Seminole County - Application for Employment

This application must be complete and accurate. All statements made on application are subject to verification. Any incorrect or false statements to any question(s) in this application may be grounds for non-selection, or for termination after you begin work. All statements are subject to investigation, including a check of your training and experience statements. All information you give will be considered in reviewing your application. Also, your application may be subject to public inspection in accordance with the Florida Public Records Law, Chapter 119, Florida Statute.

Last Name First Name Middle Name (Optional) Social Security # Height (inches) Hair Color Eye Color

Address City / State/Zip Code / Telephone/Optional Cell Select One Full Time Temporary Position applying for Salary Requirement Date Available for Work (not required)

E-Mail Address (Must be correct if given):

How long have you been at your current address (Years/Months)?    /

Are you a United States Citizen (Y or N)?   
If no, do you have the legal right to remain and work in the U.S. (Y or N)?   

Do you have a high school diploma (Y or N)?   
If no, did you pass the High School Equivalency Test (Y or N)?   

Please list any postsecondary education you have.

School Name/Address	Major/Minor	LevelCompleted	Graduated	Degree/Year
			N/A       YesNo
			N/A       Yes No
			N/A       Yes No
			N/A       Yes No

Are you presently attending school (Y or N)?  
If yes, what courses? 

List any licenses or certificates you currently hold (Technical/Professional, etc.):

List office and related equipment you can operate, if any:

List any organization to which you belong which you consider relevant to your ability to perform the job:

Do you speak any foreign languages (Y or N)?  
If yes, please list:  

Have you ever been a member of the Armed Services (Y or N)?  
If yes, Branch:        Discharge Date(m/d/y):  

List below all previous employment. List your present employer first and provide information on each consecutive previous employer. You may include volunteer work, if any.

Current Employer

Job Title Supervisor's Name Supervisor's Title / / Employed From (m/d/y) / / Employed To (m/d/y) Hours Worked Per Week

Telephone Address City / State/Zip Starting Salary  $ Last Salary  $

Name employed under (if different from current):

Specific duties performed:

Reason for leaving:

May we contact employer?   N/A Yes No

Job Title Supervisor's Name Supervisor's Title / / Employed From (m/d/y) / / Employed To (m/d/y) Hours Worked Per Week

Telephone Address City / State/Zip Starting Salary  $ Last Salary  $

Name employed under (if different from current):

Specific duties performed:

Reason for leaving:

May we contact employer?   N/A Yes No

Job Title Supervisor's Name Supervisor's Title / / Employed From (m/d/y) / / Employed To (m/d/y) Hours Worked Per Week

Telephone Address City / State/Zip Starting Salary  $ Last Salary  $

Name employed under (if different from current):

Specific duties performed:

Reason for leaving:

List below the names of three persons not related to you whom you have known at least one year:

Please check the appropriate box to indicate the level of competency or experience you have in each area.

Special Areas:		General Areas:
Bookkeeping	Select One None beginning intermediate advanced	Calculator Use	Select One None beginning intermediate advanced
Pleadings/Court Processing	Select One None beginning intermediate advanced	Computer Imaging	Select One None beginning intermediate advanced
Writing/Editing	Select One None beginning intermediate advanced	Filing	Select One None beginning intermediate advanced
Page Layout	Select One None beginning intermediate advanced	Typing/Keyboard Skills	Select One None beginning intermediate advanced
Microfilm Production	Select One None beginning intermediate advanced

Computer Hardware:

Mainframe Computer Support	Select One None beginning intermediate advanced
Network (LAN, WAN) Support	Select One None beginning intermediate advanced
PC/Mini Hardware Support	Select One None beginning intermediate advanced

Answer the following questions yes or no. If the answer is yes, please provide an explanation as requested.

1.   Have you ever been convicted of, pled guilty, no contest or nolo contendere to a crime? If yes, give details (date, place, offense(s), disposition, etc.). (A conviction does not automatically mean you cannot be appointed.)
(Y or N)        Details:

2.   Have you ever been charged with a crime? As a result, have you either been placed on a court-ordered probation, had adjudication withheld, or entered a pre-trial intervention program? If yes, give details (date, place, offense(s), disposition, etc.).
(Y or N)        Details:

3.   Have you ever been discharged for misconduct or unsatisfactory service from any job? If yes, please explain when and why you were discharged.
(Y or N)        Details:

4.   Have you ever filed an unemployment compensation claim? If yes, when and where?
(Y or N)        Details:

5.   Have you ever filed an application for employment for appointment with Seminole County or the Clerk of Circuit Court? If yes, indicate date(s) and position(s).
(Y or N)        Details:

6.   Have you ever been employed by Seminole County or appointed by the Circuit Court? If yes, indicate date(s) of employment or appointment, Department(s), Division(s), position(s), and reason for leaving.
(Y or N)        Details:

I hereby certify that all statements in this application are true and I agree and understand that any incorrect or false statement of facts shall cause forfeiture of appointment with the Clerk of the Circuit Court for Seminole County, Florida. I also certify that I have read the instructions above.

The Clerk of the Circuit Court or his Personnel Department is authorized to verify any or all of the information contained herein.

If appointed, I agree to abide by and comply with all rules, regulations, policies, and procedures of the Clerk of the Circuit Court for Seminole County, Florida.

I understand that if I am hired by the Clerk of the Circuit Court for Seminole County, Florida, that it is an appointment by the Clerk that is terminable at the will of either the Clerk or me. If hired by the Clerk of the Circuit Court, I understand and agree that I have no implied, express or statutory contract or right to employment or continued employment with the Clerk's Office.

Do you wish to certify this application? (Y or N)   
(Note: A certification is equivalent to your signature and is required for submitting applications electronically)