NAME (Print):
Last
First
Preferred Name
Middle
ADDRESS:
Street
Telephone: (
)
City
-
(
)
Home
State
-
Zip
(
)
Work
Cell
E-MAIL ADDRESS:
Home
Work
POSITION APPLYING FOR:
VETERANS’ PREFERENCE:
Other
VACANCY NUMBER:
Yes
No Are you claiming veterans’ preference? A DD214 substantiating your claim must be furnished at the time of application
Yes
No Were you in the military during a wartime activity?
Note: Certain positions are exempt from request for Veterans’ Preference.
EDUCATION: High School
Received:
Diploma
Certificate of Completion
GED
Postsecondary Education (Your name while attending school if different from above)
None, highest grade completed
Dates
(Mo./Yr.)
Name and address of college, university, business,
correspondence, trade, technical, vocational school.
From
/
/
/
/
To
Credit Hours
Earned
Sem./Qtr.
Class/Clock
Area of Study
Major/Minor
Academic
Degree
Certification
Earned
/
/
/
/
List any professional or occupational license, registration, or certification you currently hold (e.g. Networking or Software Certificate). List any specialized knowledge, skills or
abilities you possess (e.g. typing, word processing, computer use, software, mainframe equipment and programs, LAN or networking systems, audio/visual equipment, printing
equipment, heavy and light machinery). If licensure or certification is required for a position vacancy, a copy of the document must accompany the application.
TCC is an Equal Opportunity/Affirmative Action Employer. Equal opportunity will be afforded regardless of race, color, religion, national origin,
political affiliation, age, an individual's disability, gender, or marital status. Minorities, women, and the disabled are encouraged to apply. For
equity concerns contact the College Equity Officer/Director of Human Resources (850) 201-8510, located in the Administration Building.
EMPLOYMENT: List below all present and past employment, beginning with your most recent.
Previous Employer:
Address:
(
Street
Job Title:
From:
/
To:
City
Full-Time?
/
Yes
No
Supervisor Name:
State
)
Zip
Phone
Ext.
Hours Per Week:
Phone: (
)
-
Duties and Responsibilities:
Reason for Leaving:
May we contact this employer?
Yes
No
Name if different during employment
Previous Employer:
Address:
(
Street
Job Title:
From:
/
To:
City
Full-Time?
/
Yes
No
Supervisor Name:
State
)
Zip
Phone
Ext.
Hours Per Week:
Phone: (
)
-
Duties and Responsibilities:
Reason for Leaving:
May we contact this employer?
Yes
No
Name if different during employment
Previous Employer:
Address:
(
Street
Job Title:
From:
/
To:
City
Full-Time?
/
Supervisor Name:
Yes
No
State
Zip
Hours Per Week:
Phone: (
)
-
Duties and Responsibilities:
Reason for Leaving:
May we contact this employer?
Yes
No
Name if different during employment
)
Phone
Ext.
EMPLOYMENT (Continued): List below all present and past employment, beginning with your most recent.
Previous Employer:
Address:
(
Street
Job Title:
From:
/
To:
City
Full-Time?
/
Yes
No
Supervisor Name:
State
)
Zip
Phone
Ext.
Hours Per Week:
Phone: (
)
-
Duties and Responsibilities:
Reason for Leaving:
May we contact this employer?
Yes
No
Name if different during employment
Previous Employer:
Address:
(
Street
Job Title:
From:
/
To:
City
Full-Time?
/
Yes
No
Supervisor Name:
State
)
Zip
Phone
Ext.
Hours Per Week:
Phone: (
)
-
Duties and Responsibilities:
Reason for Leaving:
May we contact this employer?
Yes
No
Name if different during employment
Previous Employer:
Address:
(
Street
Job Title:
From:
/
To:
City
Full-Time?
/
Supervisor Name:
Yes
No
State
Zip
Hours Per Week:
Phone: (
)
-
Duties and Responsibilities:
Reason for Leaving:
May we contact this employer?
Yes
No
Name if different during employment
)
Phone
Ext.
BACKGROUND INFORMATION:
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR?
Yes
No
If “Yes,” what charges?
Where?
Date
/
/
HAVE YOU EVER PLED NOLO CONTENDERE OR GUILTY TO A CRIME WHICH IS A FELONY OR A FIRST DEGREE MISDEMEANOR?
Yes
No
If “Yes,” what charges?
Where?
Date
/
/
HAVE YOU EVER HAD ADJUDICATION WITHHELD FOR A CRIME WHICH IS A FELONY OR A FIRST DEGREE MISDEMEANOR?
Yes
No
If “Yes,” what charges?
Where?
Date
HAS YOUR DRIVER LICENSE EVER BEEN SUSPENDED OR REVOKED?
Yes
/
/
No
NOTE: A "Yes" answer to these questions will not necessarily bar you from employment. The nature, severity and date of an offense in relation to the position for which you
are applying are considered.
CITIZENSHIP: In accordance with federal law, Tallahassee Community College hires only U.S. citizens and lawfully authorized alien workers. If an offer of employment is
made, you will be required to provide identification and proof of citizenship or authorization to work in the U.S. on the hire date.
ARE YOU A U.S. CITIZEN?
Yes
No
IF “NO” ARE YOU AUTHORIZED TO WORK IN THE UNITED STATES?
Yes
No
SELECTIVE SERVICE REGISTRATION: In accordance with state law, males between the ages of 18 and 26 who are required to register with Selective Service may not be
employed or promoted to a position at the College without proof of registration.
Have you registered?
Yes
No
N/A
If applicable, documentation must be provided prior to employment.
PREVIOUS TALLAHASSEE COMMUNITY COLLEGE EMPLOYMENT:
Have you ever been employed by TCC?
Yes
No
If “yes”, which department?
Name during employment
Date of Separation:
/
/
Please Print
Do you have relatives currently employed by TCC?
Yes
No
If Yes, Names
CERTIFICATION
TCC is an Equal Opportunity/Affirmative Action Employer. Equal opportunity will be afforded regardless of race, color, religion, national origin, political affiliation, age, an
individual’s disability, gender, or marital status. For equity concerns, contact the Director of Human Resources, located in the Administration Building, Room 141, or call (850)
201-8510.
It is the policy of Tallahassee Community College to conduct background inquiries on prospective and current employees for security, safety and insurance
purposes.
I voluntarily authorize Tallahassee Community College to conduct a personal background inquiry. The inquiry may include driving records, criminal records, employment
verification, educational records and military service records. I agree to cooperate in such inquiry and I agree to release from all liability or responsibility all persons, schools,
companies or corporations supplying such information. If hired, written verification of previous employment and educational attainment by official transcript will be required and
is the responsibility of the employee to obtain such.
I understand that applications submitted for employment are public record, except as exempted in Chapter 119, Florida Statutes. I am aware that any omissions, falsifications,
misstatements, or misrepresentations may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I certify that to the best
of my knowledge and belief all statements contained herein and on any attachments are true, correct, complete, and made in good faith.
Signature of Applicant
Rev 1/04
/
Date
/
VOLUNTARY INFORMATION
Position:
Date:
/
/
ETHNIC BACKGROUND
American Indian
Asian of Pacific Islander
Black (not of Hispanic Origin)
Hispanic
White (not of Hispanic Origin)
GENDER
Male
Female
HOW DID YOU HEAR ABOUT THE POSITION?
TCC Vacancy Announcement – At what location?
Job Line
TCC Website
TV Channel 48
Public Agency
Friend
Newspaper Advertisement – What newspaper(s)?
How many times did you see the advertisement in the newspaper?
Other
VETERANS’ PREFERENCE
Veterans who wish to claim veterans’ preference must comply with applicable state regulations and supply appropriate supporting documents. Information is
available through the Florida Department of Veterans’ Affairs, P.O. Box 1437,
St. Petersburg, FL 33731 or visit their website at www.floridavets.org.
Veteran
(Has served on active duty for 180
consecutive days or more since 1-31-55
and has honorable discharge)
Disabled Veteran
(or Spouse of Disabled Veteran)
Unmarried
(Widow or widower of veteran who died
or has service connected disability or is
missing in action)
If you are claiming Veterans’ preference, appropriate documentation (a DD 214 Certification of Release or Discharge from active duty, and/or
equivalent certification from the VA or DVA verifying service connected disability, other appropriate DOD certification, and a marriage certificate for
spouses of disabled veterans or veterans missing in action) substantiating your claim must be furnished at the time of application.
Check here if you have worked for a county, municipality or governmental entity within the state of Florida subsequent to your veteran status.
Name of Employer:
If an applicant claiming veterans’ preference has questions concerning the College hiring process, he/she may contact the Human Resources Department at (850)
201-8510. Additionally, concerned applicants may contact the Florida Department of Veterans’ Affairs, P. O. Box 31003, St. Petersburg, FL 33731. A complaint
must be filed within 21 days of the applicant receiving notice of the hiring decision made by the employing agency or within three months of the date the
application is filed with the employer, if no notice is given.
To receive benefits as a wartime veteran, a person must have served at least one (1) day during one of the following periods of wartime service: (SPECIAL NOTE:
There are campaigns and expeditions of the armed forces since World War II, which now qualify for veterans’ preference. Contact the Florida Department of
Veterans’ Affairs for more information.)
a)
b)
c)
d)
e)
f)
Mexican Border Period: May 9, 1916 to April 5, 1917
World War I: April 6, 1917 to November 11, 1918; extended to April 1, 1920, for those veterans who served in Russia; also extended
through July 1, 1921, for those veterans who served after November 11, 1918 and before July 2, 1921, provided such veterans had at
least 1 day of service between April 5, 1917, and November 12, 1918
World War II: December 7, 1941 to December 31, 1946
Korean Conflict: June 27, 1950 to January 31, 1955
Vietnam Era: August 5, 1964 to May 7, 1975
Persian Gulf War: August 2, 1990 to January 2, 1992