The Unified Personnel System complies with the federal Drug Free by HC121105222913

VIEWS: 4 PAGES: 7

									                                                   Pinellas County Government

                                       Director of Transportation
                                          & Stormwater
General Information/Instructions:
For the recruitment for Director of Transportation and Stormwater this document replaces the standard exempt
application form. The information presented in this application serves as the first “interview” for this position.
This form must be completed by applicants interested in consideration for the position of Director of
Transportation and Stormwater. It must be returned to the Human Resources Department no later than
5:00 p.m. on Monday, October 15, 2012. Failure to return the completed form by this date will result in your
name being removed from consideration for this position.
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 “DTS 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.
 The Unified Personnel System of Pinellas County is an Equal Employment Opportunity Employer.
                                                                   Application for
                                        Director of Transportation & Stormwater
                                                    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
        First                  Middle               Last
Name:
                   Street
Home Address:
City            State                    Zip Code

                        Home                        Work            Mobile/Daytime
Phone Numbers:
Email Address:
Education and Training
College (Undergraduate/Graduate)
                                                                                     Completed         Degree
 Name and Location of College/University                   Dates Attended                                            Major
                                                                              Years       Credits     Awarded




Vocational, Trade, Armed Forces, Business Schools and Training
                        Kind of Training                                               Conducted By             Date Completed




Additional Training (List any relevant training)


Certifications, licenses, etc.
                   Certification/License                                                 Issued By               Date Issued




Honors or Awards (List any relevant honors and/or awards received)


Professional Memberships (List any relevant professional memberships)


Experience

                                                                                                                         Page | 1
Please provide the following information concerning your work experience. Please work in reverse chronological order,
listing your most recent or current experience first.
Current (or most recent) Employer:
Address:                  Phone Number:
Position:
                   From        To
Dates Employed:                           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:
                   From        To
Dates Employed:                           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:
                   From        To
Dates Employed:                           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:
                   From        To
Dates Employed:                           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:
                                                                                                              Page | 2
Position:
                   From        To
Dates Employed:                           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:
                                                       * * * * *
1.      Indicate the number of years experience you have in each of the following areas of Transportation and
        Stormwater. Briefly describe your experience and indicate the level at which you were performing.


        Watershed Management                                           years.


        Traffic Engineering                                            years.


        Stormwater Management                                          years.


        Streets and Bridges                                            years.


        Vegetative, Mosquito and Tree Management                       years.




2.      Describe your experience in the development, implementation and administration of operating and
        capital budgets. Please be specific about your role. Include dollar amount of budget(s).



3.      Describe your experience in contract administration. Include types and dollar values of contracts.
        Please be specific about your role.



4.      Describe your work style.



5.      Describe the organizational support systems (control, communication, accountability, etc.) that you
        have put into place to support organizational strategies. How did you go about doing this?



6.      Describe your experience in preparing and presenting recommendations to elected officials, citizens or
        similarly situated groups. Please include information on your public speaking experience.



                                                                                                        Page | 3
7.       Pinellas County includes 24 municipalities as well as the unincorporated area and many of our
         programs are Countywide and require participation/support/buy in from the cities. Describe any
         experience you have that would relate to a similar intergovernmental system and how you worked in
         that environment.



8.        Provide an example of a time when you used collaboration with your peers to achieve consensus on a
         cross-agency issue. How were you able to influence without authority?




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
         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
                                                    th
violations and any offense committed before your 18 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 cannot be
disqualified from 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

                                                                                                                             Page | 4
Is there any additional information that you would like to add concerning your application for the position of
Director of Transportation and Stormwater.


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 | 5
                                        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.

Position Applied for: Director of Transportation and Stormwater

Application Date:

Biographical Information
        First                  Middle              Last
Name:
Social Security Number:
                   Street
Home Address:
City            State                   Zip Code

                        Home                       Work     Mobile/Daytime
Phone Numbers:

Citizenship
Are you a U.S. Citizen?                                                      Yes          No
        If you are not a U.S. Citizen, do you have a work visa?              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
                                                                                                                   Page | 6

								
To top