General Employee Application

About the Job

Position Applying For:*

Crew Leader I - Parks & Grounds - Closes 4/26/24 Lifeguard/WSI (PT/LD) - Summer - Open Until Filled Maintenance Operator I - Cemetery - Closes 4/26/24 Parks, Recreation & Culture Project Lead - Closes 4/26/24 Recreation Leader (PT/LD-Summer Only) - Open Until Filled Summer Rec. Att. - CSR I (LD-Summer Only) - Open Until Filled Water Utility Servicer Trainee I, II, III - Open Until Filled

Select the open position you are applying for.

Would you like to submit this application for another open position?

Yes No

Second Position Applying For:*

Would you like to submit this application for another open position?

Yes No

Third Position Applying For:*

How did you hear about this employment opportunity?

Media / Advertisement City Website Indeed City Employee Job Fair

Other:

Select all that apply.

Please list the full name of the City Employee who referred you for this role.

Where did you see the job post / advertisement?

Facebook LinkedIn Instagram Newspaper Magazine Radio

Other:

About You

Your Full Name*

First Name

Middle Name (optional)

Last Name

Social Security Number

*In accord with Resolution R-08-06, this information is collected and solely used by the City of Winter Haven for identity verification and service, security background checks.

Address*

Address Line 1

City

State

ZIP Code

Home / Mobile Phone*

Alternate Phone

About You Continued

Are you at least 18 years of age? *

Yes No

How old are you? *

Note: Employment is subject to verification of minimum legal age.

Are you legally authorized to work in the U.S.? *

Yes No

Please provide details of your work authorization.

Note: Employment is subject the provision of documentation to confirm U.S. work authorization.

Have you ever served in the U.S. Armed Forces? *

Yes No

Branch:*

Entry Date:*

Discharge Date:*

Discharge Type:*

Are you claiming veteran's employment preference? *

Yes No

Upload your veteran's preference documentation.

No File Chosen

File uploads may not work on some mobile devices.

Have you ever been employed in a position for which you have claimed veteran’s preference after 10/01/1987? *

Yes No

Employer Name:*

Date Preference Claimed:*

Have you ever been employed by the City of Winter Haven? *

Yes No

When?*

Where?*

Have you ever been dismissed from a job for inefficiency, delinquency, misconduct or any other reason? *

Yes No

When?*

Describe the circumstances:*

Have you ever been formally or informally accused of unlawful harassment or discrimination? *

Yes No

When:*

Describe the circumstances:*

Are you now under charges for any offense against the law? *

Yes No

Describe charges:*

Have you EVER at any time had adjudication withheld, plead guilty, no contest or been convicted of ANY offense against the law? *

Yes No

Note: A conviction is not necessarily a disqualifying factor; truthfully give all facts so a decision can be made.

Describe the circumstances:*

Have you ever been a defendant in a civil action for an intentional tort? *

Yes No

Explain:*

Driving History

Do you have a valid Florida driver license? *

Yes No

License Class:

License Number:

Expiration Date:

Have you had one or more chargeable motor vehicle crashes or code violations (i.e. speeding ticket, seat belt violation, etc.) within the past three years? *

Yes No

Date of Incident*

If unsure of the exact date, estimate a close date.

Nature of Violation / Charge*

City / County / State*

Action Taken*

Do you have a second violation / charge to add?

Yes No

Date of Incident (2)

If unsure of the exact date, estimate a close date.

Nature of Violation / Charge (2)

City / County / State (2)

Action Taken (2)

Do you have a third violation / charge to add?

Yes No

Date of Incident (3)

If unsure of the exact date, estimate a close date.

Nature of Violation / Charge (3)

City / County / State (3)

Action Taken (3)

Do you have a fourth violation / charge to add?

Yes No

Date of Incident (4)

If unsure of the exact date, estimate a close date.

Nature of Violation / Charge (4)

City / County / State (4)

Action Taken (4)

Education

Which of these levels of education have you begun or completed?*

G.E.D. High School Trade School College / University None

Check all that apply. List all schools attended, even if the degree was not earned.

G.E.D. School Name

G.E.D. Dates Attended

G.E.D. Course(s) of Study

G.E.D. Years / Credits Completed

Did you earn your G.E.D. diploma?

Yes No

Date G.E.D. Received:

High School Name

High School Dates Attended

High School Course(s) of Study

High School Years / Credits Completed

Did you earn your high school diploma?

Yes No

High School Graduation Date:

Trade School Name

Trade School Dates Attended

Trade School Course(s) of Study

Trade School Years / Credits Completed

Did you receive a degree / diploma / certificate from trade school?

Yes No

Trade School Graduation Date

College / University Name

College / University Dates Attended

College / University Course(s) of Study

College / University Years / Credits Completed

Did you earn you college / university diploma?

Yes No

College / University Graduation Date

List other education or special courses taken; include total hours and the training provider/sponsor name.

Certifications and Licenses

Do you hold any certifications or licenses?

Building Inspector

Yes No

Building Inspector - Issued in/by which state?

Building Inspector - Date Issued

Building Inspector - Expiration Date

Code Enforcement – Level I, II or III

Yes - Level I Yes - Level II Yes - Level III No

Code Enforcement – Level I, II or III - Issued in/by which state?

Code Enforcement – Level I, II or III - Date Issued

Code Enforcement – Level I, II or III - Expiration Date

Emergency Medical Technician (EMT)

Yes No

Emergency Medical Technician (EMT) - Issued in/by which state?

Emergency Medical Technician (EMT) - Date Issued

Emergency Medical Technician (EMT) - Expiration Date

Firefighter Minimum Standards

Yes No

Firefighter Minimum Standards - Issued in/by which state?

Firefighter Minimum Standards - Date Issued

Firefighter Minimum Standards - Expiration Date

Lifeguard

Yes No

Lifeguard - Issued in/by which state?

Lifeguard - Date Issued

Lifeguard - Expiration Date

Paramedic

Yes No

Paramedic - Issued in/by which state?

Paramedic - Date Issued

Paramedic - Expiration Date

Police Officer Minimum Standards

Yes No

Police Officer Minimum Standards - Issued in/by which state?

Police Officer Minimum Standards - Date Issued

Police Officer Minimum Standards - Expiration Date

Wastewater Treatment Operator A, B or C

Yes - A Yes - B Yes - C No

Wastewater Treatment Operator A, B or C - Issued in/by which state?

Wastewater Treatment Operator A, B or C - Date Issued

Wastewater Treatment Operator A, B or C - Expiration Date

Water Treatment Operator A, B or C

Yes - A Yes - B Yes - C No

Water Treatment Operator A, B or C - Issued in/by which state?

Water Treatment Operator A, B or C - Date Issued

Water Treatment Operator A, B or C - Expiration Date

Water Safety Instructor (WSI)

Yes No

Water Safety Instructor (WSI) - Issued in/by which state?

Water Safety Instructor (WSI) - Date Issued

Water Safety Instructor (WSI) - Expiration Date

Do you hold certification / license not listed above?

Yes No

Other Cert. or License Type:

Other Cert. or License - Issued in/by which state?

Other Cert. of License - Date Issued

Other Cert. of License - Expiration Date

Do you have another certification / license to list?

Yes No

Other Cert. or License Type:

Other Cert. or License - Issued in/by which state?

Other Cert. of License - Date Issued

Other Cert. of License - Expiration Date

Employment History

NOTE: Failure to thoroughly fill out employment history on the application may disqualify the application from consideration. Uploading a resume does not fulfill this requirement.

(Begin with present employer and list all jobs held since you started working.)

Employer 1 (Present / Most Recent)

Company Name*

Job Title*

Describe Your Duties:*

Employment Start*

Employment End

Starting Pay Rate*

Ending Pay Rate*

Reason for Leaving*

Company Address

Company Telephone Number*

Supervisor Name*

Do you have another employer to add?*

Yes No

Please list all jobs you've held since you started working.

Employer 2

Company Name

Job Title

Describe Your Duties:

Employment Start

Employment End

Starting Pay Rate

Ending Pay Rate

Reason for Leaving

Company Address

Company Telephone Number

Supervisor Name

Do you have another employer to add?

Yes No

Please list all jobs you've held since you started working.

Employer 3

Company Name

Job Title

Describe Your Duties:

Employment Start

Employment End

Starting Pay Rate

Ending Pay Rate

Reason for Leaving

Company Address

Company Telephone Number

Supervisor Name

Do you have another employer to add?

Yes No

Please list all jobs you've held since you started working.

Employer 4

Company Name

Job Title

Describe Your Duties:

Employment Start

Employment End

Starting Pay Rate

Ending Pay Rate

Reason for Leaving

Company Address

Company Telephone Number

Supervisor Name

Do you have another employer to add?

Yes No

Please list all jobs you've held since you started working.

Employer 5

Company Name

Job Title

Describe Your Duties:

Employment Start

Employment End

Starting Pay Rate

Ending Pay Rate

Reason for Leaving

Company Address

Company Telephone Number

Supervisor Name

Do you have another employer to add?

Yes No

Please list all jobs you've held since you started working.

Employer 6

Company Name

Job Title

Describe Your Duties:

Employment Start

Employment End

Starting Pay Rate

Ending Pay Rate

Reason for Leaving

Company Address

Company Telephone Number

Supervisor Name

Note: Employers listed in your application (or on your resume) will be contacted, unless you indicate otherwise. Please specify which employer(s) by the employer number they are listed at above (1-6), if any, you prefer not be contacted and state the reason why.

Employer Number(s)

Reason

Upload Your Resume

No File Chosen

File uploads may not work on some mobile devices.

Not all positions require a resume to be uploaded, but all are welcome to include one. Please refer to the the job advertisement for the position you are seeking to confirm if this is required.

Upload Your Cover Letter

No File Chosen

File uploads may not work on some mobile devices.

Not all positions require a cover letter to be uploaded, but all are welcome to include one. Please refer to the the job advertisement for the position you are seeking to confirm if this is required.

REVIEW THIS APPLICATION AND YOUR ANSWERS CAREFULLY BEFORE SIGNING BELOW

I certify that all statements made by me on this application are true, complete and correct to the best of my knowledge and belief. I understand and agree that if I make any misstatements or omissions of fact, I am subject to disqualification or dismissal and to such other penalties prescribed by law, personnel policy or regulations. I voluntarily give the City of Winter Haven Human Resources’ Office , or its duly authorized representative, the right to make a thorough investigation of my past employment and activities. I agree to cooperate in such investigation and I further release from all liability and responsibility any and all persons, companies or corporations supplying such information.

Signature*

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Use your mouse or finger to draw your signature above

Date/Time

An Equal Opportunity Employer

The information requested below is used for Equal Employment Opportunity (EEO) purposes only and NOT to evaluate your application for employment with the City of Winter Haven. Completion of this form by you is strictly voluntary. You are not legally required to supply this information. However, your assistance in doing so is appreciated. Thank you.

Gender

Male Female

Age Group

16-22 23-39 40-70 Over 70

Race Ethnic Origin

White, Non-Hispanic or Latino Black or Black and White, Non-Hispanic or Latino Hispanic or Latino Asian or Asian and White, Non-Hispanic or Latino American Indian/Alaskan Native, Non-Hispanic or Latino Native Hawaiian – Other Pacific Islander, Non-Hispanic or Latino Balance 2+ Races, Non-Hispanic or Latino

Disabled

Yes No

Description of Disability

Military Status

Non-Veteran Veteran Disabled Veteran

Actively Served During

WWII / Korea Persian Gulf Vietnam Iraq / Afghanistan Operation Enduring Freedom

Other:

Check if applicable.