Pinellas County Government
Organizational Improvement
Analyst
General Information/Instructions:
For the recruitment for the positions of Organizational Improvement Analyst this document replaces the
standard exempt application form. This form must be completed by applicants interested in consideration for
these positions. The completed application should be sent to the Human Resources Department. Interested
candidates should complete and return the application form as soon as possible as consideration will be given
to candidates as applications are received. The positions are open until filled.
An improperly completed form will not be considered. Please note the following in order to properly
complete this form.

Answers to all requests for information must be shown on the application form. Answers such as "see
resume" will not be accepted or considered.

Answers must be computer entered or printed legibly in black ink.

You may save this completed form and submit electronically. Please do a “save as” and name the
file “OI your name.doc” substituting your first and last name for your name in the example. Email
the file as an attachment to bwaldron@pinellascounty.org. You may also print the document and
mail it to the Human Resources Department. If you fax the document you must also send the
original to the Human Resources Department.

Please answer the requests for information completely.

If you print out and complete the form, please do not write on the back of the application pages. If you
need additional room to record your response please use an additional page. Indicate your response is
continued on the attached sheet. If you find it necessary to include an attached sheet, please be sure that
you include your name and the identity of the item you are answering on the additional page(s).

Providing incorrect or misleading information will result in your name being removed from consideration
for employment.

A resume or reference letters may be added to this form but cannot be substituted for a completed form.
Important Notices:

Please be advised that the Florida State Supreme Court has ruled that all information supplied while
making application with all state, county and municipal entities and agencies, becomes a part of Public
Record under provisions of Chapter 119 of Florida Statutes, and as such must be made available to
interested parties upon specific request.

The Unified Personnel System complies with the federal Drug-Free Workplace Act of 1988.

Should you be offered employment, we will need to verify your eligibility for employment in accordance
with the U.S. Immigration and Reform Act of 1986. Various forms of identification are outlined by this
legislation. A copy of the required identification documents is available on request.

The Unified Personnel System complies with the Americans with Disabilities Act of 1990. Requests for
accommodation in the application and selection process should be made to the Personnel Department.
Verification of need for accommodation may be required. Reasonable accommodations will be made on
a case by case basis.

Veterans’ Preference will be given to eligible veterans or their spouses in accordance with Chapter 295 of
the Florida Statutes and Florida Administrative Code, Chapter 55-7 with respect to Veterans’ Preference.

The Unified Personnel System of Pinellas County is an Equal Employment Opportunity Employer.
Application for
Organizational Improvement Analyst
Unified Personnel System - Pinellas County Government
Human Resources Office: Room 121, County Annex Building, 400 South Fort Harrison Avenue, Clearwater, FL 33756-5113
Phone Numbers: Clearwater: [727] 464-3367
TDD: [727] 464-4063
Fax: [727] 464-3680
Biographical Information
Name:
First
Middle
Home Address:
City
Last
Street
State
Phone Numbers:
Zip Code
Home
Work
Mobile/Daytime
Email Address:
Education and Training
College (Undergraduate/Graduate)
Name and Location of College/University
Dates Attended
Completed
Years
Credits
Degree
Awarded
Major
Vocational, Trade, Armed Forces, Business Schools and Training
Kind of Training
Conducted By
Date Completed
Issued By
Date Issued
Additional Training (List any relevant training)
Certifications, licenses, etc.
Certification/License
Honors or Awards (List any relevant honors and/or awards received)
Professional Memberships (List any relevant professional memberships)
Experience
Please provide the following information concerning your work experience. Please work in reverse chronological order,
listing your most recent or current experience first.
Page | 1
Current (or most recent) Employer:
Address:
Phone Number:
Position:
Dates Employed:
From
To
Salary:
Name and title of your supervisor:
Number of employees directly supervised:
Number of employees indirectly supervised:
Reason for Leaving:
Briefly describe your major responsibilities/duties:
* * * * *
Employer:
Address:
Phone Number:
Position:
Dates Employed:
From
To
Salary:
Name and title of your supervisor:
Number of employees directly supervised:
Number of employees indirectly supervised:
Reason for Leaving:
Briefly describe your major responsibilities/duties:
* * * * *
Employer:
Address:
Phone Number:
Position:
Dates Employed:
From
To
Salary:
Name and title of your supervisor:
Number of employees directly supervised:
Number of employees indirectly supervised:
Reason for Leaving:
Briefly describe your major responsibilities/duties:
* * * * *
Employer:
Address:
Phone Number:
Position:
Dates Employed:
From
To
Salary:
Name and title of your supervisor:
Number of employees directly supervised:
Number of employees indirectly supervised:
Reason for Leaving:
Briefly describe your major responsibilities/duties:
* * * * *
Employer:
Address:
Phone Number:
Position:
Dates Employed:
From
To
Salary:
Page | 2
Name and title of your supervisor:
Number of employees directly supervised:
Number of employees indirectly supervised:
Reason for Leaving:
Briefly describe your major responsibilities/duties:
* * * * *
1.
With what quality improvement tools have you worked?
2.
Describe the qualitative data gathering and analysis you have performed.
Describe the quantitative data gathering and analysis you have performed.
3.
Describe the largest, most complex organizational improvement project in which you have been
involved. What was the scope of the project?
What was your role in the project?
What was the outcome of the project?
4.
Describe the facilitation methods that you have used and identify the one(s( that you find to be most
effective.
How do you determine which method to use?
5.
What is the most successful outcome you helped achieve as a result of facilitating a work-team?
6.
What skills, characteristics, knowledge and/or experience do you possess that would be an asset to
these positions?
Additional Information
Are you currently employed? Yes
No
The checking of references is part of our selection process. We understand that many individuals do not inform
their current employer that they have made application with another employer and do not wish to have their
current employer contacted during the reference check, so we ask, may we contact your current employer?
Yes
No
If no, please explain. Also indicate the conditions under which we might contact your current employer:
Minimum salary expected (Please indicate your starting salary requirement.):
In completing this form have you left any gaps of time which are not accounted for?
Yes
No
Page | 3
If yes, please explain:
Have you ever been terminated or asked to resign from a place of employment?
Yes
No
If yes, please explain:
Legal: Have you ever been convicted of an offense against the law or forfeited collateral? (You may omit parking
violations and any offense committed before your 18 th birthday which was finally adjudicated in a juvenile court or under a Youth
Offender law.)
Yes
No
If yes, please explain:
Have you ever been a defendant in a civil action for intentional tort?
Yes
No
If yes, please explain:
Note: A prior record of conviction(s) will not necessarily disqualify you from consideration. Each case is considered individually
considering the nature of the offense and the requirements of the job. Florida State Statute 112.011 provides that a person can not be
disqualified form employment solely because of a prior conviction of crime. A person may be denied employment only if the crime was a
felony or first degree misdemeanor and it is directly related to the position of employment being sought. However, withholding or
falsifying information may result in termination if hired. Records searches are made on every individual hired.
Professional References
Please provide the names & contact information for at least 4 professional references.
Reference 1
Reference 2
Reference 3
Reference 4
Additional Information
Is there any additional information that you would like to add concerning your application for the positions of
Organizational Improvement Analyst.
Attention: you must acknowledge your reading and understanding of the following statements
and certify the accuracy of your completed form. Failure to do so will result in your elimination
from consideration.
I.
Be advised that the Florida State Supreme Court has ruled that all information supplied while making application
with all state, county and municipal entities and agencies, becomes a part of Public Record under provisions of
Chapter 119 of Florida Statutes, and as such must be made available to interested parties upon specific request.
II.
Pinellas County has my authorization to thoroughly investigate my work, and personal history that is job-related. I
will hold no person, corporation, or organization liable for giving or receiving information in this investigation.
III.
All information you provide will be considered in reviewing your application, and a false answer to any question
may be grounds for not employing you or for dismissing you after you begin work. All statements are subject to
verification, including a check of your fingerprints, police records, and former employers.
IV.
I hereby authorize Pinellas County Government to obtain college or university transcripts, and/or employment
references from my former employers.
V.
I certify that all statements made in this application are true, complete, and correct to the best of my knowledge
and belief, and are made in good faith.
To certify that you have read and understood the above statements and that your application is accurate and complete
mark the certification box and enter your name and the date.
Certification box
Name
Date
Page | 4
Exempt Application Addendum
The following information is needed to comply with state and federal statutes or for the checking of references. The page
will be removed from the application before it is forwarded to the hiring department or review committee.
Positions Applied for: Organizational Improvement Analyst
Application Date:
Biographical Information
Name:
First
Middle
Last
Social Security Number:
Home Address:
City
Street
State
Phone Numbers:
Zip Code
Home
Work
Mobile/Daytime
Citizenship
Are you a U.S. Citizen?
If you are not a U.S. Citizen, do you have a work visa?
Yes
No
Yes
No
EEOC Information
☞
The Uniform Guidelines on Employee Selection Procedures requires records to be kept by gender and the five
race/ethnic categories defined by the Equal Employment Opportunity Commission (EEOC). The Uniform
Guidelines on employee Selection Procedures have been adopted as final rules by the EEOC, the Office of
Personnel Management, the Justice Department, and the Department of Labor.
☞
The Human Resources Department has adopted safeguards to insure that the records required are used for
appropriate purposes within this Department such as determining adverse impact, or for monitoring our affirmative
action program.
☞
The concept of race used by the EEOC does not denote clear-cut scientific definitions of anthropological origins.
Applicants may be included in the groups to which he/she appears to belong, identifies with, or is regarded in the
community as belonging.
Gender:
Male
Female
Race/Ethnic Category:
Are you Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race).
Yes
No
If you selected "NO" to the question above, please select one and only one of the choices to the right. Do not
make a selection if you answered yes to the question above
Asian
Black
American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
White
Two or more races
Veterans’ Preference
Veterans’ Preference will be given to eligible veterans and their spouses in accordance with Chapter 295 of the
Florida Statutes.
Are you claiming a veterans’ preference?

Yes
No
If yes, you must complete the Veterans’ Preference form available from the Human Resources Department.
Page | 5