Application for Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

As part of our commitment to a drug-free workplace, SSMC requires job applicants to submit to a drug test. Your refusal to take the test, or your failure to pass the test according to a minimum standard, will disqualify you from further consideration for employment.

Pleased select the desired professional position for which you are applying:
Administration
Survey Division - Field Position
Survey Division - Office Position
Sub-Surface Utility Engineering (SUE) Division - Office Position
Sub-Surface Utility Engineering (SUE) Division - Field Position
Geographic Information Systems (GIS) Division - Office Position
Geographic Information Systems (GIS) Division - Field Position
Name:
First: Middle: Last:
Aliases / Nicknames:
Email Address:
Address:
Street:
City: State: Zip:
Phone Number: for example 407-555-5555
Phone: Cell / Beeper / Other Phone Number:
Notify in Case of Emergency:
Name :
Relationship:
Phone Number:
  • If you are under 18, and it is required,
    can you furnish a work permit> Yes No 18 or older

  • Are you legally eligible for employment in this Country> Yes No

  • Date Available for Work (Month/Day/Year):

  • What is your desired hourly wage> $

  • If applying for a field position are you able to meet the
    attendance requirements of 7:00 am until 4:00 pm.> Yes No

  • Can you work overtime if the job requires> Yes No

  • Can you work out of the area if a job requires it> Yes No

  • If you are applying for a field position do you have a valid
    driver’s license> Yes No
Since your employment may involve operation of company vehicles, a check of Florida DMV records may be made to see if you meet the standards set by our insurance underwriters. A copy of your Driver's License will need to be submitted at orientation.
Employment/School Experience Please list your previous employment for the last 10 years with explanations for any gaps in employment of more than 12 months. List the most recent event first.
Most Recent Employment / School Experience :
From Date (Month/Day/Year):
To Date (Month/Day/Year):
Job Title / Position:
Name and address of former employer, school, or note circumstances if unemployed for more than 12 months

Supervisor Name:
Supervisor Title:
Phone Number (including Area Code):
Second Most Recent Employment / School Experience: within the last 10 years
From Date (Month/Day/Year):
To Date (Month/Day/Year):
Job Title / Position:
Name and address of former employer, school, or note circumstances if unemployed for more than 12 months

Supervisor Name:
Supervisor Title:
Phone Number (including Area Code):
Third Most Recent Employment / School Experience : within the last 10 years
From Date (Month/Day/Year):
To Date (Month/Day/Year):
Job Title / Position:
Name and address of former employer, school, or note circumstances if unemployed for more than 12 months

Supervisor Name:
Supervisor Title:
Phone Number (including Area Code):
Fourth Most Recent Employment / School Experience : within the last 10 years
From Date (Month/Day/Year):
To Date (Month/Day/Year):
Job Title / Position:
Name and address of former employer, school, or note circumstances if unemployed for more than 12 months

Supervisor Name:
Supervisor Title:
Phone Number (including Area Code):
Fifth Most Recent Employment / School Experience : within the last 10 years
From Date (Month/Day/Year):
To Date (Month/Day/Year):
Job Title / Position:
Name and address of former employer, school, or note circumstances if unemployed for more than 12 months

Supervisor Name:
Supervisor Title:
Phone Number (including Area Code):
Sixth Most Recent Employment / School Experience : within the last 10 years
From Date (Month/Day/Year):
To Date (Month/Day/Year):
Job Title / Position:
Name and address of former employer, school, or note circumstances if unemployed for more than 12 months

Supervisor Name:
Supervisor Title:
Phone Number (including Area Code):
If you are currently employed may we contact your present employer> Yes No
Describe any specialized training, apprenticeship, skills and extra-curricular activities that would help you with the position you are applying for.

Describe any knowledge of specialized equipment, how long you have used the equipment and how it will help you with the position you are applying for.

Other Qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience.

List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:

State any additional information you feel may be helpful to us in considering your application.

Please select the box of any of the crimes below that you have been CONVICTED or FOUND NOT GUILTY BY REASON OF INSANITY, in any jurisdiction, during the previous 10 years for any of the following crimes:

Forgery of certificates, false marking of aircraft and other aircraft registration violations.
Interference with air navigation.
Improper transportation of a hazardous material.
Aircraft piracy.
Interference with flight crew members or flight attendants.
Commission of certain crimes aboard aircraft in flight.
Carrying a weapon or explosive aboard an aircraft.
Conveying false information and threats.
Aircraft piracy outside the special aircraft jurisdiction of the United States.
Lighting violations involving controlled substances.
Unlawful entry into an aircraft or airport area that serves air carriers or foreign air carries contrary to established security requirements.
Destruction of an aircraft or aircraft facility.
Murder.
Assault with intent to murder.
Espionage.
Sedition.
Kidnapping or hostage taking.
Treason.
Rape or aggravated sexual abuse.
Unlawful possession, use, sale, distribution or manufacture of an explosive or weapon.
Extortion.
Armed robbery.
Distribution of, or intent to distribute, a controlled substance.
Felony arson.
Conspiracy to attempt to commit any of the aforementioned criminal acts.

Conviction will not necessarily disqualify an applicant from employment.
I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. Said investigation may include DMV, Employment background and possibly a criminal history records check.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I freely and voluntarily agree to submit to a drug/alcohol test as part of my application for employment. I understand that either my refusal to submit to the drug/alcohol test or the results are not negative according to the minimum standards established by the testing facility will disqualify me from further consideration for employment. I further understand that upon commencement of employment with SSMC I may again be required to submit to a drug test. I understand that my refusal to take a requested drug test or my failure to meet the minimum standards set for the examination, may result in immediate suspension or termination of my employment.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by the President of the Corporation.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.