Application For Employment

4000 Gateway Centre Blvd. Suite 100-Pinellas Park, FL 33782

www.tbrpc.org

Contact Information
Date:
Name (First/Middle/Last):
Address:
Phone: Cell:
Email:

Employment Desired
Position: Date you can start:
Salary Requirements:
Do you have any commitments (personal or with a previous employer) that might affect
your employment with the Tampa Bay Regional Planning Council? YES NO

If YES, please explain:

Are you related to anyone in our employ? YES ☐ NO ☐

Are you over 18 years of age? YES ☐ NO ☐

Have you ever been convicted of a felony? YES ☐ NO

If yes, DATE:

U.S. Military Dates of Duty: Rank at Separation:

Present Membership in National Guard or Reserve? YES ☐ NO ☐

Pre-employment drug testing and criminal background check is required.

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 Application For Employment
4000 Gateway Centre Blvd. Suite 100-Pinellas Park, FL 33782
www.tbrpc.org

Education
Official transcripts are required from all colleges and universities attended. Verification
of graduation will be required prior to employment.
High School/GED
Name/Location:
Graduation Date:

College/University
Name/Location:
Number of Years Completed:
Major Coursework:
Graduation Date:
Grade Point Average:

Graduate School
Name/Location:
Number of Years Completed:
Major Coursework:
Graduation Date:
Grade Point Average:

Vocational/Business School
Name/Location:
Number of Years Completed:
Major Coursework:
Graduation Date:
Grade Point Average:

Other Studies:
Subjects of special study, research work, graduate assistantships, and any other notable
accomplishments that you feel will enhance your qualifications for this position?

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 Application For Employment
4000 Gateway Centre Blvd. Suite 100-Pinellas Park, FL 33782
www.tbrpc.org

Employment History
Current/Previous Employment (beginning with the most
recent) May we contact these employers? YES ☐ NO

Employer: City/State:
Job Title:
Job Duties:
Employed From: To:
Starting Salary: Ending Salary:
Reason for Leaving:
Supervisor Name: Contact Info:

Employer: City/State:
Job Title:
Job Duties:
Employed From: To:
Starting Salary: Ending Salary:
Reason for Leaving:
Supervisor Name: Contact Info:

Employer: City/State:
Job Title:
Job Duties:
Employed From: To:
Starting Salary: Ending Salary:
Reason for Leaving:
Supervisor Name: Contact Info:

Employer: City/State:
Job Title:
Job Duties:
Employed From: To:
Starting Salary: Ending Salary:
Reason for Leaving:
Supervisor Name: Contact Info:

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 Application For Employment
4000 Gateway Centre Blvd. Suite 100-Pinellas Park, FL 33782
www.tbrpc.org

Employment Related References

Please provide (3) professional references and (2) personal
references.
Name: Title:
Contact Information:
Professional Reference ☐ Personal Reference ☐ Ye ars Known:

Name: Title:
Contact Information:
Professional Reference ☐ Personal Reference ☐ Ye ars Known:

Name: Title:
Contact Information:
Professional Reference ☐ Personal Reference ☐ Ye ars Known:

Name: Title:
Contact Information:
Professional Reference ☐ Personal Reference ☐ Ye ars Known:

Name: Title:
Contact Information:
Professional Reference ☐ Personal Reference ☐ Ye ars Known:

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 Application For Employment
4000 Gateway Centre Blvd. Suite 100-Pinellas Park, FL 33782
www.tbrpc.org

IMPORTANT! READ THE MATERIAL BELOW AND REVIEW YOUR ENTIRE APPLICATION BEFORE SIGNING.

I acknowledge by my signature that I have read and understand the following:

Qualification and employment considerations by the Tampa Bay Regional Planning Council are
based on the truthfulness and completeness of the statements in this application. Falsifications
or omission of information will constitute grounds for disqualification or dismissal. Upon
submission of this application, addendum sheets and other required documentation to support
employability become the property of the Tampa Bay Regional Planning Council and are matters
of public record subject to release to persons or agencies upon request. Presenting any false
document(s) to gain employment may be cause for ineligibility for hire or immediate dismissal.

I authorize the Tampa Bay Regional Planning Council to investigate the truthfulness of all
statements made on this application and to contact my former employers and other listed
references of other persons who can verify information.

I give my consent for all contacted persons, including former employers, to provide information
concerning this application, and I release each contacted person from liability for providing such
information. I waive all causes of action that I might have arising from the foregoing.

I am aware and give my consent to having a criminal background check as part of this
employment application. I further authorize the conduction of said background check.

I am aware that pre-employment drug testing is required as a condition of continued

employment. I may be subject to additional drug testing during employment at any time at the
organization’s discretion. I am aware that the Tampa Bay Regional Planning Council employees
are placed on a minimum of 90 days initial probationary period. Just as the employee is free to
leave the Council’s employment at any time, the Council has the right to terminate the employee
at any time.

I acknowledge that the APPLICATION FOR EMPLOYMENT MUST BE SIGNED in order to be

processed or evaluated.

Signature: Date:

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 Application For Employment
4000 Gateway Centre Blvd. Suite 100-Pinellas Park, FL 33782
www.tbrpc.org

AUTHORIZATION TO OBTAIN RECORDS AND OTHER INFORMATION

WAIVER
In connection with background checks, I hereby authorize Tampa Bay Regional Planning Council to obtain
Credit Reports, Criminal Records that include Felony and Misdemeanors, Education Verifications, Drivers
Records, and any and all background information allowed under the law.

I release such persons, businesses, corporations, institutions, medical establishments, local, state, and
federal law enforcement agencies from any liability of any type as a result of providing the above mentioned
information to the Tampa Bay Regional Planning Council.

I hereby release and discharge Tampa Bay Regional Planning Council, the employees, agents, successors
and assigns, from any and all liability that may arise out of the investigation of my background as set forth
herein. Background checks of applicants may include the following:

Criminal Background Checks

Signature: Date:

Birth Date:

Driver’s License # and State:

Street Address:

City/State/Zip Code:

Please list all states in which you have resided: