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Demographics

City of Flagler Beach
Human Resources Division
105 South 2nd Street,
Post Office Box 70
Flagler Beach, Florida 32136
Phone (386) 517-2000 Fax (386) 517-2008
INSTRUCTIONS:
The application must be filled out accurately and completely. Answer all required questions. Incomplete applications will not be considered. All statements made on the application are subject to verification. Exaggerated, false, or misleading statements may be cause for rejection of the application and/or termination of employment. Eligibility for hire may be based on a rating of this application; therefore, completeness and accuracy is of the utmost importance.
PLEASE DO NOT PROVIDE OR ATTACH SENSITIVE INFORMATION INCLUDING: Social Security numbers, driver's license numbers, medical information, passport numbers, passwords, tax ID number, or financial information of any kind. Please contact us at: HR@CityOfFlaglerBeach.com with any questions or concerns.
First Name*
Last Name*
Middle Initial
Position Applying For*
Street Address*
Unit or Apartment
City*
State*
Zipcode*
Phone Number*
Email Address*
Have you ever worked for the City of Flagler Beach?*
1. Yes
2. No
If yes, please provide dates of employment
Are you a U.S. citizen?*
1. Yes
2. No
If no, are you authorized by Immigration and Naturalization to work in the U.S.?
1. Yes
2. No
If yes, please provide Alien# and/or Admission #
Will you work night shift?*
1. Yes
2. No
Will you work weekends?*
1. Yes
2. No
Have you ever been fired, forced to resign, or resigned in lieu of termination?*
1. Yes
2. No
If yes, please explain below:
Employer
Dates of employment
Reason
Are you related to a City employee or is any member of yourfamily employed by the City of Flagler Beach?*
1. Yes
2. No
If yes, please provide:
Name
Relationship
Department
Position
Have you ever been found guilty of, had adjudication withheld, or pled no contest to any violation of law?*
1. Yes
2. No
If yes, please provide details below:
Date
Agency
Offense/ Charge
Outcome
1. Felony
2. Misdemeanor
3. Other
Explanation
Note: A conviction does not automatically mean you cannot be employed by the City of Flagler Beach. The nature of the offense, how long ago it occurred, etc., are given consideration. Driving under the influence, driving while intoxicated, etc., should be listed here.
Were you in the U. S. Armed Forces?*
1. Yes
2. No
If yes, did you receive an honorable discharge?
1. Yes
2. No
If yes, are you claiming veteran's preference?
1. Yes
2. No
Note: If you are claiming veteran's preference PLEASE DO NOT ATTACH OR FILL IN SENSITIVE INFORMATION ON THIS FORM. Either drop off a copy of your DD214 at the City Hall (105 South 2nd Street Flagler Beach, FL 32136) or send a copy of your DD214 to our secure email: HR@CityOfFlaglerBeach.com
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Driving History

Do you have a valid Driver's License?*
1. Yes
2. No
Has your license ever been suspended?*
1. Yes
2. No
Has your license ever been revoked?*
1. Yes
2. No
CDL Class
1. A
2. B
3. C
Endorsements
If yes, please explain
PLEASE LIST ALL TRAFFIC CITATIONS RECEIVED WITHIN THE LAST SEVEN (7) YEARS (driving under the influence, driving while intoxicated, etc., should be listed in the previous section ).
Date
Date
Agency
Offense/ Charge
Points
Outcome
Date
Date
Agency
Offense/ Charge
Points
Outcome
Date
Date
Agency
Offense/ Charge
Points
Outcome
Date
Date
Agency
Offense/ Charge
Points
Outcome
If you have more than four citations within the last seven years, please attach a separate sheet in the same format.
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Education

Do you have a High School Diploma?*
1. Yes
2. No
If no, do you have a GED?
1. Yes
2. No
If not, highest grade completed
Name of the last High School attended
Location City
Location State
List Special Training (Business, Trade, Vocational, Armed Forces Schools, etc.) including Name & Location, Total Hours Completed, Hours Required, Course/ Subject Taken, and Certificates Received below:
List Colleges and Universities Attended including Name & Location, Credit Hours Received, Major/ Minor Degree Field of Program or Study, and Type of Degree Received below:
If you would like to provide additional certifications or education, please attach a file in the same format.
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City of Flagler Beach Employment Application

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Demographics

City of Flagler Beach

Human Resources Division

105 South 2nd Street,

Post Office Box 70

Flagler Beach, Florida 32136

Phone (386) 517-2000 Fax (386) 517-2008

Driving History

Education

Employment History

Disclosures and Signature

Equal Employment Opportunity Survey

City of Flagler Beach

EQUAL EMPLOYMENT OPPORTUNITY/AFFIRMATIVE ACTION SURVEY

City of Flagler Beach