APPLICATION FOR APPOINTMENT We are an equal opportunity employer, dedicated to non- discrimination in employment on the basis of race, color, age, religion, sex, national origin, handicap, disability or marital status.
St. Lucie County, Florida
TAX COLLECTOR
 
 
Date: 
 
Social Security No: 
 
Are you 18 Years or Older?     Yes      No
 
Name: 
  Last First Middle
 
Present Address: 
  Street City State Zip
 
Permanent Address: 
  Street City State Zip
 
Phone No:  ( )   Referred by: 
 
If related to anyone who works for the Tax Collector,
State Name, Department and Location: 
 
In Case of Emergency, Please Notify : 
  Name Address Telephone
 
EDUCATION
 
  Name and Location of School Degree/Certificate Subjects Studied Grade Average
Grade School
 
      
High School
 
      
College
 
      
Trade, Business or Correspondence School
 
      
Other (including graduate school)
 
      

Have you ever been convicted of, or plead guilty, no contest or nolo contend ere to a crime?     Yes      No
 
If yes, give details (date, place, offense(s), disposition, etc.): 
 
 
 
Have you ever been charged with a crime and either been placed on a court-ordered probation,had adjudication withheld, or entered a pre-trial intervention program?     Yes      No
 
 
If yes, give details (date, place, offense(s), disposition, etc.): 
 
 
List below sequentially all of your employers in the last (10) years beginning with your current or most recent employer (use additional pages, if necessary).
 
PREVIOUS EMPLOYMENT
 
Date
Month and Year		 Name, Address and Telephone # of Employer Salary Position and Job Duties Reason for Leaving
From:

To:
 
 
      
From:

To:
 
 
      
From:

To:
 
 
      
From:

To:
 
 
      
From:

To:
 
 
      
 
Did you work for any of these employers under a different name?     Yes      No
 
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?     Yes      No
 
If yes, please explain: 
 
 
Have you ever been discharged or asked to resign?     Yes      No
 
If yes, please explain (include by whom, when and for what): 
 
 
DRIVING RECORD
 
Do you have a valid driver's license?     Yes      No
 
What class of license do you possess? 
 
Have you ever had your license or driving privileges revoked, suspended, or placed on probation?     Yes      No
 
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 (3) years?
 
List below all traffic violations (except parking) on your record for the last (5) years and all motor vehicle accidents in which you were involved (use additional pages if necessary).
 
Date Location Description Result
 
 
    
 
 
    
 
 
    
 
 
    
 
Signature