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Employment Application
Town of Belleair 901 Ponce de Leon Blvd. Belleair, FL 33756
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Equal Opportunity Employer

The Town of Belleair does not discriminate in employment on the basis of age, race, color, religion, sex, national origin or marital status. Any applicant or employee who believes he/she has been discriminated against in any town employment practice may file a report with Support Services, 901 Ponce de Leon Blvd., Belleair, FL 33756. It is the policy of the Town of Belleair not to discriminate on the basis of disability in employment or the provision of services. Individuals who require a reasonable accommodation in order to complete an evaluation process must inform the Human Resources Department before the closing deadline for the position. Veterans and spouses of veterans receive preference and are encouraged to apply. Supporting documentation (DD-214) must be presented at the time of application or sent via fax to (727) 588-3768. Florida is an "Open Records" state. Resumes and other data are subject to public/press inspection except where restricted by law.
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Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Have you ever been arrested, pled guilty, been convicted, OR pled nolo contendre to any crime?*
1. Yes
1. No
Do you currently have any law violations pending against you?
1. Yes
1. No
If yes to either question, list charges, date of conviction, location and penalty. You may omit minor traffic violations and any offense committed as a minor which was adjudicated in a juvenile court or under a youth offender law.
Are you lawfully permitted to work in the United States?*
1. Yes
1. No
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Position Information

How did you learn or hear of the position you are applying for?
If Personal Referral, please provide name.
Which position are you applying for?*
Type of employment desired*
1. Full Time
1. Part Time
1. Internship
1. Seasonal
Salary desired*
Hours of work (per week) desired*
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Driver License Information

Do you have a valid driver's license?
1. Yes
2. No
State
Class
Expiration Date
Has your driver's license been suspended or revoked within the past five (5) years?
1. Yes
1. No
If yes, explain fully, giving date(s) and reason(s).
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Education

Highest Level of Education Attained
Name of High School/Trade School
Address
State
Graduated
1. Yes
2. No
Date Graduated/Attended
Degree
Major Field of Study
Name of College
Address
State
Graduated
1. Yes
2. No
Date Graduated/Attended
Degree
Major Field of Study
Name of Grad School
Address
State
Graduated
1. Yes
2. No
Date Graduated/Attended
Degree
Major Field of Study
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Employment History

Start with your present or last job and work back. Include at least the last ten (10) years of employment history, including paid or unpaid, full or part-time, summer jobs, etc. Additional employment history can be submitted on the Town of Belleair's "Additional Employment History Information" sheet.
May we contact your present employer for a reference?
1. Yes
2. No
Company
Position
Address
Supervisor
Phone Number
Employed From - To (Date)
Responsibilities
Reason for leaving
Company
Position
Address
Supervisor
Phone Number
Employed From - To (Date)
Responsibilities
Reason for leaving
Company
Position
Address
Supervisor
Phone Number
Employed From - To (Date)
Responsibilities
Reason for leaving
Have you ever been discharged or forced to resign?
1. Yes
2. No
If yes, please give date, employer's name and the reason.
Do you have any relatives that work for the Town of Belleair?
1. Yes
2. No
If yes, state name(s) and relationship(s)
Please list any other legal names you have been known by or referred to in the past:
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Licenses - Certifications

Issued by:
In process of being renewed?
Type of License
Number
Issue Date
Expiration Date
State
Issued by:
In process of being renewed?
Type of License
Number
Issue Date
Expiration Date
State
List and describe any computer or technical skills/experience that you have that relate to the position you are applying for:
List any additional information you would like us to consider when reviewing your application, including any language skills that you possess.
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Military History/Veterans' Preference

Were you in the U.S. Armed Forces?
1. Yes
1. No
Are you claiming Veteran's Preference under Florida Law?
1. Yes
1. No
Preference eligibility no longer expires upon appointment of the eligible person to a position within the state or any political subdivision; veterans previously ineligible because they held or currently hold a job with a public employer are now eligible to use their preference again with all employers covered by law. In addition, eligible wartime periods now include Operation Enduring Freedom (10/7/01 to present) and Operation Iraqi Freedom (3/19/03 to present).
Documentation must be furnished at the time of application.
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References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
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Disclaimer & Signature

I voluntarily authorize and grant full consent to the Town of Belleair or its agent to conduct a thorough investigation into my prior employment and any other areas of my background, including criminal background, which the town believes relevant to my employment. I consent to the release and disclosure to the town or its agent from any persons, companies, corporations or government agency any information sought concerning my background and do further release from liability the town or its agent for actions taken in connection with this investigation, as well as any persons, companies, corporation or government agencies disclosing such information. I certify that the information contained in this application is correct and complete to the best of my knowledge. I understand that any false information provided by me to the town may constitute grounds for immediate discharge regardless of when the information is discovered by the town. I understand my continued employment is contingent on successfully passing any background investigation and any information discovered about me during the investigation which was deemed by the town to be unsatisfactory may constitute grounds for immediate discharge, also regardless of when discovered. I understand that the town may require a medical or other examination at the time of employment and may condition an offer of employment on the successful completion of that examination and verification of my ability to perform the essential functions of the position offered. Applicants for employment in a special risk and/or mandatory testing position are subject to pre-employment drug and alcohol test as a prerequisite to employment with the town. I understand that individuals hired as Police Officers are required to establish and/or maintain a bona-fide residence within Pinellas, Pasco or Hillsborough County at time of hire and are prohibited from using any form of tobacco product both on and off the job and I agree to abide by these conditions if hired.
Applicant Signature*
Date*
Upload your resume
Please use this file upload function to upload your resume.
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Drug Free Workplace

The Town of Belleair is a drug free workplace and as such is committed to providing an environment that encourages and supports a healthy, productive workforce and ensures safe working conditions. All employees in a special risk and/or mandatory testing position are subject to a pre-employment drug and alcohol test as a prerequisite to employment with the town. A positively confirmed drug test or refusal to submit to a drug test will result in the conditional offer of employment being withdrawn and will render the applicant ineligible for town employment for six (6) months from the date of the positive drug test. Applicants and current employees who are hired for safety-sensitive positions will be required to submit to random drug testing.

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Application for Employment

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Step One

Equal Opportunity Employer

Personal Information

Position Information

Driver License Information

Education

Employment History

Licenses - Certifications

Military History/Veterans' Preference

References

Disclaimer & Signature

Drug Free Workplace

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