Employment Application

  • Applicant
  • Employment Desired
  • Education
  • Previous Employment
  • References
  • Military Record
  • Background Check
  • Non-Tobacco Use Affidavit
  • Consent

Applicant Information

Required Fields are Marked with *

Please fill out all required fields
Are you 18 Years or Older?
Are you 18 Years or Older?

Present Address


Permanent Address


Employment Desired

Please fill out all required fields
Are you employed now?
Are you employed now?
Ever applied to this office before?
Ever applied to this office before?
Are there any days, shifts or hours you will not work?
Are there any days, shifts or hours you will not work?

Education

Please fill out all required fields

Grade School


High School


College


Trade, Business, or Correspondence School


Other (including Graduate School Within the past seven (7) years)


Have you ever been convicted of, or pled guilty, no contest or nolo contendere to, a crime?
Have you ever been convicted of, or pled guilty, no contest or nolo contendere to, a crime?
Have you ever been charged with a crime and either been placed on a court ordered probation, had adjudication withheld, or entered a pre-trial intervention program?
Have you ever been charged with a crime and either been placed on a court ordered probation, had adjudication withheld, or entered a pre-trial intervention program?

Previous Employment

List below sequentially all of your employers in the last ten (10) years beginning with your current or most recent employer.

Most Recent Employer

Employer Two

Employer Three

Did you work for any of these employers under a different name?
Did you work for any of these employers under a different name?

Have you received any written reprimands or disciplinary suspensions during any previous employment?
Have you received any written reprimands or disciplinary suspensions during any previous employment?

Have you ever been discharged or asked to resign?
Have you ever been discharged or asked to resign?

References

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


Reference One

Reference Two

Reference Three

Military Record

Were you in the U.S. Armed Forces?
Were you in the U.S. Armed Forces?

Employment in this office will require a copy of your DD-214.


Veterans' Preference

(Complete this section only if you are claiming Veterans' Preference).

Have you entered into covered employment by a covered employer after having claimed preference since October 1, 1987?
Have you entered into covered employment by a covered employer after having claimed preference since October 1, 1987?

If you claim Veterans' Preference, check the type below. Be prepared to present documents upon interview to support your claim.

  1. Veteran of a wartime era - Requires (A) DD214 or other document showing dates of service and type of discharge.
  2. Disabled Veteran - Requires (A) and (B) letter of service connected disability from the V.A.
  3. Veterans' Widow - Requires (A) and marriage and death certificates, and statement saying not remarried.
  4. Disabled Veterans' Spouse - Requires (A) and (B), evidence of marriage to the veteran, a statement that the spouse is still married at the time of application, and proof that the disabled veteran cannot qualify for employment because of disability.
  5. Permanently Disabled Veteran - Requires (A) indicating veteran is permanently disabled, or (A) and letter from V.A. indicating that the veteran is permanently disabled.
  6. Receipt of any Armed Forces Expeditionary Medal - Requires (A) DD214.

If any preference-eligible applicant claiming Veterans' Preference for a vacant position is not selected for the position, they have the right to an investigation by the Division of Veterans' Affairs if a non-preference-eligible applicant is appointed to a position. In order to commence the investigation, the applicant must file a written complaint addressed to the Division of Veterans' Affairs, P.O. Box 1437, St. Petersburg, FL 33731. A complaint shall be filed within 21 days after notice of a hiring decision. If a notice of a hiring decision is not given, it is the responsibility of the veteran to contact the employer within two months of the application to determine if the position has been filled. For further information, contact the Department of Veterans' Affairs.

Note: Veterans' Preference pertains to all positions except the following:

  1. Elected Officials.
  2. Board and Commission Members.
  3. Department Heads.
  4. Personal secretary of each such office or appointee.
  5. Temporary employee for the purpose of conducting special studies.
  6. Positions filled internally by means of promotion, demotion or reassignment.

Background Check Information

Driving Record

Do you have a valid driver license? *
Do you have a valid driver license? *
Have you had a suspension or probation of your license within the last five (5) years?
Have you had a suspension or probation of your license within the last five (5) years?

List below all traffic violations (except parking) on your record for the last five (5) years and all motor vehicle accidents in which you were involved.

Incident One


Incident Two


Incident Three

Non-Tobacco Use Affidavit

I do herby affirm that I have not been a user of tobacco products for at least six (6) months immediately preceding my application for employment; and I also affirm that I will maintain my non-use of tobacco products for the duration of my employment with the Marion County Tax Collector's office, if I am hired. Violation of this policy may result in your immediate termination.

Do you agree with all Non-Tobacco use information?
Do you agree with all Non-Tobacco use information?

Statement of Consent

I hereby certify that all of the facts and information listed on this employment application are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any such false, incomplete, or misleading information discovered on this application at any time after I am employed may result in my dismissal.

If I am offered employment, I understand that such an offer will be conditioned upon satisfactory results of a review of publicly available information concerning my driving record and/or a medical examination or inquiry, including a drug screen test. If then employed, I understand that I will be required to serve a one (1) year probationary period. I further understand that my employment is at the discretion of the Marion County Tax Collector and compensation and employment can be terminated, with or without cause or notice, at any time, regardless of the successful completion of my training period, at the option of either the Marion County Tax Collector or myself. I understand that no supervisor or other representative of the Marion County Tax Collector has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

I further understand and voluntarily agree as a condition of work or my continued employment that I may be requested by the office to submit to a urinalysis or other drug or alcohol 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 work, or if I am then working, may result in my immediate dismissal.

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

Statement of Consent
Statement of Consent