State Job Application Form Page 3
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Name of Next Previous Employer: ________________________________________________________________________________________
(_______) ________________
Address: __________________________________________________________________ Phone No.:
Your Job Title: _____________________________________________________________ Supervisor’s Name: _____________________________
_____/_____/_____
_____/_____/_____
FROM:
TO:
HOURS PER WEEK: _______
YOUR NAME IF DIFFERENT DURING EMPLOYMENT
MONTH
DAY
YEAR
MONTH
DAY
YEAR
Duties and Responsibilities:
Reason For Leaving: _______________________________________________________________________________________________________
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Name of Next Previous Employer: ________________________________________________________________________________________
(_______) ________________
Address: __________________________________________________________________ Phone No.:
Your Job Title: _____________________________________________________________ Supervisor’s Name: _____________________________
_____/_____/_____
_____/_____/_____
FROM:
TO:
HOURS PER WEEK: _______
YOUR NAME IF DIFFERENT DURING EMPLOYMENT
MONTH
DAY
YEAR
MONTH
DAY
YEAR
Duties and Responsibilities:
Reason For Leaving: _______________________________________________________________________________________________________
KNOWLEDGE / SKILLS / ABILITIES (KSAs)
List KSAs you possess and believe relevant to the position you seek, such as operating heavy equipment, computer skills, fluency in language(s), etc.
VETERANS’ PREFERENCE INFORMATION
Completion of the Veterans’ Preference section is made on a voluntary basis and kept confidential in accordance with the Americans with Disabilities Act. Listed below are the
four Veterans’ Preference categories.
1. A veteran with a service-connected disability who is eligible for or receiving compensation, disability retirement, or pension under public laws administered by the U.S.
Department of Veterans’ Affairs and the Department of Defense, or
2. The spouse of a veteran who cannot qualify for employment because of a total and permanent disability, or the spouse of a veteran missing in action, captured, or forcibly detained
by a foreign power, or
3. A veteran of any war who has served on active duty for one day or more during a wartime period, excluding active duty for training, and who was discharged under honorable
conditions from the Armed Forces of the United States of America, or
4. The unremarried widow or widower of a veteran who died of a service-connected disability.
A DD214 or comparable document which serves as a certificate of release or discharge claim must be furnished at the time of application. In addition, applicants claiming
categories 1,2, or 4 above must furnish supporting documentation in accordance with the provisions of Rule 55A-7.013, F.A. C. Wartime periods are defined in §.1.01(14), F.S.
Veterans’ Preference shall expire after an eligible person has been employed by any state or agency of a political subdivision of that state. Under Florida law, preference in
appointment shall be given by the state to those persons in categories 1 and 2 and then those in categories 3 and 4. Veterans’ Preference does not apply to retired-for-longevity
military personnel when a competitive examination is used. However, retired military personnel with a compensable disability are eligible, regardless of whether a competitive
examination is used.
If an applicant claiming Veterans’ Preference for a vacant position is not selected, he/she may file a complaint with the Florida Department of Veterans’ Affairs, P.O. Box 31003,
St. Petersburg, Florida 33731-8903. A complaint must be filed within 21 days of the applicant receiving notice of the hiring decision made by the employing agency or within 3
months of the date the application is filed with the employer if no notice is given.
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