Employer Name:
92. Employment Dates:
94. Address:
96. Starting Salary:
97. Ending Salary:
99. Job Title:
101. Supervisor:
102. Phone Number:
104. Reason for Leaving:
105. Work Performed:
109. Education
111. Name of High School:*
112. Address of School:
114. Graduate?*

     1. Yes

     1. No
115. Years Completed:
117. Diploma/Degree:
121. Name of College:
122. Address of School:
124. Graduate?

     1. Yes

     1. No
125. Years Completed:
127. Diploma/Degree:
131. Graduate/Professional School Name:
132. Address of School:
134. Graduate?

     1. Yes

     1. No
135. Years Completed:
137. Diploma/Degree:
141. Other (Specify):
143. Name of School:
144. Address of School:
146. Graduate?

     1. Yes

     1. No
147. Years Completed:
149. Diploma/Degree:
153. Specialized Skills
155. Computer Knowledge: (Check box best describing level of skill)
157. Microsoft Word:

     1. None
     2. Basic
     3. Proficient
158. Excel:

     1. None
     2. Basic
     3. Proficient
160. MUNIS:

     1. None
     2. Basic
     3. Proficient
161. PT Win:

     1. None
     2. Basic
     3. Proficient
163. Outlook (email, calendar, contacts):

     1. None
     2. Basic
     3. Proficient
164. Outlook (tasks, journal, notes):

     1. None
     2. Basic
     3. Proficient
166. Internet Use:

     1. None
     2. Basic
     3. Proficient
167. Other computer systems:
169. List any mechanical equipment/skills, if applicable:
171. Describe any other specialized training, apprenticeship, skills (including military):
173. List any professional, trade, business or civic activities:
175. State any additional information you feel may be helpful in considering your application:
179. References
181. Name:*
182. Phone:*
184. Address:
188. Name:
189. Phone:
191. Address:
195. Name:
196. Phone:
198. Address:
200. Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job position(s) for which you applied?*

     1. Yes

     1. No
202. If you wish to send a resume, please send as a Word or pdf document via email to Administration@Inverness-FL.Gov
204. Applicant's Statement:
206. • I certify that answers given herein are true and complete
     • I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
     • This application for employment shall be considered active for a period of time not to exceed 45 days.
     • I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is on an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
     • In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
     • I understand when submitted, the application and contents are a public document and subject to review by the public and media upon request.
208. Signature of Applicant:
209. Date:
211. 
     
Leave This Blank:


213. 1. Receive an email copy of this form.
214. Email address

     This field is not part of the form submission.

215. Submit Submit and Print

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