Personal
Full name:
Social Security Number:
Date of birth:
Driver License Number
Address (include city, state and zip):
Home phone number:
Cell phone number:
Email address:
Best time to reach you:

What is the position you are applying for?
Are you eligible to work in the United States?

How did you learn about this open position?
If you selected "Other" please specify.
Have you ever been convicted of ANY offense against the law or received a traffic citation, including speeding?

If you selected "Yes" please specify.
Have you ever been involved in a situation involving workplace violence?

If you selected "Yes" please specify.
To the best of your knowledge, have you ever been the subject of any complaints, charges or lawsuits for unlawful harrassment?

If you selected "Yes" please specify.
Affirmative answers to the above questions do not constitute an automatic bar to employment. Provide all facts so that an informed decision may be made. An intential omission of falsification of answers either verbally or in writing may result in no consideration or termination of employment.
Have you ever worked for the Collier County Supervisor of Elections?

If so, when?
Is an immediate member of your family or household employed by the Collier County Supervisor of Elections?

Will you accept shift work?

Education
What is the highest education level you have completed?
Beginning with your most recent education level, please list the institutions you attended.
School name and address:
Graduation year or anticipated graduation year:
Degree or certificate obtained:
Major or area of concentration:
School name and address:
Graduation year:
Degree or certificate obtained:
Major or area of concentration:
School name and address:
Graduation year:
Degree or certificate obtained:
Major or area of concentration:
School name and address:
Graduation year:
Degree or certificate obtained:
Major or area of concentration:
Military Service
Are you or have you ever been enlisted in the U.S. Armed Forces?

If yes, what branch of the military?
Dates of duty:
Rank at discharge:
Please list any military duties or special training you completed that may relate to the position you are applying for.
Have you previously been employed through veterans preference?

Do you wish to claim veterans preference at this time?

If you are claiming veterans preference, you must provide a copy of your DD214 to the Veteran Services Department and this application certified.
Special Skills
What is your typing speed (words per minute)? Leave blank if unknown.
Are you proficient using a computer?

Please rank your skill level for each of the below software programs.
Microsoft Word
Microsoft Excel
Microsoft Access
Microsoft Power Point
Microsoft Publisher
Adobe Acrobat
Adobe PageMaker
Adobe Photoshop
Adobe Indesign
SQL
HTML
Crystal Reports
Please list any professional associations you belong to or any professional licenses or certifications you hold.
Please list any additional languages you speak fluently outside of English.
Employment History
Please list all present and past employment below beginning with your most recent position.
Name and address of employer:
Job title:
Start date:
End date (leave blank if still employed with this company):
Beginning salary:
Ending salary:
Reason for leaving:
Direct Supervisor name and contact information:
May we contact them for a reference?

Please list any daily duties and/or accomplishments while employed with this company.
Name and address of employer:
Job title:
Start date:
End date (leave blank if still employed with this company):
Beginning salary:
Ending salary:
Reason for leaving:
Direct Supervisor name and contact information:
May we contact them for a reference?

Please list any daily duties and/or accomplishments while employed with this company.
Name and address of employer:
Job title:
Start date:
End date (leave blank if still employed with this company):
Beginning salary:
Ending salary:
Reason for leaving:
Direct Supervisor name and contact information:
May we contact them for a reference?

Please list any daily duties and/or accomplishments while employed with this company.
Have you ever been discharged or forced to resign for misconduct or unsatisfactory performance?

If you selected "Yes" please provide details of the situation including the contact information of the employer who terminated your employment.
Personal References
Please provide at least three references we may contact excluding family members and former employers.
Reference name and contact information (address, phone and email if available):
Occupation:
Best time to contact them:

Reference name and contact information (address, phone and email if available):
Occupation:
Best time to contact them:

Reference name and contact information (address, phone and email if available):
Occupation:
Best time to contact them:

To assist us in determining if you meet the qualifications for the applied position(s), please use the space below to summarize any additional information that would be helpful to us in considering you as the best candidate for this position. Please also use this area to explain any gaps, six months or more, in your employment history.
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