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General Employment Application

  1. Please read all the instructions carefully
    1. It is our intention to hire only individuals who are U.S. citizens or aliens authorized to work in the United States. Every offer of employment is contingent upon the employee completing an Employment Verification Form (Form 1-9), and showing original or certified documents designated by law to prove identity and right to work.
  2. 2. Please answer all questions completely. Under the ADA, reasonable accommodations will be made in completing the application. You may submit a résumé, but this application is still required to be completed. Incomplete applications will be rejected from consideration for employment.
  3. 3. Applications are only considered for the position that you apply. You must reapply for any other job postings. Applications shall remain on file for a period of four (4) years after the application deadline.
  4. 4. Whenever the demands of service may require, the Human Resources Department of the Fire District will notify applicants, who possess the minimum requirements, and whose applications have been filed, accepted, and are on record to appear for an interview at the time and place to be specified in such notification.
  5. 5. Notice of applicant's change of address should be promptly sent to the Human Resources Department of the Fire District
  6. 6. The Human Resources Department of the Fire District may reject consideration of the application of any person for any of the following reasons: (a) For not possessing the established minimum requirements. (b) For the current use of illegal drugs or the abuse of controlled substances, including alcohol. (c) For failing to pass the pre-employment physical. (d) For having been dismissed from public service or from other employment. (e) For making omissions, misleading or false statements in the filing of this application.
  7. 7. If you are claiming Veteran's Preference, please attach a copy of your DD-214 to this application.
  8. 8. For additional space to respond to any question(s), please attach additional pages marked “Addendum”.
  9. 9. Applicants must submit copies of their high school diploma or GED and driver’s license. College graduates must submit a copy of official transcript(s) and degree(s).
  10. 10. Applicants must submit a signed and notarized Authorization to release records form that is available to download on our employment page at
  12. Have you ever been dismissed from employment?*
  13. Have you ever been convicted, had adjudication withheld and/or plead nolo contender to a crime whether it be a felony, misdemeanor or driving offense such as driving under the influence by a court or military tribunal, excluding minor traffic violations?*
  14. A conviction record will not necessarily be a bar to employment. Factors such as age and time of offense, seriousness, and nature of the violation, and rehabilitation will be taken into account. The Fire District may consider a conviction during the hiring process and will consider the following factors: economic and human risk; nature and gravity of the offense; nature of the job; the time since the conviction or completion of the sentence.
  15. If you answered “yes” to any of the above, please attach a separate sheet giving complete details for each incident.
  16. Education:
    Provide the information requested below on all schools that you have attended since tenth (10th) grade
  17. Did you graduate? (Copy of diploma is required)*
  18. Earned degree?*
    Provide the following information for all employment, including part-time employment as far back as age 18. List the most recent position FIRST.
  20. You can submit a resume here, but please also fill out your employment history.
  21. May we contact this employer for a reference?
  22. May we contact this employer for a reference?
  23. May we contact this employer for a reference?
  24. May we contact this employer for a reference?
  25. Is there anything which would in any way restrict or prohibit you from working on particular days or hours?*
  26. Can you work overtime?*
  27. Can you work shift work?*
  28. Have you ever applied for a position with any federal, state, or local law enforcement agency or any fire department?*
  29. Have you ever applied for any position with the federal, state, or local government for which a background investigation was initiated?*
  30. Have you ever been denied employment by any federal, state, or local law enforcement agency or fire department?*
    Enter the foreign language that you know and indicate your knowledge of each.
  32. Reading
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  44. *The Florida Human Rights Acts of 1992 prohibits discrimination based on age. The age discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals whom are at least 40 years of age.
  45. Are you a U.S. Citizen or national, a lawful, permanent resident alien, or an alien authorized by the Immigration and Naturalization Service to work int he United States?*
  46. *Every offer of employment is contingent upon the employee completing an employment verification form (Form I-9) and showing original documents designated by law to prove identity and right to work.
  47. An outside personal economic relationship, such as those described below, which affords present or future financial benefits to an employee, his/her family or individuals with whom he/she has business or financial ties may be considered a conflict of interest requiring evaluation by the Fire District. Family members include: spouse, children (biological, step, adopted), father, mother (biological/step), sisters, brothers (biological/step), grandparents, father/mother-in-law, brother/sister-in-law. Florida Statutes 112, Part III also prohibits financial conflict of interest.
  48. 1. The employee is engaged in a private business or financial relationship, which may secure advantage of goods, services, or influence due to the position of the employee with the Fire District.
  49. 2. The employee designates sources for procurement or procures parts, materials, services, supplies and facilities by purchase or lease, or sells or leases to the Fire District his/her own name or the name of others.
  50. 3. The employee acts as director, officer, agent, sole proprietor, partner, stockholder (if owning in excess of five (5) percent of securities outstanding), employee, paid consultant or adviser to a supplier.
  51. Are you presently involved in any work or business, whether self-employed or for another employer, which you intend to continue working should you be employed by the Fire District? *
  53. Do you currently have a valid Florida driver's license?*
  54. Do you currently have a valid Florida Class "E" license?
  55. Please provide the information requested below on all Florida driver's licenses that are now or have been issued to you.
  56. Is your driver's license now, or has it ever been: (Check all that apply)
  57. Have you been the driver of a vehicle involved in a motor vehicle accident within the last ten (10) years? *
  58. At any time since you first began driving, have you ever been the driver of a vehicle involved in a motor vehicle accident, where there was loss of life, personal injury, or damage in excess of $500.00? *
  59. Indicate below all traffic violation or citations (EXCLUDING PARKING TICKETS) that you have received within the last ten (10) years including but not limited to, such violations as speeding, reckless driving, changing lanes without caution, defective equipment, stop sign violations, and red light violations. List each incident below:
  60. Military Data
    If none, please check the box
  61. Military Service:
  62. Reserve Service:
  63. National Guard Membership:
  64. Were you recommended for re-enlistment after each period of military duty?
  65. Have you ever received a less than honorable discharge from the armed forces? **see bottom of section
  66. Were you ever subject to any disciplinary action (judicial or non-judicial) while in the armed forces?
  67. Were you ever the subject of any criminal investigation that was being conducted by military authorities concerning any alleged misconduct on your part?
  68. **If discharged for medical or psychological reasons, the Fire District will not use that information in making a decision of whether to offer employment. This information will only be available to the examining physician after an offer of employment.
  69. Veteran's Preference Information
  70. Are you claiming Veteran's Preference on your application?
  71. Eligibility:
    Florida law provides that preference in employment, reemployment, promotion, and retention, shall be given to an eligible veteran, pursuant to Chapter 295.07, et seq., Florida Statutes, as long as the veteran meets the minimum eligibility requirements and has the knowledge, skills, and abilities required for the particular position. The Fire District shall give veterans’ preference to eligible veterans and spouses of veterans, pursuant to the provisions of Section 295.07, Florida Statutes and Chapter 55A-7, Florida Administrative Code (“FAC”).
  72. Preference-eligible applicants are hereby informed that they would have the right to an investigation by the Florida Department of Veterans’ Affairs if a non-preference eligible applicant is appointed to a position, pursuant to the provisions and time frames of Rule 55A-7.016, FAC.
  73. The following information is provided to all applicants for positions with St. Lucie County Fire District. Section 295.07, et seq., Florida Statutes, specifies the procedures for awarding hiring and retention preference to those eligible veterans and spouses of veterans who have honorably served in the United States Armed Forces. This law does not apply to anyone discharged under less than honorable conditions.
  74. There are now three levels under which points will be given to a veterans’ preference eligible person. In accordance with the categories listed in Section 295.07, Florida Statutes, preference points will be given as follows:
  75. 1. 15 points for a person under categories a or b of Section 295.07, Florida Statutes;
  76. 2. 10 points for a person under categories c, d, or e of Section 295.07, Florida Statutes;
  77. 3. 5 points for a person under categories f or g of Section 295.07, Florida Statutes.
  78. These points added will be based on a 100 points rating system.
  79. To be eligible for veterans’ preference as a wartime veteran, pursuant to Section 295.07, Florida Statutes, a veteran must have served in a campaign or expedition for which a campaign badge or expeditionary medal has been authorized or a veteran who has served on active duty in a non-training status for at least one (1) day during one of the periods of wartime service listed in Section 1.01 (140, Florida Statutes.
  80. To receive preference as a veteran during non-wartime era, applicant must provide discharge documentation, such as DD Form 214 or comparable documentation, and served on active duty in a non-training status for at least one (1) day.
  81. To receive preference under any of the other categories listed in Section 295.07, Florida Statutes, applicant must provide documentation pursuant to Rule 55A-7, FAC.
  82. NOTE: You are required to provide documentation of service, such as a discharge or DD Form 214, as set forth in Rule 55A-7.013, FAC. Any person claiming preference based upon a Service Connected Disability shall provide documentation of the extent of the disability, such as a document from the Department of Defense, Veterans Administration, or the Division of Veterans Affairs. Required documents will not be accepted after the closing date.
  83. Should you feel that you have not been awarded your Veterans’ Preference rights as required by the Florida Statutes, you may file a complaint with the State of Florida Division of Veterans Affairs, Division of Benefits and Assistance, Post Office Box 31003, St. Petersburg, FL 33731, within twenty-one (21) calendar days of receiving notice of a hiring decision or within three months of the date the application is filed with the Fire District if no notice is given to applicant. It is responsibility of the preferred applicant to maintain contact with the Fire District to determine if the position has been filled.
  84. Social Security Number Collection
  85. The St. Lucie County Fire District collects your social security number for the following purposes: identification and verification; credit worthiness, data collection, reconciliation, tracking, benefit processing, tax reporting, and identification and verification. SOCIAL SECURITY NUMBERS ARE ALSO USED AS A UNIQUE NUMERIC IDENTIFIER AND MAY BE USED FOR SEARCH PURPOSES.
  86. The St. Lucie County Fire District is a drug-free workplace. All employees are placed on probation for one (1) year.
  87. This is a public document. Under Florida law, applications cannot be kept confidential.
  88. I understand that the Human Resources Department of the Fire District may reject this Application for consideration for any of the reasons listed on Page 1, #6 (a-e).
  89. Should I qualify and become a regular employee of the Fire District, I understand there will be deductions from my salary for Retirement and other items required or allowed by law.
  90. Please read the following statements carefully before signing this form:
    I certify that the answers given by me to the foregoing questions and statements are true and correct without any falsifications, omissions, or misleading statements of any kind whatsoever. I agree that the employer shall not be held liable in any respect if my employment is terminated because of the falsity of statements, inaccuracies or omissions made by me in this application, without regard to either my knowledge of the inaccuracy, omissions or falsity or the length of employment. I authorize previous employers, schools, or persons named above to give any information regarding my employment together with any information they may have regarding me, whether or not it is in their records, unless I have otherwise indicated above. I hereby release all companies, employers, schools, or persons from all liability for any damage for issuing this information.
  91. If accepted for employment, I agree to abide by the rules and policies of the employer and to work whatever hours are required by the employer. I hereby agree that I will submit myself to a pre-hire drug test, and I understand that failure to pass such test may prevent me from being employed. I further understand and agree that failure of the employer to request a medical or physical examination shall not be construed as an admission by the employer that I am medically or physically qualified to perform any specific type of service.
  92. I authorize an investigation of all statements made by me whether or not I am employed. I hereby agree to be employed for a probationary period pursuant to the employer's policy.
  93. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  94. Fair Credit Reporting Act Disclosure and Authorization
  95. The Fire District, at any time when considering your application for employment, when making a decision whether to offer you employment, when deciding whether to continue your employment (if you are hired), and when making other employment related decisions directly affecting you, may obtain and use a “consumer report” from a “consumer reporting agency” for employment purposes. These terms are defined in the Fair Credit Reporting Act (“FCRA”), which applies to you. As an applicant for employment or employee of the Fire District, you are a “consumer” with rights under the FCRA.
  96. A “consumer reporting agency” is a person or business which, for monetary fees, dues or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing “consumer reports” to others, such as the Fire District.
  97. A “consumer report” is any written, oral other communication of any information by a “consumer reporting agency” bearing on a consumer’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living which is used or collected for the purpose of serving as a factor in establishing the consumer’s eligibility for employment purposes.
  98. If the Fire District obtains a “consumer report” about you, and if the Fire District considers any information in the “consumer report” when making an employment related decision that directly and adversely affects you, you will be provided with a copy of the “consumer report” before the decision is finalized. If the Fire District procures or causes to be prepared an investigative consumer report, you have the right to request the employer to provide you with a complete and accurate disclosure of the nature and scope of the investigation requested. You also have the right to request and receive a written summary of your rights under the Fair Credit Reporting Act. You also may contact the Federal Trade Commission about your rights under FCRA as a “consumer” with regard to “consumer reports” and “consumer reporting agencies.”
  99. hereby voluntarily authorize the Fire District to obtain "consumer reports" about me from a "consumer reporting agency" and to consider the "consumer reports" when making decisions regarding my employment at the Fire District. I understand that I have rights under the Fair Credit Reporting Act, including the rights discussed above.
  100. Electronic signature agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  101. Prescribed Summary of Consumer Rights
  102. The prescribed for this summary is as a separate document, on paper no smaller than 8x11 inches in size, with text no less than 12-point type (8-point for the cart of federal agencies), in bold or capital letters as indicated. The form in this appendix prescribes both the content and the sequence of items in the required summary. A summary may accurately reflect changes in numerical items that change over time (e.g., dollar amounts, or phone numbers and addresses of federal agencies), and remain in compliance.
  103. A Summary of Your Rights Under the Fair Credit Reporting Act
  104. The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every “consumer reporting agency” (CRA). Most CRAs are credit bureaus that gather and sell information about you – such as if you pay your bills on time or have filed bankruptcy – to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. 1681-1681u, at the Federal Trade Commission’s web site ( The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights.
  105. • You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you – such as denying an application for credit, insurance, or employment – must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.
  106. • You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action. You also are entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.
  107. • You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs – to which it has provided the data – of any error.) The CRA must give you a written report of the investigation, and a copy of your report if the investigation results in any change. If the CRA’s investigation does no resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.
  108. • Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source.
  109. • You can dispute inaccurate items with the source of the information. If you tell anyone – such as a creditor who reports to a CRA – that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you’ve notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.
  110. • Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies.
  111. • Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA – usually to consider an application with a creditor, insurer, employer, landlord, or other business
  112. • Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission.
  113. • You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you all, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.
  114. • You may seek damages from violators. If a CRA, a user or (in some cases) a provider of the CRA data, violates the FCRA, you may sue them in state or federal court.
  115. The FCRA gives several different federal agencies authority to enforce the FCRA.
  116. FCRA Contacts
  117. Leave This Blank:

  118. This field is not part of the form submission.