Contractor Application Contact Step 1Step 2Step 3Step 4 Contractor Application Nineteenth Judicial Circuit | Serving Indian River, Martin, Okeechobee, and St. Lucie Counties Contract Information First Name:Last Name:Address:City, State, Zip:Phone Number:Email address:Contract Position Desired: Digital Court Reporter Mediator Stenographer Transcriptionist Court InterpreterSkilled Interpreting Language:Available: Full-Time Part-Time Substitute OtherOther: Education (Transcripts May Be Required) Education Level: School or Institution: Location: Dates of Attendance: Major/Minor: Diploma/Degree or Credits Earned: High SchoolCollege / UniversityTrade School or Other Job - Related Training or Course Work (Vocational, Trade, Armed Forces) School or Institution: Location: Dates of Attendance: Major/Minor: Diploma/Degree or Credits Earned: Your Name if Different While Attending School: Licensure, Certification, Registration License/Registration/Certification: State Agency: Issue Date: Expiration Date: PreviousNext Employment History 1. Name of Current Employer:Address:Job Title:Supervisor's Name:Phone Number:Dates of Employment:From:To:Salary:Duties and Responsibilities:2. Name of Previous Employer:Address:Job Title:Supervisor's Name:Phone Number:Dates of Employment:From:To:Salary:Duties and Responsibilities:3. Name of Previous Employer:Address:Job Title:Supervisor's Name:Phone Number:Dates of Employment:From:To:Salary:Duties and Responsibilities:4. Name of Previous Employer:Address:Job Title:Supervisor's Name:Phone Number:Dates of Employment:From:To:Salary:Duties and Responsibilities:PreviousNext Background Information 1. Have you ever been convicted of a FELONY or a FIRST-DEGREE MISDEMEANOR? Yes NoIf "Yes", what charges?Where?Date:2. Have you ever pled NOLO CONTENDERE or pled guilty to a crime which is a FELONY or FIRST-DEGREE MISDEMEANOR? Yes NoIf "Yes", what charges?Where?Date:3. Have you ever had the adjudication of guilt withheld for a crime which is a FELONY or a FIRST-DEGREE MISDEMEANOR? Yes NoIf "Yes", what charges?Where?Date:NOTE: A “YES” answer to these questions will not automatically bar you from employment. The nature, job-relatedness, severity, and date of the offense in relation to the position for which you are applying are taken into consideration. Citizenship The state of Florida hires only U.S. citizens and lawfully authorized alien workers.1. Are you a U.S. Citizen? Yes NoIf “NO”, are you legally authorized to accept employment with the specific hiring authority to which you are applying? Yes No Military Experience 1. Were you in the U.S Armed Forces? Yes NoIf “YES”, list military experience including special training which you feel would aid you in the position for which you are applying. Relatives 1. To your knowledge, do you have any relatives working for the 19th Judicial Circuit? Yes No Selective Services System Registration Section 110.1128, Florida Statues, prohibits employment by the State (including re-hire after a break in service) of any male born after October 1, 2962 who failed to register with the Selective Service System, under the provisions of the U.S. Military Selective Service Act, during the person’s period of eligibility (ages 18 through 25). Additionally, if currently employed by the stated, this law prohibits the promotion of such person. References (Please Include One Professional Reference) 1. Name:2. Name:Occupation:Occupation:Address:Address:Phone:Phone:PreviousNextThe Nineteenth Judicial Circuit is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity or expression, marital or familial status, veteran status, genetic information or other protected status. If you are a person with a disability who requires a special accommodation to participate in the application process, please contact the Circuit’s ADA Coordinator at 772-807-4370 to ensure availability of appropriate accommodations. Certification I am aware that any omissions, falsifications, misstatements, or misrepresentations above may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I understand that any information may be investigated as allowed by law. I consent to the release of information about my ability, employment history, and fitness for employment by employers, schools, law enforcement agencies, and other individuals and organizations to investigators, human resources staff, and other authorized employees of Florida state government for employment purposes. This consent shall continue to be effective during my employment if I am hired. I understand that applications submitted for state employment are public records. I certify that to the best of my knowledge and belief all of the statements contained herein an on any attachments are true, correct, complete, and made in good faith. By checking this box, I confirm that I have read, understand, and agree to the certification statement above, and that all information provided is true, correct, and complete to the best of my knowledge.EEO SURVEYAlthough the following information is not mandatory, it is requested to aid the State of Florida in its commitment to Equal Employment Opportunity, Affirmative Action and to meet federal reporting requirements. Refusal to answer will not result in adverse treatment of any applicant. Applicants who believe they have been discriminated against may file a complaint with the Florida Commission on Human Relations, 2009 Apalachee Parkway, Tallahassee, FL 32301 Race / Ethnicity (Please identify both Race and Ethnicity) Race: White Black / African American Asian Native Hawaiian / Other Pacific Islander American Indian / Alaska Native 2 or more racesSex: Male FemaleDate of Birth:Ethnicity: Hispanic or Latino Not Hispanic or Latino Previous Submit Form
