State of Florida EMPLOYMENT meses APPLICATION nat Opry Enpyitioate Aton Enes ‘Whe Fin canyon: + Outen peptic ‘Sie Ageey tan esoacas Once onay Department of Environmental Protaction ‘me Government Operations Consultant I poor new STIT9ZA2 an nee 2/16/2022 cota othr LEON em dcmgma sae $20,00%n6 See Compt a ronan win tie appeaton ns ety + Wpecrpretini, Alefomaton pei wie a pubic ced an wile elasnd upon request nes exe caren Specty the potion fr which you we app ote: A sepa pletion mas be submited fr ach vacarey-Phoocapes ae sccepiaie) “Fimes Gaddis "242 Cake Eta Dr., Apt. 2 + Sat sppstin tothe Paopa Fat Sve Canta, a fod ano 210, nol han 158 PMESTonitw nonce | | Tallahassee Leon FL___32303, + Sgn you rae nthe Coscaton Section page) Mlnforsten you | | 860-339-4378 ‘emis net vertetion Earner [email protected] EDUCATION Brandon High School; Brandon, FL oom oo YOUR KAUE. DIFFERENT WHILE ATTENDING SCHOOL Poa mace | i ims | Es | Se = Florida State University | Talahaseee, FL cine joao | [18 | in Reations Forda State University __| Tallahassee, FL 01708 [1209 | [60 | Geographyiist._| Bachelor Talanassee Community Coi._|Talhessee, FL owos|iaa7 | [eo |General stucies [AA YOUR NAME. OF FERENT WHE ATTEXONG SCHOOL YOUR NAME. OFFER LICENSURE, REGISTRATION, CERTIFICATION (EXAMPLES Teacher Ceificton, RN LPN. PE. CPA et) reat HAE ATTENDING SCHOOLPERIODS OF EMPLOYMENT Desc wot cere ei ging Wh yor ret os ett hee nt see esa rk eran ncaa ort wa gp ete iron Seepuyes teed Ut aap Cece sss suspen pn henpoyer Hed ach pst es rg We sane at rn sper a oman ak Secunrinte cone’ Rerun ny be ata earner Pema io ‘Name of Present or Last Emotoyee. Agency for Health Gare Administration 7 ‘Adwress: 2727 Mahan Dr.; Tallahassee, FL 32303 Your Job Tile: Operations Manager Supervisor's Name. Nick Constantino Rene from 02 / 28/2011 qo, 01 __/ 03_/ 2022 Hours PERWeEK:40__ ( utes and Responsbites: Lwas the supervisor af the Provider Eligibility and Comy reports thot were responsibe for executing Medicaid provider correct terminal ) 443-0550 1s, producing ineligible provider Reason For Leaving: Resigned to pursue a change in career path. [ET or 280 ins eromyer Petco Addess: 1654 Governor's Square Bivd; Tallahassee, FL 32301 Your Job Tle Department Manager ‘Supervisor's Name: Quincy Albers Phone no. (204 _) 521-3447 From or / 15 2910 to: _93_/ 1g _/201z__woursrenwesx: 40_ utes ora Renpenstines. Responsibility over inventory, especially livestock. Received and processed incoming shipments of new store merchandise. Supervised and trained sales associates. Opened and closed the store and reconciled sales. Your J Tate: Phone Ne. ( ) HOURS PER WEEK:"are of Next Previous Employer: ‘dsr: Your Job Te ‘Supervisor's Name: Phone No. ( ) FROM: I HOURS PER WEEK: utes and Responsibities Your dob Tle: Phone No: ( ) HOURS PER WEEK: Duties and Responses: Reason For Leaving erence ‘ase: Your dob Tie: Superasor's Name: Phone No. ( ) FROM: I I HOURS PER WEEK: € Duties and Responsibties: Veeco atch acatoral sats, ge sane fama ee aplcaton Rewane may be ache reve aional ramatenIn-depth knowledge of Micrnsaft Office programs and Oracle database query tools. Excellent yerbal and wniten communication skils. EXEMPTION FROM PUBLIC RECORDS DISCLOSURE ARE YOU A CURRENT OR FORMER LAW ENFORCEMENT OFFICER, OTHER COVERED EMPLOYEE™, OA THE SPOUSE OR CHILD OF ONE, WHOSE INCORMATION IS EXEMPT FROM PUBLIC RECORDS DISCLOSURE UNDER SECTION 119.071/44d), FLORIDA STATUTES 8,77 Lye “Other covera jobs Include but are not fnted to: correctional and correctional probation officers, frofghters, cantsin judges, aeestant state attomeys, stat atforneys, asistant and statewide prosecutors, personnel ofthe Department of Revenue ot local goverments whose resporsitities secs eves collection and efercarat cr cd supp erircerert, and cera rvesigters he Deparment of Chiron and Faron of BACKGROUND INFORMATION HAVE YOU EVER BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR? Cys [yo W-YES*, what charges? Were convicts? Date o Conviction [HAVE YOU EVER PLED NOLO CONTENDERE OR PLED GUILTY TO A CRIME WHICH IS A FELONY OR A FAST DEGREE MISDEMEANOR? rs [yo 1-YES", what charges? Where? Date: HAVE YOU EVER HAD THE ADJUDICATION OF GUILT WITHHELD FOR A CRIME WHICH IS A FELONY OR A FIRST DEGREE Meese Ino YES", what charges? Wrare?, Date: NOTE: AYES" answer to theso questions will not automatically bar you from employment. The nature, job-elatedneee, savory and date ofthe offense in relation to ‘the postion for which you ar applying are considered eee §112.011, FS] CITIZENSHIP. ‘The state of Florida hires only US. ctzens and lawfully authorized aon workers. You vil be required to provide identification and ether proof of citizenship or pro of authonzation to work nthe U.S, 1. ARE YOU AUS. CMZEN? v L_]e0, 2. IF NO, ARE YOU LEGALLY AUTHORIZED TO ACCEPT ENPLOYMENT WITH THE SPECIFIC HFING AUTHORITY TO WHICH YOU ARE APPLYING? les jo, RELATIVES ‘TO YOUR KNOWLEDGE, DO YOU HAVE ANY RELATIVES WORKING IN THIS AGENCY? ss [Z]no ‘SELECTIVE SERVICE SYSTEM REGISTRATION, Section 110.1128, Flas Statutes, prohibits employment bythe State Gntueng rei ater a breakin service of any malo bon ser October 1, 1962. wih feed to register wh the Selective Serica System, unde th provalens othe US. Miltary Selective Service Act during te persons er ct Sigblty lagen 1 trough 25). Adena, #eurnily employed by te Staats aw prohibits fe promotion of such person, IF YOU ARE AMALE BORN AFTER OCTOBER 1, 1862, HAVE YOU REGISTERED WITH THE ‘SERVIGE OR DO YOU HAVE PROOF OF AN EXEMPTION FROM THIS REQUIREMENT (DOCUMENTATION MAY BE REQUIRED)? vpes = [_]no [__ot Applicable CERTIFICATION | ar aware that any omissions, aiiatons, misstatements, or msropresentations above may Eaqualty me for employment consideration an 1am fired may be grounds to" termination ats ater Gate. uncestan that any inlorration | give may be rweaigated as alowed by Law| conan tone ‘oleae of voratan about my ality employment history. end fines for employment by employer, schods law ervorcement agencies and ether Incivcuals and crgarizsions {0 vestigate, human resources staf, and utr authorized employees of Flic state government fr Durposes. This consent shal cotnue tbe elective Curng my employment! am ied | understand that appbeatons submitted for state employment Er pubic recone cary tat othe beste my knowledge ans Beet al of te statements containes havin and on any acer aro, core, Sane ae GLb. DATE 2/ut fee 4 Seemanyour name James Gaddis POSTON THLE FOR WHICH YOU ARE ApPLNNG:. Government Operations Consultant I POsmTiON NuMAER: 37979242 __ VETERANS’ PREFERENCE: (Career Service positions only) Veterans’ Preference ensures that veterans and eligible persons are civen consideration at each step of the selection process. However, preference does not guarantee that a veteran or other eligible person willbe the candidate selected to fill the position. Section 296.07, FS. specifies who is eligible for Veterans” Preference. State of Florida residency is not required for Veterans" Preference. For applicants seeking Veterans’ Preference in accordance with Rule 554-7. Florida Administrative Code (A.C), completion of the Veterans’ Preference section below is required and will be kept confidential, as appropriate, in accordance with the Americans with Disabilities Act. Florida Department of Veterans’ Affairs Veterans’ Preference Certification ‘Section 295.07(1), Florida Statutes (FS), provides for Veteran’ Preference in employment appointment and retention if qualified under one of the following categories, and not exempt under Section 295.07(), FS. Section 295.09, FS. also provides Veterans’ Preference for reinstatement, reemphoy- ‘ment, and promotion. Usted below are the seven Veterans’ Preference categories as outinod onthe Florida Department of Veterans’ Affairs Veterans’ Preference Certification, FDVA form VP-1, effective date: June/2016, incorporated in Rule 55A-7.013, FAC. a A disabled veteran: 1. Who has served on active duty in ay branch ofthe United States Armed Forces, has received an honorable discharge, and has established the present existence of a service-connected gisabilty that is compensable under public laws administered by the United States Department of Veterans’ Aare; of 2. Whois receiving compensation, disability retrement benefits, or pension by reason of public laws administred by the United States Depart- ‘ment of Veterans’ Affairs and the United States Department of Defense. (section 295.07(1), FS] “The spouse ofa person who has @ total cisablly, permanent in nature, resulting from a servce-connected disabilty and who, Because ofthis dis ‘abil, cannot qualy for employment, and the spouse of a person missing in action, captured in ine of duty by @ hostile force, or foribly detained or interned inne of cuty by a foreign government or power. (section 295.07(1)0), FS] ‘Awartime veteran as defined in section 1.01(14), FS, who has served atleast 1 day during a wartime period or who has served in a qualifying camt= ‘paign or expedition. Active duty for taining may not be alowed fo eighilty under this paragraph. [section 295.07(1)0), FS.] “The unremaried widow or widower ofa veteran who died ofa service-connected disability (section 295.07(1)), FS] A completed “Certification of \Unremarried Widow or Widower” form (FDVA form VP-3) must be provided. “The mother, ater, legal guardian, or unremarred widow or widower of a member of the United States Armed Forces who ci inthe line of duty under combat-elated conditions, as verfed by the United States Department of Defense. [section 295.07(1}e), FS] A “Ceriication of Unremaied ‘Widow or Widower” form (FDVA form VP-8) must be provided. ‘A eteran as defined in ction 1.01(14), FS., excluding active duty for traning [section 295.07(1\0, FS. ‘Accurent member of any reserve component ofthe United States Armed Forces or the Florida National Guard, (section 296.07(1)\@) FS.] A compl (04 “Certification of Cuttent Member of Reserve Component of the United States Armed Forces or the Florida National Guard” form (FOVA form VP-2) must be provided. VETERANS’ PREFERENCE CLAIM: | CERTIFY THAT | AM QUALIFIED TO CLAIM VETERANS’ PREFERENCE UNDER THE CATEGORY SELECTED, PLEASE INDICATE THE LETTER THAT CORRESPONDS \WITH YOUR PREFERENCE FROM THE VETERANS’ PREFERENCE INFORMATION SECTION ABOVE.) {YOU CURRENTLY EMPLOYED WITHTHE AGENCY TO WHICH YOUARE CURRENTLY APPLING? es ave YOU RECEVE A PROMOTCNAL APPOINT HTN THE CAREER SERVICE, SUBSEQUENT TO ACTNE MLA” SERIE VATA THE AGENCY TO WHCHYOU ARE APNG? Che ‘Al applicants claiming Veterans’ Preference must submit a DD Form 214 (member copy #4) or comparable discharge, separation or canon reserve documentation that indicates the character of service as honorable. tn addition, all applicants claiming Categories a, b-c.d. or e above must also furnish supporting documentation in accordance withthe provisions of Rule SSA-7, FAC. Please fax your supporting Gocumentation to the People First Service Center at (888) 402-2110 by the closing date of the job announcement. Be sure fo include the position number for which you are applying on each page submitted. All required documents must be submitted no later than the closing date of the job announcement. Under Florida law, preference in appointment shall be given fist to those persons in Categories a or b and then to those in Categories oe toro, ita qualified applicant claiming Veterans’ Preference believes he/she was not afforded employment preference, he/she ‘fay fe ¢ complaint with the Florida Department of Veterans’ Affairs, Division of Benelits and Assistance, 9500 Bay Pines Biva., Room B14, St. Petersburg, FL 33708 in accordance with the timelines specified in Rule 55A-7.016, FAC. A complaint must be fled within 60 avendar days of the applicant receiving notice ofthe hiring decision made by the employing agency. I a notice of the hiring decision is fot received. itis the responsibility of the preference-eligible applicant to contact the Human Resource Ofice or other contact person vinere the vacancy occurred prior to filing @ complaint. Such contact shall occur atleast one time alter 45 days have passed from the final date for submitting an application or the interview date, whichever is later in time.‘Tht snctlon SHOULD be removed proto he salen process EEO SURVEY Athough the folowing information isnot mandatory, itis requested fo aid the State of Florida ints commitment to Equal Employment ‘Opportunity, Armative Action and to meet federal reporting requirements. Refusal o answer wil not resut in adverse treatment of any applicant. AnD Ccants who believe they have been discriminated agains! may flea complant with the Floida Commission on Humen Relations, 2009 Apalachee Parkway, Tollhassee, Florida 22201, RACE! ETHNICITY (Please identy both Race and Etricy) ace (CHECK ONLY ONE): Ethnicity (CHECK ONLY ONE}: Wnite Hispanic or Latino [BlncuAtican American Not Hispanic or Latino ‘sian [Native Hawaiar/Other Pacific Islander ‘American Indian/Alaska Native or mare races 5x (Zpwe Creme Dare orem ___ 12/6/1982 POSITION NUMBER: 37979242 POSITION TITLE FOR WHICH YOU ARE APPLYING: Government Operations Consuitant ee ees