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State of Florida

EMPLOYMENT APPLICATION

The State of Florida does not tolerate violence in the workplace.

Where to Find Vacancy Information:

• One Stop Career Centers - Consult

FOR OFFICIAL USE ONLY

Agency Authorized SignatureDate Broadband/Class Code Status

POSITION APPLIED FOR

Agency: ___________________________________________________________________________

Title:______________________________________________________________________________

Position Number:___________________________ Date Available: ____________________________

Counties of Interest: _________________________________________________________________

Minimum Acceptable Salary: __________________________________________________________

GENERAL INSTRUCTIONS FOR COMPLETION OF APPLICATION:

•Complete all information within this application in its entirety.

•Type or print in ink.

•All information provided will be a public record and will be released upon

•Specify the position for which you are applying. (Note: A separate application must be submitted for each vacancy. Photocopies are acceptable.)

•Submit application to the People First Service Center,

fax: (888) 403-2110, no later than 11:59 PM (EST) on the announced deadline date.

HOW DO WE CONTACT YOU?

Name

People First Employee ID Number (if any)

Mailing Address

City	County	State	Zip Code

Phone	Alternate Phone

E-mail Address

EDUCATION

HIGH SCHOOL:

NAME / LOCATION OF SCHOOL

RECEIVED:

Diploma

Other (specify)

None

YOUR NAME, IF DIFFERENT WHILE ATTENDING SCHOOL: ________________________________________________________________________________________________________________

COLLEGE, UNIVERSITY OR PROFESSIONAL SCHOOL: (TRANSCRIPTS MAY BE REQUIRED)

DATES OF

CREDIT

MAJOR / MINOR

TYPE OF

ATTENDANCE

HOURS

COURSE OF

DEGREE

NAME OF SCHOOL

LOCATION

(MONTH / YEAR)

EARNED

STUDY

EARNED

FROM

QTR

SEM

YOUR NAME, IF DIFFERENT WHILE ATTENDING SCHOOL: ________________________________________________________________________________________________________________

JOB-RELATED TRAINING OR COURSE WORK: (VOCATIONAL, TRADE, GOVERNMENTAL, BUSINESS, ARMED FORCES, ETC.)

		DATES OF		CREDIT
NAME OF SCHOOL	LOCATION	ATTENDANCE		HOURS
		(MONTH / YEAR)		EARNED
		FROM	TO	CLASS	CLOCK

COURSE OF

STUDY

TRAINING

COMPLETED

YES NO

YOUR NAME, IF DIFFERENT WHILE ATTENDING SCHOOL: ________________________________________________________________________________________________________________

LICENSURE, REGISTRATION, CERTIFICATION (

LICENSE, REGISTRATION OR CERTIFICATION:

Number

Date Received

Expiration Date

State Licensing Agency

PERIODS OF EMPLOYMENT

Describe all work experience in detail, beginning with your current or most recent job. Include military service (indicate rank), internships and job-related volunteer work, if applicable. Indicate number of employees supervised. Use a separate block to describe each position or gap in employment. If needed, attach additional sheets, using the same format as on the application. All information in this section must be completed. Resumes may be attached to provide additional information.

Name of Present or Last Employer: _____________________________________________________________________________________________________

Address: ____________________________________________________________________________ Your Job Title: ____________________________________

Supervisor’s Name: _____________________________________________________________Phone No.: (_____) ________________________

FROM: _____/_____/_____			TO: _____/_____/_____			HOURS PER WEEK: _______ (_________________________)
MONTH	DAY	YEAR	MONTH	DAY	YEAR	YOUR NAME IF DIFFERENT DURING EMPLOYMENT

Duties and Responsibilities: ______________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

Reason For Leaving: ____________________________________________________________________________________________________________________

Name of Next Previous Employer: ______________________________________________________________________________________________________

Address: ____________________________________________________________________________ Your Job Title: ____________________________________

Supervisor’s Name: _____________________________________________________________Phone No.: (_____) ________________________

FROM: _____/_____/_____			TO: _____/_____/_____			HOURS PER WEEK: _______ (_________________________)
MONTH	DAY	YEAR	MONTH	DAY	YEAR	YOUR NAME IF DIFFERENT DURING EMPLOYMENT

Duties and Responsibilities: ______________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

Reason For Leaving: ____________________________________________________________________________________________________________________

Name of Next Previous Employer: ______________________________________________________________________________________________________

Address: ____________________________________________________________________________ Your Job Title: ____________________________________

Supervisor’s Name: _____________________________________________________________Phone No.: (_____) ________________________

FROM: _____/_____/_____			TO: _____/_____/_____			HOURS PER WEEK: _______ (_________________________)
MONTH	DAY	YEAR	MONTH	DAY	YEAR	YOUR NAME IF DIFFERENT DURING EMPLOYMENT

Duties and Responsibilities: ______________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

Reason For Leaving: ____________________________________________________________________________________________________________________

Name of Next Previous Employer: ______________________________________________________________________________________________________

Address: ____________________________________________________________________________ Your Job Title: ____________________________________

Supervisor’s Name: _____________________________________________________________Phone No.: (_____) ________________________

FROM: _____/_____/_____			TO: _____/_____/_____			HOURS PER WEEK: _______ (_________________________)
MONTH	DAY	YEAR	MONTH	DAY	YEAR	YOUR NAME IF DIFFERENT DURING EMPLOYMENT

Duties and Responsibilities: ______________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

Reason For Leaving: ____________________________________________________________________________________________________________________

Name of Next Previous Employer: ______________________________________________________________________________________________________

Address: ____________________________________________________________________________ Your Job Title: ____________________________________

Supervisor’s Name: _____________________________________________________________Phone No.: (_____) ________________________

FROM: _____/_____/_____			TO: _____/_____/_____			HOURS PER WEEK: _______ (_________________________)
MONTH	DAY	YEAR	MONTH	DAY	YEAR	YOUR NAME IF DIFFERENT DURING EMPLOYMENT

Duties and Responsibilities: ______________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

Reason For Leaving: ____________________________________________________________________________________________________________________

Name of Next Previous Employer: ______________________________________________________________________________________________________

Address: ____________________________________________________________________________ Your Job Title: ____________________________________

Supervisor’s Name: _____________________________________________________________Phone No.: (_____) ________________________

FROM: _____/_____/_____			TO: _____/_____/_____			HOURS PER WEEK: _______ (_________________________)
MONTH	DAY	YEAR	MONTH	DAY	YEAR	YOUR NAME IF DIFFERENT DURING EMPLOYMENT

Duties and Responsibilities: ______________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

Reason For Leaving: ____________________________________________________________________________________________________________________

If needed, attach additional sheets, using the same format as on the application. Resumes may be attached to provide additional information.

KNOWLEDGE / SKILLS / ABILITIES (KSAs)

List KSAs you possess and believe relevant to the position you seek, such as operating heavy equipment

_________________________________________________________________________________________________________________________________________

EXEMPTION FROM PUBLIC RECORDS DISCLOSURE

ARE YOU A CURRENT OR FORMER LAW ENFORCEMENT OFFICER, OTHER COVERED EMPLOYEE**,

OR THE SPOUSE OR CHILD OF ONE, WHOSE INFORMATION IS EXEMPT FROM PUBLIC RECORDS

DISCLOSURE UNDER SECTION 119.071(4)(d), FLORIDA STATUTES (F.S.)?

YES

sistant and statewide prosecutors, personnel of the Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child support enforcement, and certain investigators in the Department of Children and Families [see§ 119.071.F.S.].

BACKGROUND INFORMATION

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR?

YES

If “YES _____________________________________________________________________________________________________________________

Where convicted? _________________________________________________________________

Date of Conviction: ______________________________________

HAVE YOU EVER PLED NOLO CONTENDERE OR PLED GUILTY TO A CRIME WHICH IS A FELONY OR A FIRST DEGREE MISDEMEANOR?

YES

If “YES______________________________________________________________________________________________________________________

Where? _________________________________________________________________________	Date: ________________________________________________
HAVE YOU EVER HAD THE ADJUDICATION OF GUILT WITHHELD FOR A CRIME WHICH IS A
FELONY OR A FIRST DEGREE MISDEMEANOR?	YES	NO
If “YES ____________________________________________________________________________________________________________________
Where? __________________________________________________________________________	Date: _________________________________________________
NOTE: A “YESThe nature, job-relatedness, severity a	nd date of the offense in relation to
the position for which you are applying are considered [see §112.011, F.S.]

CITIZENSHIP

The

authorization to work in the U.S.

1.ARE YOU A U.S. CITIZEN?

2.IF NO, ARE YOU LEGALLY AUTHORIZED TO ACCEPT EMPLOYMENT WITH THE SPECIFIC HIRING AUTHORITY TO WHICH YOU ARE APPLYING?

YES

RELATIVES

TO YOUR KNOWLEDGE, DO YOU HAVE ANY RELATIVES WORKING IN THIS AGENCY?

YES

SELECTIVE SERVICE SYSTEM REGISTRATION

Section 110.1128, Florida Statutes, prohibits employment by the State (including re-hire after a break in service) of any male born after October 1, 1962, who failed to register with the Selective Service System, under the provisions of the U.S. Military Selective Service Act, during the person’s period of eligibility (ages 18 through 25). Additionally, if currently employed by the State, this law prohibits the promotion of such person.

IF YOU ARE A MALE BORN AFTER OCTOBER 1, 1962, HAVE YOU REGISTERED WITH THE SELECTIVE SERVICE OR DO YOU HAVE PROOF OF AN EXEMPTION

FROM THIS REQUIREMENT (DOCUMENTATION MAY BE REQUIRED )?

YES

Not Applicable

CERTIFICATION

grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I consent to the release of information about

human resources staff, and other authorized employees of Florida state government for employment purposes. This consent shall continue to be effective during my employment if I am hired. I understand that applications submitted for state employment are public records. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith.

SIGNATURE: ___________________________________________________________________________ DATE: ___________________________________

4	DP-E-16 Rev. 07/01/2014

Employer, remove this section upon completion of the selection process.

YOUR NAME: _____________________________________________________________________________________________________________________________

POSITION TITLE FOR WHICH YOU ARE APPLYING: _________________________________________________________ POSITION NUMBER: ________________

VETERANS’ PREFERENCE INFORMATION: (Career Service positions only) For the purposes of appointment, retention, reinstatement, reemployment and promotion, Veterans’ Preference ensures that veterans and eligible persons are given consideration at each step of the selection process. However, preference does not guarantee that a veteran or other eligible person will be the candi-

residency is not required for Veterans’ Preference. Completion of the Veterans’ Preference section below is voluntary and will be kept

a.A veteran with a service-connected disability who is eligible for or receiving compensation, disability retirement, or pension under public laws admin- istered by the U.S. Department of Veterans’ Affairs and the Department of Defense. [section 295.07(1)(a), F.S.]

b.The spouse of a veteran who cannot qualify for employment because of a total and permanent service-connected disability, or the spouse of a veteran missing in action, captured, or forcibly detained or interned in line of duty by a foreign government or power. [section 295.07(1)(b), F.S.]

served in a qualifying campaign or expedition. Active duty for training shall not qualify for eligibility under this paragraph. [section 295.07(1)(c), F.S.]

d.The un-remarried widow or widower of a veteran who died of a service-connected disability. [section 295.07(1)(d), F.S.]

e.The mother, father, legal guardian, or unremarried widow or widower of a member of the United States Armed Forces who died in the line of duty

g. A current member of any reserve component of the United States Armed Forces or the Florida National Guard. [section 295.07(1)(g), F.S.]

All applicants claiming Veterans’ Preference must submit a DD Form 214 (member copy #4) or comparable discharge, separation or cur- rent reserve documentation that indicates the character of service as honorable. In addition, all applicants claiming Categories a, b, d, or e above must also furnish supporting documentation in accordance with the provisions of Rule 55A-7 Florida Administrative Code. Please fax your supporting documentation to the People First Service Center at (888) 403-2110 by the closing date of the job announcement. Be sure to include the position number for which you are applying on each page submitted. All required documents must be submitted no later than the closing date of the job announcement.

complaint with the Florida Department of Veterans’ Affairs, Veterans’ Preference, P. O. Box 31003, St. Petersburg, FL 33731. A complaint

VETERANS’ PREFERENCE CLAIM: IF ELIGIBILE, WHICH VETERANS’ PREFERENCE CATEGORY
ABOVE ARE YOU CLAIMING?

ARE YOU CURRENTLY EMPLOYED WITH THE AGENCY TO WHICH YOU ARE CURRENTLY APPLYING?	YES	NO
HAVE YOU RECEIVED A PROMOTIONAL APPOINTMENT IN A CAREER SERVICE POSITION,
SUBSEQUENT TO ACTIVE MILITARY SERVICE, WITH THE AGENCY TO WHICH YOU ARE CURRENTLY APPLYING?	YES	NO

This section SHOULD be removed prior to the selection process.

EEO SURVEY Although the following information is not mandatory, it is requested to aid the State of Florida in its commitment to Equal Employment Opportunity,

RACE/ ETHNICITY (Please identify both Race and Ethnicity)

Race (CHECK ONLY ONE):		Ethnicity (CHECK ONLY ONE):
White		Hispanic or Latino
Black/African American		Not Hispanic or Latino
Asian
American Indian/Alaska Native
2 or more races
SEX:	MALE	FEMALE
DATE OF BIRTH:	_____________________________________

POSITION NUMBER: ____________________________________

POSITION TITLE FOR WHICH YOU ARE APPLYING: _____________________________________________________________________________________________

Employment with the State of Florida

Note: This hard copy of the State of Florida employment application is to be used only if you are unable

to use the online application process at https://jobs.

State Government

Personnel Structure

State government is a major employer in Florida, offering a diverse range of challenging and rewarding jobs, with a comprehensive compensation package and opportunities for career mobility.

Non-State Personnel System agencies are agencies in which jobs do not

fall under the Career Service,

Selected Exempt Service

or Senior Management

Service pay plans and their

employment procedures

may differ. These

employers may or may not

accept the State of Florida

employment application.

Additionally, their job titles and salaries may not be comparable

to those in the State Personnel System.

How to Search for Vacancies

by carefully reviewing the job vacancy announcement or by contacting the employing agency, if necessary.

Use this information to ensure your application, cover letter, resume and other supporting materials address how

these requirements.

How Candidates are

Selected

takes in the selection process is to review the applications which have been received to determine who

Employees with the State of Florida fall into a variety of different and autonomous personnel systems each with their own set of rules and regulations, collective bargaining

packages. The State Personnel System, comprised of employees in the Career Service, Selected Exempt Service and Senior Management Service pay plans, is the largest of these systems and is the focus of this narrative. The State of Florida employment application is used to apply for vacancies within the State Personnel System.

Most state jobs are in the Career Service pay plan. The Career Service provides uniform pay, job

for the majority of non-managerial jobs within state agencies. The Senior Management Service (SMS) includes upper management and policy-making jobs. Middle management, such as bureau chiefs, professional jobs, such as physicians and attorneys, and supervisory jobs are included in the Selected Exempt Service. Employees can move between agencies without

Individual state agencies are responsible for announcing their job vacancies and making hiring decisions. Generally, agencies accept job applications for advertised vacancies only. However, agencies may accept applications

for certain positions on a continuous basis. A completed State of Florida employment application is required for each job vacancy to which you apply.

There are several ways for you to obtain state job vacancy information:

•Access the People First job information web site on the Internet at:

•Contact individual State Personnel System agencies directly for information regarding their employment opportunities.

•Contact a Florida One Stop Career Center for job information on and other employment opportunities. To

your telephone directory under “Workforce One Stop Career Center or visit:

Completed applications should be submitted by fax to the People First Service Center at (888) 403-2110.

is eligible to compete further in the selection process. Job-related criteria are used to determine those applicants who will be asked to participate in additional assessment steps such as an oral interview, a work sample exercise,

information gained during the selection

Action goals are also considered by the agency in the decision-making process.

If, because of a disability, you require a special accommodation to participate in the application and selection process, please notify the hiring authority in advance.

	Temporary jobs are funded by Other	How to Market Yourself
	Personal Services (OPS) appropriations.	Prior to completing an application for
	OPS employees receive an hourly wage	Prior to completing an application for
	OPS employees receive an hourly wage
		about the duties of the job and relevant
		knowledge, skills and abilities required

Question	Answer
Form Name	Employment Application Florida Form
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	florida application form, fl dp e 16, dp e 16, florida employment application printable

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