INSTRUCTIONS

To complete the City of Gulf Breeze application

1. Complete Application.

2. Sign and Date Application.

3. Complete all blanks and provide all information; please do not use "see resume."

COMMON ERRORS:
a) Not entering "salary expected."
b) Not entering complete address, zip and telephone numbers of references.
c) Not entering the city and state of schools attended, date of attendance, graduation, degree and
major subject taken.
d) Not entering complete employment record, name, address, zip, telephone, position held, dates of
employment and reason for leaving.
e) Not signing and dating application

4. Mail application to:

City of Gulf Breeze
Attn: Human Resources
P.O. Box 640
Gulf Breeze, FL 32562

5. Or fax application to:

(850) 934-5114 Main Fax

6. An incomplete application will be rejected.

7. Those who wish to submit a resume may do so; however an application must be completed and
have the resume as an attachment.
 APPLICATION FOR EMPLOYMENT
Mail to: Phone: (850) 934-5115
CITY OF GULF BREEZE Fax: (850) 934-5114
P.O. Box 640 Web Site: www.cityofgulfbreeze.com
Gulf Breeze, FL 32562 E-Mail: [email protected]
Please complete the application in legible handwriting, printing, or type. Please list only one position per application.

PERSONAL INFORMATION

Name (Last, First, MI)

Street Address City, State, Zip

( ) ( )
Home Telephone Number Day-time Telephone Number E-mail address

Valid Florida Driver’s License [ ] YES [ ] NO other: ___________________________________________

If under age 18, proof of age and a work permit will be required, and certain positions requiring operation of motorized equipment will
not be available. Can you furnish proof/permit if necessary? [ ] YES [ ] NO [ ] NOT APPLICABLE

Proof of eligibility to work in the United States will be required, are you legally eligible to work in the United States?
[ ] YES [ ] NO

EMPLOYMENT INFORMATION

$
Title of Position for which you are applying Application Date Salary Expected

Type of Employment Desired: [ ] Full-Time [ ] Part-Time [ ] Temporary

Will you work hours other than 7;30 to 4? [ ] YES [ ] NO

Will you work schedules other than Monday thru Friday? [ ] YES [ ] NO

Will you accept temporary work? [ ] YES [ ] NO

Have you ever been employed by the City of Gulf Breeze before? [ ] YES [ ] NO
(If “yes”, please give dates and explanation)

Have you ever been discharged from employment because your work or conduct was not satisfactory? [ ] YES [ ] NO

Have you ever been convicted of a felony in the last seven (7) years? [ ] YES [ ] NO
If “yes”, please give dates and explanation) **Note: conviction does not necessarily bar you from employment
REFERENCES: List three (3) persons, other than relatives who have knowledge of your work experience and/or education.
Name Address Phone # (Day) and email
1.

2.

3.

EDUCATION AND TRAINING

Circle Highest Did you

School Name and Location of School Last Attended
Grade Completed Graduate?
High School 9 10 11 12
Did you
Names of School(s) Dates
Graduate?
Location (City and State) Attended Degree Major Subject
Yes/No

College

College

Vo-Tech

Licenses/CDL
Class

Other
Certifications
Federal or
State
EMPLOYMENT RECORD
Supervisor’s Dates Employed
Employer’s Name Position Held Reason For
Name
Address & Phone Title/Duties FROM TO Leaving
And Title
Please, start with your present position.

Please list any special knowledge/skills/abilities that you possess pertinent to the position:

Applicant’s Statement: I certify that all information and statements given on this application are true and correct to the best of my knowledge and agree to be bound
thereby. I hereby give consent to duly authorized representatives of the City of Gulf Breeze to contact any former employers, educational institutions indicated, and any
other persons or organizations that it determines might have information relevant to this application. I further give consent to said organizations to divulge relevant
information to the City of Gulf Breeze, notwithstanding that it might otherwise be confidential, such as records of disciplinary proceedings. I understand that any
information obtained by the City of Gulf Breeze in the course of those contacts will be treated confidences. I understand that by accepting this application, the City
incurs no liability for my future employment and that acceptance of an offer of employment does not create a contractual obligation upon the City to continue
employment in the future. In the event of employment, I understand that false or misleading information given on the application or in an interview may result in
discharge. If employed, I agree to abide by the work rules and regulations of the City of Gulf Breeze, Laws of the State of Florida, and applicable Federal Laws and
Regulations.

Signature of Applicant Date

The City of Gulf Breeze is a Tobacco and Drug-Free Workplace Employer and requires applicants and employees to submit to Drug Testing.
The City is an Equal Employment Opportunity Employer and will consider all applicants for all positions without regard to race, color, religion,
creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status. Individuals who require accommodations
in order to complete the employment application process should contact the Human Resources Manager at the phone number, or mailing address
listed above.
 EQUAL EMPLOYMENT OPPORTUNITY
APPLICANT SURVEY INFORMATION

The information is requested on a voluntary basis. This information will be used for research, analysis, and to
evaluate the effectiveness of our recruiting efforts. The information in no way affects you as an individual
applicant and will not be used in making an employment decision.

Position applied for: _________________________________________

Please check the category that applies:

Age Group
Under 18 years of age
18-40 years of age
Over 40 years of age

Gender

Male Female

Race/Ethnic Identification

White Black Hispanic Asian or Pacific Islander

American Indian or Alaskan Native

SUBMIT