BROWARD CO BOARD OF › CodeAppeals › Documents › Mechanical.pdf104.5.1 An Engineer in the discipline requested and having practiced for at least three (3) years, and two (2) years

BROWARD CO BOARD OF RULES AND APPEALS Chief Code Compliance Officer‐ Mechanical Initial Salary up to $83,750 Pay range is $74,472 to $110,431 Prof. pos. to assist in the consistent application of building codes throughout Broward Co. Must be certifiable as Chief Mechanical Inspector by BORA in accordance with the FBC as applicable to Broward Co. For info view http://www.broward.org/CodeAppeals/ Documents/Mechanical.pdf. Send resume and application with sal. history/lic. #s by May 30, 2013 to: BC BORA Mechanical CCCO Screening Comm. 1 North University Dr. Suite 3500 B. Plantation FL, 33324 EOE

May 30, 2013 g:\shared\interviews\cmcco\mechpospackage1.docx

Broward County Board of Rules & Appeals (BORA) The Board of Rules & Appeals first met on January 10, 1971. On March 9, 1976, the voters of Broward County recognized the need for a single autonomous agency to write, modify, and interpret a uniform body of building codes applicable throughout the County. The County Charter was amended, as proposed by the Charter Review Commission, to establish the Broward County Board of Rules and Appeals as an arm of county government. Made up of professionals, some appointed by the Broward County League of Cities others by the Broward County Commissioners, Board members are volunteers who serve without pay. BORA works throughout the year to provide educational programs available to inspectors, contractors and design professionals, and to increase and improve the knowledge and performance of the persons certified by BORA pursuant to the Building Code. The Board convenes monthly, as needed, to consider proposed amendments to the Florida Building and Fire Prevention codes to hear appeals on decisions made by Building and Fire Code Officials, and to render formal interpretations on the precise meanings of code sections that may be disputed. Board members and staff are continually working to provide stronger codes and greater safety for all who live and work in Broward County, and are well represented in state, national, and international organizations developing codes and standards. Chief Code Compliance Officer—Mechanical, Salary Range The pay range for this title is $74,472 to $110,431.The initial hiring salary is up to $83,750* with full benefits. The pay range is periodically reviewed by BORA and adjusted upward when appropriate. BORA provides the same employee benefits as Broward County and we participate in the Florida Retirement System (Pension Plan or Investment option). A county waiting period for health and life insurance benefits apply. *The option of a take-home vehicle is available at an employee cost of $30.00 per week, $1,560.00 per year for employees who reside in Broward County, thereby reducing the stated salary range. Chief Mechanical Code Compliance Officer—Hiring Process and Organizational Structure A screening committee, appointed by the Director, is being used to narrow the field of applicants. Out of the final group, a single recommended appointment will be brought to the Board by the Director for requested ratification. In the organization, there are a total of ten (10) positions, including Director, six (6) Compliance Officers, and an Administrative Assistant staff of three (3). The previous employee for this position retired after more than 27 years of service to BORA.

Broward County Board of Rules and Appeals �Effective Date: March 15, 2012

2010 FBC — Building 1.6 Broward County Administrative Provisions

eligible for appointment as a Chief Inspector (each discipline stated above), such person shall be certified by the BORA.

104.4 Powers and Duties of the Chief Electrical, Mechan-ical, Plumbing and Structural Inspector. The Chief In-spector (each discipline stated above) shall be subject to the powers vested by the BORA as set forth in Section 112 of this Code. The Chief Inspector shall have the power to dele-gate powers, duties and assignments to subordinate regular employees working under his/her authority, but only to those employees certified by the BORA as qualified to perform such powers, duties and assignments within his/her particu-lar discipline. It shall be his/her duty and responsibility to supervise and coordinate the work of all subordinate Plans Examiners and Inspectors within his/her particular disci-pline. The Chief Inspector shall have the sole authority to render interpretations of this Code and to adopt policies and procedures in order to clarify the application of its provi-sions within his/her particular discipline. Such interpreta-tions, policies, and procedures shall be in compliance with the intent and purpose of this Code. Such policies and pro-cedures shall not have the effect of waving requirements specifically provided for in this Code. The Inspection De-partment shall consist of one (1) Chief Inspector, one (1) or more Plans Examiner and one (1) or more Inspectors within his/her particular discipline. The Chief Inspector may hold any or all of these positions within his/her particular disci-pline.

104.5 Certification of the Chief Electrical Inspector or the Electrical Plans Examiner. To be eligible for appointment as a Chief Electrical Inspector or Electrical Plans Examiner, such person shall be certified as required by the State of Florida, by BCAIB as a (Electrical) Plans Examiner and (Electrical) Inspector. Such person shall be certified by the BORA and shall meet one or more of the following qualifications. Exception: Architects and engineers are exempt from BCAIB Certification only.

104.5.1 An Engineer in the discipline requested and having practiced for at least three (3) years, and two (2) years as an Electrical Inspector; or

104.5.2 Ten (10) years experience as a Master Electri-cian/Electrical Contractor or Journeyman Electrician, five (5) years of which shall have been construction experience in the Electrical discipline and two (2) years as an Electrical Inspector; or 104.5.3 Five (5) years experience in the State of Florida as an Electrical Plans Examiner or Electrical Inspector, three (3) years of construction experience in the Electrical disci-pline, and certified by BCAIB. 104.5.4 An applicant for Certification as a Chief Electrical Inspector or Electrical Plans Examiner under the provisions of this section who is a graduate from an accredited school holding a Bachelor or Associate of Science Degree in Engi-neering, Architecture or Building Construction may be cred-

ited for three (3) years for Bachelor Degree or one (1) year for an Associate Degree of the required ten-year experience for the Electrical discipline as listed below. In addition to the education credit, an applicant who is certified as required by the State of Florida, BCAIB as a (Electrical) Plans Examiner may be credited for two (2) years of the ten (10) years in section 104.5.2 and one (1) year of the five (5) years as spec-ified in section 104.5.3. Such credit shall not reduce the two (2) year experience requirement as an Electrical Inspector to be certified as a Chief Electrical Inspector or Electrical Plans Examiner. 104.5.5 Each of the applicants shall possess a current Certif-icate of Competency as a Master Electrician/Electrical Con-tractor issued by:

A. Florida Electrical Contractors Licensing Board. B. Broward County Central Examining Board of Electri-

cians. C. Dade County Construction Trades Qualifying Board,

Block proctored, issued on or after January 1, 1968. D. Florida Department of Business and Professional

Regulation as an architect or engineer.

104.6 Certification of the Chief Mechanical Inspector or the Mechanical Plans Examiner. To be eligible for appoint-ment as a Chief Mechanical Inspector or Mechanical Plans Examiner, such person shall be certified as required by the BCAIB as a (Mechanical) Plans Examiner and (Mechanical) Inspector. Such person shall be certified by the BORA and shall meet one or more of the following qualifications: Exception: Architects and engineers are exempt from BCAIB Certification only.

104.6.1 An Engineer in the discipline requested and having practiced for at least three (3) years, and two (2) years as a Mechanical Inspector; or 104.6.2 Ten (10) years experience as a Mechanical Contrac-tor, Class “A” Air Conditioning Contractor or Journeyman, five (5) years of which shall have been construction experi-ence in the Mechanical discipline and two (2) years as a Me-chanical Inspector; or 104.6.3 Five (5) years experience in the State of Florida as a Mechanical Plans Examiner or Mechanical Inspector, three (3) years of construction experience in the Mechanical disci-pline, and certified by BCAIB. 104.6.4 An applicant for Certification as a Chief Mechanical Inspector or Mechanical Plans Examiner under the provi-sions of this section who is a graduate from an accredited school holding a Bachelor or Associate of Science Degree in Engineering, Architecture or Building Construction may be credited for three (3) years for Bachelor Degree or one (1) year for an Associate Degree of the required ten-year experi-ence for the Mechanical discipline as listed below. In addi-tion to the education credit, an applicant who is certified as required by the State of Florida, BCAIB as a (Mechanical)

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Broward County Board of Rules and Appeals �Effective Date: March 15, 2012

2010 FBC — Building 1.7 Broward County Administrative Provisions

Plans Examiner may be credited for two (2) years of the ten (10) years in section 104.6.2 and one (1) year of the five (5) years as specified in section 104.6.3. Such credit shall not reduce the two (2) year experience requirement as a Me-chanical Inspector to be certified as a Chief Mechanical In-spector or Mechanical Plans Examiner. 104.6.5 Each of the applicants shall possess a current Certif-icate of Competency as a Mechanical Contractor or Class “A” Air Conditioning Contractor issued by:

A. Florida Construction Industry Licensing Board B. Broward County Central Examining Board of Me-

chanical Contractors and Specialty Mechanical Con-tractors

C. Dade County Construction Trades Qualifying Board, Block proctored, issued on or after January 1, 1968.

D. Florida Department of Business and Professional Regulation as an architect or engineer.

104.7 Certification of Chief Plumbing Inspector or Plumb-ing Plans Examiner. To be eligible for appointment as a Chief Plumbing Inspector or Plumbing Plans Examiner, such person shall be certified as required by the State of Florida, BCAIB as a (Plumbing) Plans Examiner and (Plumbing) Inspector. Such person shall be certified by the BORA and shall meet one or more of the following qualifications.

Exception: Architects and engineers are exempt from BCAIB certification only.

104.7.1 An Engineer in the discipline requested and having practiced for at least three (3) years, and two (2) years as a Plumbing Inspector; or 104.7.2 Ten (10) years experience as a Master Plumb-er/Plumbing Contractor or Journeyman Plumber, five (5) years of which shall have been construction experience in the Plumbing discipline and two (2) years as a Plumbing Inspector; or 104.7.3 Five (5) years experience in the State of Florida Plumbing Plans Examiner or Plumbing Inspector, three (3) years of construction experience in the Plumbing discipline, and certified by BCAIB. 104.7.4 An applicant for Certification as a Chief Plumbing Inspector or Plumbing Plans Examiner under the provisions of this section who is a graduate from an accredited school holding a Bachelor or Associate of Science Degree in Engi-neering, Architecture or Building Construction may be cred-ited for three (3) years for Bachelor Degree or one (1) year for an Associate Degree of the required ten-year experience for the Plumbing discipline as listed below. In addition to the education credit, an applicant who is certified as required by the State of Florida, BCAIB as a (Plumbing) Plans Exam-iner may be credited for two (2) years of the ten (10) years in section 104.7.2 and one (1) year of the five (5) years as spec-ified in section 104.7.3. Such credit shall not reduce the two (2) year experience requirement as a Plumbing Inspector to

be certified as a Chief Plumbing Inspector or Plumbing Plans Examiner. 104.7.5 Each of the applicants shall possess a current Certif-icate of Competency as a Master Plumber/Plumbing Con-tractor issued by:

A. Florida Construction Industry Licensing Board. B. Broward County Central Examining Board of Plumb-

ers. C. Dade County Construction Trades Qualifying Board,

Block proctored, issued on or after January 1, 1968. D. Florida Department of Business and Professional

Regulation as an architect or engineer.

104.8 Certification of Chief Structural Inspector or Struc-tural Plans Examiner. To be eligible for appointment as a Chief Structural Inspector or Structural Plans Examiner, such person shall be certified as required by the State of Florida, BCAIB as a (Structural) Plans Examiner and (Structural) Inspector. Such person shall be certified by the BORA and shall meet one or more of the following qualifications. Exception: Architects and engineers are exempt from BCAIB certification only.

104.8.1 An architect or an engineer in the discipline request-ed and having practiced within the HVHZ for at least three (3) years, and two (2) years as an Structural Inspector within the HVHZ; or

104.8.2 Ten (10) years experience as a licensed General Contractor (Unlimited), five (5) years of which shall have been construction experience in the Structural discipline within the HVHZ, and two (2) years as a structural inspector within the HVHZ; or: 104.8.3 Five (5) years experience as a Structural Plans Ex-aminer or Structural Inspector, three (3) years of construc-tion experience in the Structural discipline, which shall have been within the HVHZ, and certified by BCAIB.

104.8.4 An applicant for Certification as a Chief Structural Inspector or Structural Plans Examiner under the provisions of this section who is a graduate from an accredited school holding a Bachelor or Associate of Science Degree in Engi-neering, Architecture or Building Construction may be cred-ited for three (3) years for Bachelor Degree or one (1) year for an Associate Degree of the required ten-year experience for the Structural discipline as listed above. In addition to the education credit, an applicant who is certified as required by the State of Florida, BCAIB as a (Structural) Plans Examiner may be credited for two (2) years of the ten (10) years in section 104.8.2 and one (1) year of the five (5) years as spec-ified in section 104.8.3. Such credit shall not reduce the two (2) year experience requirement as a Structural Inspector to be certified as a Chief Structural Inspector or Structural Plans Examiner.

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Broward County > Human Resources > Employment BENEFITS That Work For You!

Employment BENEFITS That Work For You! Annual Leave Health Benefits Bus Passes Career Advancement Credit Union Deferred Compensation Employee Development Flexible Spending Accounts Florida Retirement System Free Parking Holidays Legal Insurance Life Insurance Long Term Care Insurance Long Term Disability Personal Income Protection Positive Start Prescription Drug Coverage Sick Leave Tri-Rail Passes Tuition Reimbursement National Holidays

The ABCs of Broward County Employment

Annual Leave

Benefit-eligible employees whose positions are not covered by a collective bargaining agreement accrue annual leave as shown below:

Health Benefits

The County offers three Consumer Driven Health Plans through Humana Inc. Some of the highlights are:

As a component of the health plans, the County funds a Health Reimbursement Account based on tier of coverage that can be used to pay health and pharmacy expenses.

The County self-insures the pharmacy plan through Catamaran (formerly Walgreens Initiative/Catalyst Rx). All plans are Open Access with no referral required to see a specialist. The County provides coverage for Domestic Partners (same and opposite sex) and children of Domestic Partners when

Domestic Partnership is registered in Broward County. (Special tax rules apply) The County provides coverage for Over Age Dependents ages 26-30. (Special tax rules apply)

A list of our Consumer Driven Health Plans

Dental Plans

Humana Comp Benefits The Standard Dental (PDF)

Vision Plan

Biweekly Benefit Plan Rates (PDF)

County Service Accrual Rate

Less than 5 years 80 hours per year

5 to 10 years 120 hours per year

10 + years 160 hours per year

Page 1 of 4Employment BENEFITS That Work For You!

4/23/2013http://www.broward.org/HUmanResources/Pages/EmploymentBenefits.aspx?print=1

Bus Passes

Bus passes at discounted rates are available on a pre-tax basis through payroll deductions.

Career Advancement

With approximately 60 agencies, 1,000 different job classes and over 5,000 employees working in numerous work sites, exciting career opportunities are available in diverse areas.

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Credit Union

All County employees and their family members are eligible for membership in the state-chartered City County Credit Union (CCCU).

Deferred Compensation

This is also known as a "457 plan" and it can reduce your taxes each pay period, through income deferral, and provides future benefits for retirement. The County has three providers; in alphabetical order they are: ICMA Retirement Corporation, MetLife (formerly Security First), and Nationwide Retirement Solutions (formerly PEBSCO).

Employee Development

The County sponsors a variety of classes to address the professional growth needs of employees and the developmental needs of the organization through classroom and electronic delivery.

Flexible Spending Accounts

Medical Expense and Dependent Care Accounts allow benefit-eligible employees to be reimbursed for qualified medical and/or child care expenses on a pre-tax basis, saving FICA and income taxes.

Florida Retirement System

Retirement benefits are provided under the Florida Retirement System (FRS) for full-time, part-time 20+ and part-time 19 employees.

Members can elect to enroll in the Pension Plan (Defined Benefit Plan) or Investment Plan (Defined Contribution Plan). Effective July 1, 2011 the State requires all eligible employees to contribute 3% of their gross salary on a pre-tax basis

to the FRS plan of their choice. Employees hired on or after July 1, 2011 will vest in the FRS Pension plan occurs upon completion of eight (8) years of

credited service. Employees hired prior to July 1, 2011 will vest in the FRS Pension plan upon completion of six (6) years of credited

service. Vesting in the FRS Investment Plan occurs upon completion of one (1) year of credited service. If you have FRS credited service from other public employment, it automatically consolidates into one account. If you have already retired under the FRS Pension Plan or taken a distribution from the FRS Investment plan you will

not be permitted to participate in a State of Florida administered retirement plan to earn an additional retirement benefit. Please contact FRS at 1-866-446-9377 to ensure you understand how re-employment with an FRS employer will affect you.

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Free Parking

Free parking is located in the two garages adjacent to the Government Center and arrangements are made for employees that work at other County locations.

Holidays

Nine (9) national holidays and two (2) personal days.

Legal Insurance

Legal insurance provides members with legal services through an in-network attorney or reimbursement when using a non-network attorney (up to plan limits). A wide array of legal services are available within this plan, including: divorce, child support and custody, traffic violations, debt, law suits and much more.

Life Insurance

Life Insurance Coverage

Basic Life Insurance $25,000 of group term life insurance FREE.



Long Term Care Insurance

Long Term Care - coverage assists with the cost of providing help for people who can no longer care for themselves for reasons covered by the plan.

Long Term Disability

Long Term Disability - insurance provides disability income for covered individuals to assure regular income if you cannot work for an extended period of time because of a covered illness or injury.

Personal Income Protection

A variety of Personal Income Protection Plans are offered through AFLAC.

Positive Start

Newly promoted, first time supervisors or those new to supervision in Broward County are required to successfully complete a training program that addresses both the behavioral and technical skills necessary to be an effective supervisor.

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Prescription Drug Coverage

Prescription benefits are provided as a part of the health insurance coverage under the County's self-insured pharmacy plan through Catamaran. There is a mandatory 90 supply requirement for maintenance medicines through which a three (3) month supply can be obtained for a two (2) month co-payment. Your co-payments in the pharmacy plan will depend on your medication choices:

Sick Leave

Eight (8) hours accrued every month. If the employee does not use any sick leave over thirteen (13) consecutive pay periods, s/he will accrue an extra day

or eight (8) hours of annual leave. Employees may convert qualified sick leave hours into annual leave, usually on a two-to-one ratio, once annually.

Tri-Rail Passes Zoned Fares

Tri-Rail's Employer Discount Program allows employees to pay for monthly Tri-Rail passes through pre-tax payroll deductions.

Tuition Reimbursement

Broward County’s Tuition Reimbursement Program provides opportunities for employees to enhance their knowledge, skills, and abilities through undergraduate, graduate, and doctorate courses and/or coursework in vocational or technical institutions in the State of Florida. The program reimburses the cost of eligible tuition for courses related to an employee’s official duties. Some restrictions apply.

National Holidays

Employee Optional Life Insurance Up to $150,000 is available in $25,000 increments.

Dependent and Spouse/Domestic Partner Life Insurance

Employees who elect at least $25,000 of employee optional life insurance coverage may purchase group term life insurance coverage on their eligible dependents, spouse/domestic partner or dependent children of their spouse/domestic partner.

PHARMACY PLAN 30-Day Supply 90-Day Supply (Mail Order)

Generic Formulary $5.00 $10.00

Brand Name Formulary $25.00 $50.00

Non-Formulary $40.00 $80.00

New Year's Day - January 1st

Martin Luther King, Jr. Day - 3rd Monday in January

Memorial Day - Last Monday in May



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Independence Day - July 4th

Labor Day - 1st Monday in September

Veteran's Day - November 11th

Thanksgiving Day - 4th Thursday in November

Day After Thanksgiving - 4th Friday in November

Christmas Day - December 25th



Board of County Commlsaloners, Br.oward County , Florida

HUMAN RESOURCES·USE ONLY

"An Equal Opportunity Employer" Entered Reg.

Rating E.P. V.P. Total Score

Dis .

. Broward County Division of Human Resources

of Rules" Appeals Human Resources Staffing Center ONE NORTH UNIVERSITY DRIVE, SUITE 3500-8 115 S. Andrews Avenue

PlANTATION, FLORIDA 33324 Ft. Lauderdale, FL 33301 PHONE: 954-765-4500 (954) 357-6444

FAX: 954-765-4504

.... WWW __ .B_RO_W_'A_R_D._O_RG ... 'C_O_D_E'A .... P ... PE'A_l.S ...... APPLICAnON FOR EMPLOYMENT

I POIIIION APPL YlNO FOR II JOB ~NCEMENr NUII8ER

INSTRUCTIONS: Please print or type all information. The application must be filled out completely •. Answer all questions. Do not leave an Item blank. If an item does not apply, write NlA (not applicable). If you need additional space to answer a question fullY, you may use full sheet$ of paper that are the same size as this page. On each additional page, be sure to inclUde your name, the position title, and the announcement number. You may also attach copies of documents or certlfica. which support your application. All materialssubmltted become the property of the County and will not be returned. Nothing can be added to your application after the announcement period hail Closed. All steternants made on the application are subject to verification. Exaggerated. false, or mi8leadlng stetements maybe cause for rejection and/or termination of employment THIS APPUCAnON MUST BE SIGNED ON THE LAST PAGE OR IT WIU BE VOIDED.

1. PRESENT LEGAL NAME

I~- I-- I ~1. 2. SOCIAL SECURITY NO. 3. WHEN AVAILABLE - If yO!:' require assistance with testing due to

a disability, please notify our staff.

4. APPLYING FOR - (Check all responses that apply) o Fulltime D Part time U9 Hours - No BenefitS) D 20+ (BenefitS) o Will call (No Set HoursINo BenefIts)

·5. HOME PHONE NUMBER 6. DRIVERS LICENSE

I-- I Number I Do you have a valid license? D Yes 0 No

Ucense Type: D Operator D COL DC/ass OTHER TELEPHONE NUMBER ,-

I-~ I Number I Endorsement Code

Ucense, State Exp. Date

7. PRESENT ADDRESS

Street Address ApU

City State Zip Code

How long have you lived at present address? Years Months

8. PREVIOUS ADDRESS.

Street Address Apt.

City State Zip Code

How long did you live at this address? Years Months

103-100 (Rev. 7197)

I

9. EDUCATION AND SPECIAL TRAINING

CheckHighestgtacie completed: 1 I 2 I 3 I 4 I 5 U 6 U 7 U 8 U 9 U 10 U 11 U 12 L High School Diploma? (X)

~ Yes

~ No If yes. date received:

Equivalency - GED (X) ""-

Yes ""-

No If Yes. date received:

Name and location of last HIGH SCHOOL ATTENDED:

Name. City State

List Spec:ijll Training (Business. Trade. Vocational. Armed Forces Schools. etc. 1 Below

Dates Attended Total CaulSesor Certificates Given or Other

From To Months . Subject Taken Pertinent Information Name and Location

Me Yr Mo Yr Completed

Ust Colleges and Universities Attended Below:

Dates Attended C!edit HoulS

From To Received Grade MajorlMinor Degree Degree Point Reid or Program Received

Name and Location Me Yr Me Yr Sam Qtr

Average of StudY

10. EMPLO,,{MENT RECORD - Ust aU jobs in the last TEN yealS and any other jobs relitvant to the position for which you are applying. Major changes in duties or job titles with the same employer should be I.isted as separate jobs. Start with your PRESENT or MOST RECENT position and work back. BE SPECIFIC -

all or part of )'Our rating may depend on the information )'Ou provide. If additional space is needed. please use continuation sheet. You may submit a resume in lieu 01 completing this section. providing it contains all the infonnation requested. Periods of unemployment should be listed separately in Section 11. NOTE: We may contact previous employers to verify )'Our descriptions of past duties.

May we contact your present employer regarding your record of employment? Yes 0 NoD

(Job 1) Present or Most Recent Job Emplo),&r

From To Total Time Address

Mo Yr Me Yr YIS Mths Telephone

Your Job Title

HoulS per week SuperviSOr's Name and Title

Starting Salary S Per Reesen for Leaving Position

Last Salary S Per

Specific Duties

Number of employees supervised (if applicable)

(Job 2) Previous Job Employer


Mo Yr Mo Yr Yrs Mths Telephone

Your Job Title

Hours per week SuperviSOr's Name and Title

Starting Salary $ Per Reason for Leaving Position

Last Salary $ Per

Specific Duties



From To Total TIme Address

Mo Yr Mo Yr Yrs Mths Telephone

Your Job Tille

Hours per week Supervisor's Name and Title


Last Salary $ Per

Specific Duties

,




Mo Yr MO Yr Yrs Mths Telephone Number

Your Job Title

Hours per week Supervisor's Name and Title


Last Salary $ Per

Specific Duties

Number 01 employees supervised (if applicable)

11. LIST ANY RELEVANT VOLUNTEER WORK AND ALL PERIODS OF UNEMPLOYMENT DURING THE PAST 10 YEARS

From To

Mo Yr Mo Yr Description of Activity or Volunteer Work

12. SPECIFIC SKILLS - Us! below the Job Number from your Employment Record (Section 19) and total number of months of experience in skillfully operating the equipment andlor total number of months of substantial experience in craft(s). or technical profession(s).

No. of Job List of Office & No. of Job Ustof All No. of Job Ust of Crafts. Trades Mths. No. Related Equipment Operated Mlhs. No. Other Equipment Operated Mh. No. & Technical Professions

13. Ust membership(s) in professional

14. Ust any active professional. technical. occupational licenses or certificates and registrations you now

15. Ust awards, commendations, or other recognition received for outstanding achievement in school, military service, your work, or civic

16. Have you ever used a legal name other than the one indicated on Page 1 U NoU If Yes indicate name(s) and dates used

17. Veteran Preferences: In keeping with Florida State Law and Broward County Civil Service rules, one point for each year of County service, to a maximum of five points, may be added to the numerical score of eligibte applicants who are County employees; and honorably diacharged wartime veterans, service connected disabled veterans presently receiving disability benefits, and disabled veteran or MIA person spouses, who are FlorIcIII .... may be eligible for 5 or 10 points prelerence. Veterans who have been 8I'IIpIo)'8d by the State of Florida or one of its Counties, Cities, etc., are excluded fIOm theIe Statues. POINTS WILL BE AWARDED ONLY IF SUPPORTING DOCUMENTATION IS SUBMITTED AT THE TIME OF APPUCATION. Acceptable documentation is a copy of a 00·214 and/or proof of receipt of disability benefits dated within six months of the date of application. Materials supplied with the application become the property of the County. Do not submit originaVs0t8 copies of documents.

Did you serve in the Armed Services? B NoB'·--......-· § No§ Are you claiming Veteran's Points? No Are you retired from the military? No

Are you or have you ever been employed by the State of Florida or one of its Counties, Cities, etc.? No

18. Have you ever worked for the Broward Count}! Board of County 19. Are you related to a county employee or is any member of your

Commissioners? D No D Household employed by the Broward County of County

Commissioners? D NoD

If yes, give date(s) of If yes, give the person's:

Name

Employing Division(s) Relationship to you

Employing Division(s)

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20. Since your 18'h birthday, have you been CONVICTED of ANY violation of the law, other than minor traffic offenses, or pleaded NOLO

CONTENDERE to criminal charges, even if adjudication was withheld? D No D If yes, please give:

Name of offense

Name of and location of court

Deposition of case Date:

NOTE: A conviction does not automatically mean you cannot be employed by the Country. The nature of the offense, how long ago it occurred, relationship to this job, etc. are given consideration.

21.How did you leam of the position for which you are applying? - Check the response that applies. o Newspaper ad o Visit to Division of Human o Florida ~tate Employment Agency

o County Employee o Human Resources Analyst D Recruiting Program· career Day

o High School o College Counselor (Please

o Other Source (please specify) o Professional Journal

22. REFERENCES: List three (3) Dersonal references who are not relatives or former emDloyers.

Name and Occuoation Address Telephone No. Years Known

IMPORTANT: Employment is subject to verification of an appIicanfs background and conviction record. Persons selected tor emptoyment must (1) present a vatid social security card, (2) take a Loyalty Oath, as per Florida Statute Section 876.05 and, (3) subsequent to an offer of employment, pass a medical examination by a County physician. The medical examination may include testing for current use of drugs anellor conti"ollecl substances. If traces of drugs or controlled .substances are present in a candidate's blood or urine and have NOT been obtained and taken as directed by a valid prescription, the candidate WIll. NOT be given further consideratiol'l under the present announcement for this classification. Additionally, Broward County is required by federal law to verify having seen documents, which the applicant must provide as part of employment processing, that show the applicanfs identity and right to work in the United States.

APPUCATION MUST BE SIGNED. APPLICANT: PLEASE READ THIS STATEMENT CAREFULLY BEFORE SIGNING BELOW. UNSIGNED APPLICATIONS WILL BE VOIDED. I hereby certify that each response on the application and all other information I have furnished in applying for employment with Broward County Board of County Commissioners is true and correct. I understand that any incorrect, incomplete, or false statement or information I have fumished may subject me to disqualification in an examination or to discharge at any time. Subsequent to an offer of employment, I give my voluntary consent to be medically examined and to provide a sample of my blood or urine which may be tested for recent use of drugs anellor controlled substances. Further, I release Broward County, its officers, agents, and employees from any liability whatsoever in connection with such a medical examination or the use of the test results therefrom.

Signature of Date

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