First name*

Last name*

Email address*

Phone number*

Upload your resume OR use the following section to type or paste your resume.

Type or Paste your Resume below
**Note: If you do not have a Resume, type "Not Applicable" in the box provided.

Upload your cover letter OR use the following section to type or paste your cover letter.

Type or Paste your Cover Letter below
**Note: If you do not have a Cover Letter, type "Not Applicable" in the box provided.

Have you retired or received a payout from the Florida Retirement System in the last 12 months?

What location(s) will you be willing to work ?

Are there any days, shifts or hours you will not work?

PERSONAL INFORMATION

Are you 21 years old or older

Street Address/Apt/Suite

City, State, Zipcode

Date you can start

Other than English, what languages do you speak fluently?

Were you referred to our office?

If yes, please list reference

If you are related to anyone in our employ, please state their name and department

EDUCATION

My highest degree is:

High School Name and Location

High School Grade Point Average

College(s) Name and Location

College Major(s)/Degree

College Grade Point Average

EMPLOYMENT HISTORY

Do you have one or more years of Customer Service experience in an office setting?

Are you employed now?

If so, may we inquire of your present employer?

Name of Supervisor

Current or Most Recent Employer Name, Address and Phone Number

Dates Employed To and From (month and year)

Salary

Position and Duties

Reason for Leaving

PREVIOUS EMPLOYER #2

Name of Supervisor

Previous Employer #2 Name, Address and Phone Number

Dates Employed To and From (month and year)

Salary

Position and Duties

Reason for Leaving

PREVIOUS EMPLOYER #3

Name of Supervisor

Previous Employer #3 Name, Address and Phone Number

Dates Employed To and From (month and year)

Salary

Position and Duties

Reason for Leaving

Did you work for any of these employers under a different name?

If yes, which employer(s) and under what name(s)?

Please explain any gaps in your employment history

Have you received any written reprimands or disciplinary suspension during any previous employment?

If yes, please explain

Have you ever been discharged or asked to resign?

If yes, please explain (include by whom, when and for what)

MILITARY RECORD

Were you in the U.S. Armed Forces?

If yes, what branch?

Did you receive any training in the U.S. Armed Forces that is relevant to this office?

VETERANS' PREFERENCE

Are you claiming Veterans' Preference?

Veterans' preference is awarded for selection procedures taken and passed, providing this and all required documentation will need to be uploaded below. Do not mail your documents to the Human Resources Office. Preference will not be awarded retroactively. Click here for Veterans form

Have you entered into covered employment by a covered employer after having claimed preference since October 1, 1987?

If yes, give name of employer(s)

DRIVING RECORD

Do you have a valid driver's license?

What class of license do you possess?

Driver's license number and state of issuance*

Have you ever had your license or driving privileges revoked, suspended, or placed on probation?

If yes, please explain (include when, where and what action was taken)

How many speeding or other moving violations have you received in the last three years?

CRIMINAL HISTORY

Have you ever been convicted of, or pled guilty, no contest or nolo contendere to a crime?

If yes, give details (date, place, offense(s), disposition, etc)

Have you even been charged with a crime and either been placed on a court-ordered probation, had adjudication withheld, or entered a pre-trial intervention program.

If yes, give details (date, place, offense(s), disposition, etc)

Have you ever been a defendant in a civil action for intentional torts(s) (e.g. assault, battery, intentional infliction of emotional distress), or an unlawful employment practice (e.g. sexual or racial harassment)?

If yes, give details (date, place, offense(s) charged, disposition, etc)

REFERENCES

Please provide three references below - persons not related to you, whom you have known for at least one year

1st Reference Name, Email, Phone Number, Occupation, Years Acquainted, Relation*

2nd Reference Name, Email, Phone Number, Occupation, Years Acquainted, Relation*

3rd Reference Name, Email, Phone Number, Occupation, Years Acquainted, Relation

SHARED VALUES are those personal qualities and traits that, as a member of the Tax Collector’s Office for Polk County we individually and collectively believe are essential in fulfilling our Mission and Vision.

Our shared values are: Integrity, Innovation, Accountability, Compassion and Teamwork*

I hereby certify that all of the facts and information listed on this appointment application are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any such false, incomplete, or misleading information discovered on this application at any time after I am employed may result in my dismissal.*

I hereby authorize the Tax Collector to investigate all statements contained in this application, to interview the references and previous employers listed in this application, and to obtain a report from a consumer reporting agency to be used for employment purposes in accordance with the Fair Credit Reporting Act. I authorize the references and previous employers listed to give the Tax Collector all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise, and release all such parties from any liability which may allegedly arise from furnishing such information to the Tax Collector, including, but not limited to, any liability for defamation or invasion of privacy.*

If I am offered appointment, I understand that such an offer will be conditioned upon satisfactory results of a background investigation and/or Tax Collector medical examination or inquiry, including a drug screen test. If then employed, I understand that I will be required to serve a 180 day probationary period. I further understand that my appointment and compensation can be terminated, with or without cause or notice, at any time, regardless of the successful completion of my probationary period, at the option of either the Tax Collector or myself. I understand that no supervisor or other representative of the Tax Collector other than the Tax Collector has any authority to enter into any agreement for appointment for any specified period of time, or to make any agreement contrary to the foregoing.*

I further understand and voluntarily agree as a condition of appointment of my continued appointment, that I may be requested by the Tax Collector to submit to a urinalysis or other drug screen test and that my failure to take such test(s) when requested to do so or unsatisfactory test results will disqualify me from consideration for appointment, or if I am than appointed, may result in my immediate dismissal.*

Initial and Date - MM/DD/YYYY - By initialing and dating below I am providing my electronic signature*

Human Check*