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Rev. 1/16
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1
JOB-RELATED TRAINING OR COURSE WORK: (VOCATIONAL, TRADE, GOVERNMENTAL, BUSINESS, ARMED FORCES, ETC.)
GNINIARTTIDERCFO SETAD
ATTENDANCE HOURS COURSE OF COMPLETED?
YDUTSDENR
AE)RAEY/HTNOM(NOITACOLLOOHCS FO EMAN
ONSEYKCOLCSSALCOT MORF
POSITION APPLIED FOR
FOR OFFICIAL USE ONLY
Departmental Categories Date Received Receipt Sent
Title: ______________________________________________________________________________
Minimum Acceptable Salary: _________________________________________________________
Where to Find BCPA Vacancy Information:
• On the Internet: http://www.bcpa.net/
• Contact the BCPA Human Resources Office at 954.357.6910
• Type or clearly print in ink this application in its entirety.
• All positions in the BCPA are "employment at will." This means
either you or the BCPA may sever the employment relationship
at any time, for any reason, with or without caus
e.
• Basic computer skills -- or "computer literacy" -- are an essential job
function of EVERY position in our organization.
• All answers are subject to verification. All job offers are conditioned
upon applicant passing a criminal background check.
• Notify the BCPA's HR Office in advance if you require special
disability accommodations to participate in the employment process.
Your Name
Social Security Number
Your Mailing Address
edoC piZ etatS ytnuoCytiC
enohP ssenisuB enohP emoH
E-mail Address
Broward County Property Appraiser's Office
EMPLOYMENT
EDUCATION
YOUR NAME, IF DIFFERENT WHILE ATTENDING SCHOOL: ______________________________________________________________________________________________________________
HIGH SCHOOL:
:DEVIECERLOOHCS FO NOITACOL / EMAN enoN)yficeps( rehtOamolpiD
ycnegA gnisneciL etatSetaD noitaripxEdevieceR etaDrebmuN:NOITACIFITREC RO NOITARTSIGER ,ESNECIL
HOW DO WE CONTACT YOU?
COLLEGE, UNIVERSITY OR PROFESSIONAL SCHOOL: (TRANSCRIPTS MAY BE REQUIRED)
DATES OF CREDIT MAJOR / MINOR TYPE OF
ATTENDANCE HOURS COURSE OF DEGREE
DENRAEYDUTSDENRAE)RAEY / HTNOM(NOITACOLLOOHCS FO EMAN
FROM TO QTR SEM
YOUR NAME, IF DIFFERENT WHILE ATTENDING SCHOOL: ______________________________________________________________________________________________________________
GENERAL INFORMATION AND INSTRUCTIONS
YOUR NAME, IF DIFFERENT WHILE ATTENDING SCHOOL: ______________________________________________________________________________________________________________
LICENSURE, REGISTRATION, CERTIFICATION
EXAMPLES: Driver License, CFE, ASA, MAI, CCM, PE, CPA, MSCE, Florida Bar, etc.
Equal Opportunity Employer/Affirmative Action Employer
The BCPA does not tolerate violence or drugs in the workplace.
APPLICATI ON
115 S. ANDREWS AVE.
ROOM 111
FT. LAUDERDALE, FL 33301
HR: 954.357.6910
FAX: 954.357.6804
WWW.BCPA.NET
2
Name of Present or Last Employer: __________________________________________________________________________________________________
Address: ______________________________________________________________________________________ Phone No.:
(_____)___________
Your Job Title: ____________________________________________________________ Supervisor’s Name: _______________________________________
FROM:
_____/_____/_____ TO: _____/_____/_____ HOURS PER WEEK: _______ (_________________________)
Duties and Responsibilities: ____________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Reason For Leaving: __________________________________________________________________________________________________________________
1
PERIODS OF EMPLOYMENT
Describe your work experience in detail, beginning with your current or most recent job. Include military service (indicate rank) and job-related volunteer work, if applicable. Indicate number of
employees supervised. Use a separate block to describe each position or gap in employment. If needed, attach additional sheets, using the same format as on the application. All information
in this section must be completed. Resumes may be attached to provide additional information. At a minimum, list all employment covering the past ten (10) years.
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME IF DIFFERENT DURING EMPLOYMENT
Name of Next Previous Employer: ___________________________________________________________________________________________________
Address: _____________________________________________________________________________________ Phone No.:
(_____) ___________
Your Job Title: ____________________________________________________________ Supervisor’s Name: _______________________________________
FROM:
_____/_____/_____ TO: _____/_____/_____ HOURS PER WEEK: _______ (_________________________)
Duties and Responsibilities: ____________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Reason For Leaving: __________________________________________________________________________________________________________________
2
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME IF DIFFERENT DURING EMPLOYMENT
Name of Next Previous Employer: ___________________________________________________________________________________________________
Address: _____________________________________________________________________________________ Phone No.:
(_____) ___________
Your Job Title: ____________________________________________________________ Supervisor’s Name: _______________________________________
FROM:
_____/_____/_____ TO: _____/_____/_____ HOURS PER WEEK: _______ (_________________________)
Duties and Responsibilities: ____________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Reason For Leaving: __________________________________________________________________________________________________________________
3
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME IF DIFFERENT DURING EMPLOYMENT
3
Name of Next Previous Employer: ___________________________________________________________________________________________________
Address: _____________________________________________________________________________________ Phone No.:
(_____) ___________
Your Job Title: ____________________________________________________________ Supervisor’s Name: _______________________________________
FROM:
_____/_____/_____ TO: _____/_____/_____ HOURS PER WEEK: _______ (_________________________)
Duties and Responsibilities: ____________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Reason For Leaving: __________________________________________________________________________________________________________________
4
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME IF DIFFERENT DURING EMPLOYMENT
Name of Next Previous Employer: ___________________________________________________________________________________________________
Address: _____________________________________________________________________________________ Phone No.:
(_____) ___________
Your Job Title: ____________________________________________________________ Supervisor’s Name: _______________________________________
FROM:
_____/_____/_____ TO: _____/_____/_____ HOURS PER WEEK: _______ (_________________________)
Duties and Responsibilities: ____________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Reason For Leaving: __________________________________________________________________________________________________________________
5
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME IF DIFFERENT DURING EMPLOYMENT
Name of Next Previous Employer: ___________________________________________________________________________________________________
Address: _____________________________________________________________________________________ Phone No.:
(_____) ___________
Your Job Title: ____________________________________________________________ Supervisor’s Name: _______________________________________
FROM:
_____/_____/_____ TO: _____/_____/_____ HOURS PER WEEK: _______ (_________________________)
Duties and Responsibilities: ____________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Reason For Leaving: __________________________________________________________________________________________________________________
6
MONTH DAY YEAR MONTH DAY YEAR
YOUR NAME IF DIFFERENT DURING EMPLOYMENT
If needed, attach additional sheets, using the same format as on the application. Resumes may be attached to provide additional information.
4
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 I give may be investigated. 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 and
other authorized employees of the BCPA for employment purposes. This consent shall continue to be effective during my employment if I am hired. I understand that
applications submitted for BCPA employment are public records except as exempted above. I understand any offer of employment in the BCPA is conditioned upon
passing a drug test. I certify that to the best of my knowledge and belief all of the statements contained herein are true, correct, complete, and made in good faith.
SIGNATURE: ___________________________________________________________________________ DATE: ___________________________________
KNOWLEDGE / SKILLS / ABILITIES (KSAs)
List KSAs you possess and believe relevant to the position you seek, such as appraisal or real estate experience, computer skills, fluency in language(s), etc.
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
EXEMPTION FROM PUBLIC RECORDS DISCLOSUR
E
ARE YOU A CURRENT OR FORMER LAW ENFORCEMENT OFFICER, OTHER EMPLOYEE** OR THE SPOUSE
OR CHILD OF ONE, WHO IS EXEMPT FROM PUBLIC RECORDS DISCLOSURE UNDER §119.07, F.S.?
YES NO
**Other covered jobs include: correctional and correctional probation officers, firefighters, certain judges, assistant state attorneys, state attorneys, assistant and
statewide prosecutors, personnel of the Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child
support enforcement, and certain investigators in the Department of Children and Families [see §119.07, F.S.].
CITIZENSHIP
The State of Florida hires only U.S. citizens and lawfully authorized alien workers. If a conditional offer of employment is made, you will be required to provide
identification and proof of citizenship or authorization to work in the U.S.
ARE YOU A U.S. CITIZEN OR ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?
YES NO
RELATIVES AND FAMILY
TO YOUR KNOWLEDGE, DO YOU HAVE ANY RELATIVE OR DOMESTIC PARTNER WORKING IN THE BCPA OFFICE? YES NO
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Rev. 1/16
Employer: remove this section upon completion of the selection process.
YOUR NAME:
POSITION TITLE FOR WHICH YOU ARE APPLYING:
VETERANS’ PREFERENCE INFORMATION
Completion of the Veterans’ Preference section below is made on a voluntary basis and kept confidential in accordance with the Americans with Disabilities Act.
Listed below are the seven Veterans’ Preference categories.
1. Disabled Veterans who have served on active duty in any branch of the Armed Forces and who presently have an existing service-connected disability which is
compensable under public laws administered by the DVA or are receiving compensation, disability retirement benefits, or pension by reason of public laws
administered by the DVA and the Department of Defense.
2. The spouse of
a veteran who cannot qualify for employment because of a total and permanent service-connected disability, or the spouse of a veteran missing
in action, captured in the line of duty by a hostile force, or
detained or interned in line of duty by a foreign government or power.
3. A Veteran of any war, who
has served at least one day during that war time period as defined in subsection 1.01 (14) or who has been awarded a campaign
or expeditionary medal. Active duty for training shall not be allowed for eligibility under this paragraph.
4. The unremarr
ied widow or widower of a Veteran who died of a service-connected disability.
5. The mother, father, legal guardian, or unremarried widow or widower of a service member who died as a result of military service under combat-related
conditions as
verified by the U.S. Department of Defense.
6. A Veteran as defined in section 1.01m (14) Fl
orida Statutes. “Active Duty for Training” may not be allowed under this paragraph. The term “veteran” is defined as a
person who served in the active military, naval, or air service and who was discharged or released therefrom under honorable conditions only or who later received
an upgraded discharge under honorable conditions.
7. A current member of any reserve component of the U.S. Armed Forces or the Florida National Guard.
A
DD214
or comparable document which serves as a certificate of release or discharge
must be furnished at the time of application
. In addition, applicants
claiming categories 1, 2, or 4 above must furnish supporting documentation in accordance with the provisions of Rule 55A-7.013, F.A.C. Wartime periods are defined
in §1.01, F.S. Veterans’ Preference shall expire after an eligible person has been employed by the state or an agency of a political subdivision of the state. Under
Florida law, preference in appointment shall be given by the state to those persons in categories 1 and 2 and then those in categories 3 and 4. Veterans’ Preference
is only available to Florida residents.
If an applicant claiming Veterans’ Preference for a vacant position is not selected, he/she may file a complaint with the Florida Department of Veterans’ Affairs,
P.O. Box 31003, St. Petersburg, Florida 33731-8903. A complaint must be filed within 21 days of the applicant receiving notice of the hiring decision made by the
employing agency or within 3 months of the date the application is filed with the employer if no notice is given.
VETERANS’ PREFERENCE CLAIM
IF ELIGIBLE, WHICH VETERANS’ PREFERENCE CATEGORY ARE YOU CLAIMING?
(Please indicate number from Veterans’ Preference Information section above.)
HAVE YOU EVER BEEN EMPLOYED BY ANY GOVERNMENTAL ENTITY WITHIN THE STATE OF FLORIDA?
YES NO
NOTE:
If you are claiming Veterans’ Preference you
must
meet the criteria and substantiate your claim by furnishing a DD 214 (Certificate of Release or Discharge from
Active Duty) and any other required supporting documentation with your application.
Employer
: Remove this section prior to the selection process.
EEO SURVEY
Although the following information is not mandatory, it is requested to aid the BCPA in our commitment to Equal Employment Opportunity and Affirmative Action.
Refusal to answer will not result in adverse treatment of any applicant.
POSITION FOR WHICH YOU ARE APPLYING:
SEX: MALE FEMALE
DATE OF BIRTH:
_____________________________________
RACE (Check Only One):
WHITE (Non-Hispanic) BLACK (Non-Hispanic) HISPANIC ASIAN or PACIFIC ISLANDER NATIVE AMERICAN
OTHER (Specify)
______________________________________________________________________________________
NON-DISCRIMINATION:
The Broward County Property Appraiser's Office complies with all local, state and federal equal employment opportunity guidelines which prohibit discrimination
based upon race, religion, sex, color, national origin, disability, age, marital status, sexual orientation, and other categories protected by law. We are fully committed to
promoting diversity in our workplace.
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Completed 20 January 2021

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