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Employment Application

April 7, 2020
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  • A city application is required for all positions. Information from the application will be used to determine if minimum qualifications are met. Resumes may be included but are not accepted in lieu of a fully completed application form. Once completed, there should be no blank spaces on the employment application.
  • Complete all items; mark N/A to questions that are not applicable. Incomplete, false or evasive answers may result in loss of employment opportunities. Please account for all adult employment following high school or college. Unsigned application will not be considered.
  • Name: * Required
  • Your social security number is requested for the purpose of identification and verification, data collection, applicant and employee background checks, benefit processing, tax reporting and payroll eligibility in compliance with the Department of Homeland Security. You may elect to withhold your social security number until the time of interview.
  • Address * Required
  • If not applicable answer N/A
  • How did you learn about the position you are applying for?
    Choose one or more from the list.
  • Enter the name of the position you are applying for.
  • Please specify per hour or salary
  • Are you lawfully permitted to work in the United States? * Required
  • Would you work: * Required
  • Have you ever been employed by the City of Madeira Beach? * Required
  • If no, answer N/A
  • Do you have any relatives or friends working for the City of Madeira Beach? * Required
  • If no, answer N/A
  • Driver's License Info

  • Name: * Required
  • Do you have a valid driver's license? * Required
  • Has your driver's license been suspended or revoked in the last five (5) years? * Required
  • If no, answer N/A
  • Criminal & Civil Background

  • NOTE: In responding to the questions below you may consider that non-criminal traffic and code enforcement violations are not convictions for purposes of answering these questions. Convictions will not be an arbitrary bar to your employment. Factors such as age at the time of the offense, how long ago the offense occurred, seriousness and nature of the offense, relationship between the offense the positions applying for, and rehabilitation efforts will be taken into consideration. Falsification of your answers may result in loss of employment opportunities.
  • Have you ever been convicted of any offense against the law or entered a plea of nolo contender (no contest) to an offense against the law or forfeited bond or been a defendant in a civil action for intentional tort? * Required
  • Are you now under any current charge for any offenses against the law? * Required
  • While you were in the military were you ever convicted by a court martial? * Required
  • If you answered "NO" to the above questions, answer N/A.
  • Military History/Veteran's Preference

  • Are you now, or have your been, in the U.S. Armed Forces? * Required
  • If no, answer N/A.
  • Are you claiming Veteran's Preference under Florida Law? * Required
    If you answer yes, you will be sent the Veteran's Preference Form to fill out.
  • NOTE: Preference eligibility no longer expires upon appointment of the eligible person to a position within the state or any political subdivision; veteran's previously ineligible because they held or currently hold a job with a public employer are now eligible to use the preference again with all employees covered by law. In addition, eligible wartime periods now include Operation Enduring Freedom and Operation Iraqi Freedom. Our Human Resources Department will send the Veteran's Preference Form for any veteran looking to claim Veteran's Preference.
  • Record of Education

  • High School
    Enter in your High School information below:
  • Undergraduate College
    Enter in your Undergraduate College information below:
  • Graduate School
    Enter in your Graduate School information below:
  • Technical, Vocational, Business School
    Enter in your Technical, Vocational, Business School information below:
  • Professional Licenses- Certifications

  • Professional License & Certifications
    Enter in your Professional License & Certifications information below:
  • Employment History

  • Start with your present or last job and work backwards. Include at least the last 10 years of employment history including paid or unpaid, full or part time, summer jobs, etc. If you require more than 4 employers for a 10 year period, please photocopy the next page and attach to this application.
  • May we contact your present employer? * Required
    NOTE: We may contact any previous employer to verify your description of past duties and reasons for separation.
  • 1.
    Current or most recent employer
  • or indicate "Current Employer".
  • 2.
  • or indicate "Current Employer".
  • 3.
  • or indicate "Current Employer".
  • 4.
  • or indicate "Current Employer".
  • Have you ever been discharged or forced to resign? * Required
  • If no, answer N/A
  • Exclude membership that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disability, or other similarity protected status.
  • If you are applying for a life safety position such as Firefighter/EMT/or Firefighter/Paramedic, there is an addendum to the employment application that will be sent to you by the Human Resources Department.
  • Notice of Discrimination in Employment

  • The City of Madeira Beach does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under application federal, state, or local law. I understand that if the position(s) I am applying for warrant a credit check, I have specific prescribed rights as a consumer under the federal Fair Credit Reporting Act (FCRA), and may have additional rights under relevant Florida law.
  • The City likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status.
  • Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee. The City of Madeira Beach takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.
  • The City of Madeira Beach clearly denounces and will not tolerate violence or any form of physical harassment and endangerment. No employee or visitor (with exception of sworn law enforcement officers) shall bring any weapons into any City facility, including but not limited to City Hall, Recreation, Marina, Public Works, out of doors work areas, etc.
  • Employee Questionnaire for Self-Identification or Race/Ethnicity

    The purpose of capturing this information is Affirmative Action monitoring and enforcement purposes only. YOUR PARTICIPATION IS VOLUNTARY. If you chose to self-identify, you may check only one of the boxes presented below.
  • What is your race/ethnicity?
    Your participation is voluntary.
  • Gender:
    Your participation is voluntary.
  • Release of Information

  • I voluntarily authorize and grant full consent to the City or its agent to conduct a thorough investigation into my prior employment and any other areas of my background, including criminal and civil background, verification of credentials and employment, motor vehicles reports, etc. which the City believed relevant to my employment. I consent to the release and disclosure to the City or its agent from any persons, companies, corporation or government agency and information sought concerning my background and do further release from liability to City or its agent for actions taken in connection with this investigation, as well as any person, companies, corporations or governmental agencies disclosing such information.
  • I certify that the information contained in this application is correct and complete to the best of my knowledge. I understand that any false information provided by me to the City may constitute ground for immediate discharge regardless of when the information is discovered by the City. I understand my continued employment is contingent on successfully passing any background investigation and any information discovered about me during the investigation which was deemed by the City to be unsatisfactory may constitute ground for immediate discharge, also regardless of when discovered.
  • I understand that the City will require a medical or other examination at the time of employment and shall condition an offer of employment on the successful completion of that examination and verification of my ability to perform the essential functions of the position offer. Post offer employment drug testing and release of the results of those tests to the City shall be required for safety sensitive positions. I understand that I may be subject to drug and alcohol testing after employment. Drug screen results which indicate the presence of illegal drugs shall result in the withdrawal of offer of employment.
  • I understand that individuals hired as Firefighters are prohibited from using any form of tobacco products both on and off the job and cannot have any tobacco products for a period of one year prior to the date of State of Florida Firefighter Certification.
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