Position Applying For
Title*
Preferred Customer/Contract:*
- TECO
- Duke
- FP&L
- None
Date Available*
MM slash DD slash YYYY
Minimum Acceptable Salary*
Payment*
- Hourly
- Salary

Personal Information
Name*
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone (Cell)*
Phone (Alternate)
Email Address*

High School
Name / Location of School*
Received*
- Diploma / GED
- None
Your name, if different wile attending school:
College, University, or Professional School
Transcripts may be required.
College, University, or Professional School
Click the plus button to add a row.
Name of School Location Dates of Attendance (Month/Year) Major/Minor Course of Study Type of Degree Earned
Job Related Training or Course Work
Vocational, Trade, Governmental, Business, Armed Forces, etc.
Job Related Training or Coursework
Click the plus button to add a row.
Name of School Location Dates of Attendance (Month/Year) Course of Study Credit Hours Earned Training Completed
License, Registration or Certification
License, Registration or Certification
Click the plus button to add a row.
Name Number Date Received Expiration Date State Licensing Agency

Employment History
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.
1
Name of Last Employer
Address
Your Job Title
Supervisors Name
Phone Number
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Hours Per Week
Duties and Responsibilities
Reason for Leaving
2
Name of Last Employer
Address
Your Job Title
Supervisors Name
Phone Number
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Hours Per Week
Duties and Responsibilities
Reason for Leaving
3
Name of Last Employer
Address
Your Job Title
Supervisors Name
Phone Number
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Hours Per Week
Duties and Responsibilities
Reason for Leaving
4
Name of Last Employer
Address
Your Job Title
Supervisors Name
Phone Number
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Hours Per Week
Duties and Responsibilities
Reason for Leaving

Knowledge / Skills / Abilities (KSAs)
List KSAs
List KSAs you possess and believe relevant to the position you seek, such as operating heavy equipment, computer skills, fluency in language(s), etc.
Citizenship
You will be required to provide identification and either proof of citizenship or proof of authorization to work in the U.S.
Are you 18 years of age or older?*
- Yes
- No
Are you legally authorized to accept employment to which you are applying?*
- Yes
- No
Relatives
To your knowledge, do you have any relatives working in this agency?*
- Yes
- No
If yes, who?
Certification
I am aware that any omissions, falsifications, misstatements, or misrepresentations above may disqualify me for employment consideration and, if I am hired, may be 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 my ability, employment history, and fitness for employment by employers, schools, law enforcement agencies, and other individuals and organizations to investigators, personnel 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*

Name of School	Location	Dates of Attendance (Month/Year)	Major/Minor Course of Study	Type of Degree Earned

Name of School	Location	Dates of Attendance (Month/Year)	Course of Study	Credit Hours Earned	Training Completed

Name	Number	Date Received	Expiration Date	State	Licensing Agency

Apply

Step 1 of 5 - Position

Position Applying For

Personal Information

High School

College, University, or Professional School

Job Related Training or Course Work

License, Registration or Certification

Employment History

Knowledge / Skills / Abilities (KSAs)

Citizenship

Relatives

Certification