Fillable Florida Legislature Employment Application (Page 5 of 5) in pdf

EMPLOYMENT ELIGIBILITY

The Florida Legislature hires only U.S. citizens and lawfully authorized alien workers. If hired you will be required to provide identification and either

proof of citizenship or proof of authorization to work in the U.S.

Are you legally eligible to work in the United States?

Yes

SELECTIVE SERVICE

Section 110.1128, Florida Statutes, requires male applicants between the ages of 18 and 26 to provide proof of registration or exemption issued

by the United States Selective Service as required by the Military Selective Service Act. If you are in this age group, please provide your

Selective Service number, if applicable.

Registration Number:

________________________

RELATIVES

Please list the names and relationships of relatives* who are a member of the Legislature, a legislative employee, a lobbyist, a member of the

Florida Cabinet or the Governor, a key Cabinet aide, the head of an executive branch department or an appointed secretary or executive director.

Name:

Relationship:

Office:

Name:

Relationship:

Office:

*"Relative" is defined as: Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law,

mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister,

half brother, or half sister.

LEGAL HISTORY

A criminal history record check will be conducted prior to hiring.

Have you pleaded nolo contendere to, or been convicted of, a first degree misdemeanor or a felony in any court, domestic or foreign?

_____ Yes

_____No

A conviction includes a plea of guilty, guilty verdict, or finding of guilt, regardless of whether the sentence is imposed by the Court or adjudication

is withheld. If "Yes", please explain:

A "yes" answer to these questions will not necessarily bar you from employment. Each case will be judged on its own merit, with respect to time,

circumstances, and seriousness as it may relate to employment.

REFERENCES

Please list three references excluding relatives and former employers.

NAME

MAILING ADDRESS

TELEPHONE NUMBER

AUTHORIZATION AND CERTIFICATION

I hereby authorize the Florida Legislature to verify all information contained in this application and supplement hereto. I consent to the release of

any information regarding my eligibility for legislative employment by employers, educational institutions, law enforcement agencies, personal

references or other organizations.

I certify that the above statements are true and complete to the best of my knowledge. I further understand that any misrepresentations or false

statements made by me on this application, or any supplement hereto, may be grounds for immediate discharge and/or rejection from

consideration for further employment. If employed, I understand that my employment and compensation can be terminated with or without cause

and with or without notice at any time at the option of either the Legislature or myself.

Signature:

Date:

If employed by the Florida Legislature, you will be subject to the provisions of Section 11.26, Florida Statutes which prohibit legislative employees

from lobbying or providing legal advice outside the Legislature.

All employment applications will remain active for six months, and pursuant to legislative policy, are available for review by the public.

10-01-2014

Florida Legislature Employment Application Page 5

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