No Were you in the military during a wartime activity? Note: Certain positions are exempt from request for Veterans Preference. Dates (Mo./Yr.

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1 NAME (Print): Last First Preferred Name Middle ADDRESS: Street City State Zip Telephone: Home Work Cell ADDRESS: Home Work Other POSITION APPLYING FOR: VACANCY NUMBER: VETERANS PREFERENCE: 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 None, highest grade completed Postsecondary Education (Your name while attending school if different from above) Name and address of college, university, business, correspondence, trade, technical, vocational school. Dates (Mo./Yr.) 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) , located in the Administration Building.

2 EMPLOYMENT: List below all present and past employment, beginning with your most recent.

3 EMPLOYMENT (Continued): List below all present and past employment, beginning with your most recent.

4 BACKGROUND INFORMATION: HAVE YOU EVER BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR? Yes No Where? Date HAVE YOU EVER PLED NOLO CONTENDERE OR GUILTY TO A CRIME WHICH IS A FELONY OR A FIRST DEGREE MISDEMEANOR? Yes No Where? Date HAVE YOU EVER HAD ADJUDICATION WITHHELD FOR A CRIME WHICH IS A FELONY OR A FIRST DEGREE MISDEMEANOR? Yes No 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) 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. Rev 1/04 Signature of Applicant Date

5 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)? Other How many times did you see the advertisement in the newspaper? 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 or visit their website at Veteran Disabled Veteran Unmarried (or Spouse of Disabled Veteran) (Has served on active duty for 180 consecutive days or more since and has honorable discharge) (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) Additionally, concerned applicants may contact the Florida Department of Veterans Affairs, P. O. Box 31003, St. Petersburg, FL 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) Mexican Border Period: May 9, 1916 to April 5, 1917 b) 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 c) World War II: December 7, 1941 to December 31, 1946 d) Korean Conflict: June 27, 1950 to January 31, 1955 e) Vietnam Era: August 5, 1964 to May 7, 1975 f) Persian Gulf War: August 2, 1990 to January 2, 1992

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