Official website of The Miami Shores Village

General Employment Application

Miami Shores Village (the "Village") is an Equal Opportunity Employer and a Drug Free Workplace. Qualified applicants are considered for employment without regard to race, color, religion, sex, national origin, age, sexual orientation, marital status, disability, or other legally protected status.

Although a resume may be attached, all sections of the employment application must be fully completed for consideration. Use the "Additional Notes" field at the bottom of the form if more space is needed for any answer.

*Type of position you are available for

Full Time

Part-Time

Seasonal

*Position applying for

You may list more than one position.

How did you learn about the Village?

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Employment Agency

Employment Agency

Walk-In (please specify where)

Other (please specify)

Friend (please specify name)

Relative (please specify name)

Applicant Information

*Last Name

*First Name

Middle Name

*Street Address

*City

*State

*Zip Code

Home Phone

Format: 305-555-0100

Cellular Phone

Format: 305-555-0100

*Social Security Number

Format: 123-45-6789. See the Social Security Number Notification at the bottom of this form.

*Email Address

Driver License Information

Only required for jobs that require the operation of a motor vehicle.

Driver's License Type

Operator Class E

Commercial Drivers License (CDL)

None

Driver License Number

Driver License State

Eligibility and History

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes

*Have you ever filed an employment application with the Village before?

Yes

If yes, give date of previous application

Format: MM/DD/YYYY

*Have you ever been employed by the Village before?

Yes

If yes, give date(s) of previous Village employment

*Are you currently employed?

Yes

*May we contact your present employer?

Yes

*If hired, can you provide proof that you are authorized to work in the United States?

Yes

Proof of citizenship or immigration status will be required upon employment.

*Do you have any friends or relatives employed by the Village?

Yes

If yes, please indicate name and relationship

*Have you ever been convicted of a felony or first-degree misdemeanor?

Yes

If yes, please explain

This will not automatically disqualify an applicant from employment. The nature of the offense, how long ago it occurred, and its relationship to the position applying for are taken into consideration.

Employment Experience

Please list the names of your present and previous employers in chronological order starting with the present or most recent employer. Be sure to account for all periods of time including military service and any periods of unemployment.

Employer 1

Employer 1 -- Company Name

Employer 1 -- Address

Employer 1 -- Phone

Format: 305-555-0100

Employer 1 -- Job Title

Employer 1 -- Length of Service: From

Format: MM/YYYY

Employer 1 -- Length of Service: To

Format: MM/YYYY (or write 'present')

Employer 1 -- Hourly Rate / Salary

Employer 1 -- Supervisor's Name

Employer 1 -- Supervisor's Phone

Format: 305-555-0100

Employer 1 -- Reason for Leaving

Employer 1 -- Duties Performed

Employer 2

Employer 2 -- Company Name

Employer 2 -- Address

Employer 2 -- Phone

Format: 305-555-0100

Employer 2 -- Job Title

Employer 2 -- Length of Service: From

Format: MM/YYYY

Employer 2 -- Length of Service: To

Format: MM/YYYY (or write 'present')

Employer 2 -- Hourly Rate / Salary

Employer 2 -- Supervisor's Name

Employer 2 -- Supervisor's Phone

Format: 305-555-0100

Employer 2 -- Reason for Leaving

Employer 2 -- Duties Performed

Employer 3

Employer 3 -- Company Name

Employer 3 -- Address

Employer 3 -- Phone

Format: 305-555-0100

Employer 3 -- Job Title

Employer 3 -- Length of Service: From

Format: MM/YYYY

Employer 3 -- Length of Service: To

Format: MM/YYYY (or write 'present')

Employer 3 -- Hourly Rate / Salary

Employer 3 -- Supervisor's Name

Employer 3 -- Supervisor's Phone

Format: 305-555-0100

Employer 3 -- Reason for Leaving

Employer 3 -- Duties Performed

Employer 4

Employer 4 -- Company Name

Employer 4 -- Address

Employer 4 -- Phone

Format: 305-555-0100

Employer 4 -- Job Title

Employer 4 -- Length of Service: From

Format: MM/YYYY

Employer 4 -- Length of Service: To

Format: MM/YYYY (or write 'present')

Employer 4 -- Hourly Rate / Salary

Employer 4 -- Supervisor's Name

Employer 4 -- Supervisor's Phone

Format: 305-555-0100

Employer 4 -- Reason for Leaving

Employer 4 -- Duties Performed

Education

High School -- Name

High School -- Diploma / Degree

High School -- Course of Study

Technical / Vocational School -- Name

Technical / Vocational School -- Diploma / Degree

Technical / Vocational School -- Course of Study

Undergraduate College / University -- Name

Undergraduate College / University -- Diploma / Degree

Undergraduate College / University -- Course of Study

Graduate School -- Name

Graduate School -- Diploma / Degree

Graduate School -- Course of Study

Knowledge, Skills, and Abilities

Describe all knowledge, skills, and abilities you possess and believe relevant to the position(s) you seek

Examples: computer skills, supervisory or management certifications, operation of specific equipment, etc.

*Are you able to perform all the essential functions of the position(s) for which you are applying?

Yes

If no, is there a reasonable accommodation that can be made?

Foreign Languages

If you speak, read, or write a foreign language, please indicate your skill level.

Foreign Language

e.g., Spanish, Haitian Creole, Portuguese

Foreign Language -- Speaking ability

Fluent

Good

Fair

Not applicable

Foreign Language -- Reading ability

Fluent

Good

Fair

Not applicable

Foreign Language -- Writing ability

Fluent

Good

Fair

Not applicable

References

Provide the name, address, and phone number of three references who are not related to you and are not previous employers.

Reference 1 -- Name

Reference 1 -- Address

Reference 1 -- Phone Number

Format: 305-555-0100

Reference 2 -- Name

Reference 2 -- Address

Reference 2 -- Phone Number

Format: 305-555-0100

Reference 3 -- Name

Reference 3 -- Address

Reference 3 -- Phone Number

Format: 305-555-0100

Veterans' Preference Claim

The veterans' preference seeking applicant must have received an honorable discharge or must present documentation stating current service is honorable, and in accordance with section 295.07 F.S., meet one or more of the categories below.

If you are not the veteran and are claiming veterans' preference, additional documentation may be required pursuant to Rule 55A-7, F.A.C.

Do you wish to claim Veterans' Preference?

Yes

If Yes, it is your responsibility to submit a DD form 214 or comparable documentation that serves as a certificate of release or discharge at the time of application. You may attach it using the upload field below.

If eligible, which Veterans' Preference category are you claiming?

Category a -- Veteran with service-connected disability

Category b -- Spouse of veteran with total/permanent service-connected disability, or spouse of veteran missing in action, captured, or detained

Category c -- Wartime veteran (one day or more during a wartime period or qualifying campaign)

Category d -- Unremarried widow or widower of veteran who died of service-connected disability

Category e -- Mother, father, legal guardian, or unremarried widow or widower of a service member who died in line of duty under combat conditions

Category f -- Veteran as defined in section 1.01(14), F.S., excluding active duty for training

Category g -- Current member of any reserve component of the U.S. Armed Forces or the Florida National Guard

Not claiming Veterans Preference

Upload supporting documentation (DD-214 or equivalent)

Required if claiming Veterans' Preference. See the form description for the full list of acceptable documentation per Rule 55A-7, F.A.C.

Authorization and Consent

I certify that the answers given herein are true and complete to the best of my knowledge. I hereby authorize Miami Shores Village (the "Village") to verify all information contained herein. I authorize my current and former employers, references, registration and licensing boards, and educational institutions listed on this application to provide the Village with any job-related information requested. I also release all past employers and references from any and all liability for the release of information to the Village.

I understand that all job offers from the Village are conditioned on the successful completion of a criminal background check, physical, drug screening (if applicable), credit check, drivers' record (if applicable), reference check, past employment verification, and proof of education (collectively a "background check"). I hereby authorize the National Records Center, St. Louis, Missouri, or other custodian of my military record to release information or photocopies from my military personnel and related medical records, including a photocopy of my DD-214 Report of Separation, to the Village.

By signing this application, I authorize the Village to conduct a background check and, if applicable, a consumer report to be procured for employment purposes. A photocopy of this form will be as effective as the original.

This application for employment shall be considered active for a period of time not to exceed six months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I understand that neither this document nor any offer of employment from the Village constitutes an employment contract unless a specific document to that effect is executed by the Village and employee in writing. In consideration for my employment I agree to conform to the rules and regulations of the Village. I acknowledge that rules may be changed, withdrawn, added, or interpreted at any time, at the Village's sole option and without prior notice to me.

*Printed Name of Applicant (Authorization and Consent)

Type your full legal name to acknowledge the authorization and consent above.

*Electronic Signature -- Authorization and Consent

Type your full name as your electronic signature for the Authorization and Consent.

Social Security Number Notification

Notification of Social Security Number Collection and Usage
Human Resources Department, 10050 NE 2nd Avenue, Miami Shores, FL 33138 -- (305) 762-4871

In compliance with Florida Statutes §119.071(5), Miami Shores Village collects and uses your Social Security number only for legitimate employment business purposes, including: completing an Employment / Volunteer Application; Federal I-9 (Employment Eligibility Verification); Federal W-4, W-2, and 1099 tax forms; Federal Social Security taxes; Quarterly Unemployment Reports; Federal and State Employee and Educational Reports; Direct Deposit transactions; group health, life, disability, and dental coverage enrollment; Supplemental Insurance Deduction Reports; Workers' Compensation Claims; background screening and validation of educational credentials; Retirement Contribution Reports; and processing of retirement and employee benefits.

Notification: Providing a Social Security number is a condition of employment at Miami Shores Village. The Village may disclose Social Security numbers to another agency or governmental entity if such disclosure is necessary for the receiving agency or entity to perform its duties and responsibilities.

I understand the above information and acknowledge receipt of this notification.

*Printed Name (SSN Notification)

Type your full legal name to acknowledge the SSN notification above.

*Electronic Signature -- SSN Notification

Type your full name as your electronic signature for the SSN notification.

Additional Information

Additional notes

Use this space if any earlier answer needs more room.

Attach a resume (optional)

PDF, Word, or plain text. Optional -- resume does not replace any required field above.

Contact Info

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