11/20/2012 Agreement DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE: December 10, 2012
TO: Thomas Ravenel, Assistant Finance Director
Finance Department
ATTN: Payroll Department
1
FROM: Pamela G. Hanc. '�i P.C.
At the November 20, 2012, Board of County Commissioner's meeting the Board granted
approval of the following:
Item F12 Employment Agreement and confirmation of Pamela A. Johnson as Executive
Assistant to Commissioner Sylvia J. Murphy, District 5.
Item F13 Employment Agreement and confirmation of Isabel C. DeSantis as Executive
Assistant to Commissioner Danny L. Kolhage, District 1.
Attached is a copy of each of the above - mentioned for your handling. Should you have
any questions please feel free to contact our office.
cc: County Attorney w/o document
File
EMPLOYMENT AGREEMENT
BETWEEN MONROE COUNTY, FLORIDA
AND
PAMELA A. JOHNSON
FOR POSITION OF
EXECUTIVE ASSISTANT TO COMMISSIONER SYLVIA J. MURPHY
THIS AGREEMENT is entered into upon the date last below written by and between
Monroe County, Florida, acting through its Board of County Commissioners ( "Board or
"BOCC "), a political subdivision of the State of Florida, whose main business address is 1100
Simonton Street, Key West, Florida 33040, and Pamela A. Johnson ( "Employee ").
WHEREAS, the position of Executive Assistant to County Commissioner Sylvia J.
Murphy, District 5, is currently open; and
WHEREAS, the BOCC has solicited applicants for the position; and
WHEREAS, Employee has interviewed and been selected for the position; and
WHEREAS, negotiations between the County and Employee have resulted in this
mutually acceptable Employment Agreement ("Agreement ");
NOW THEREFORE, in consideration of the mutual promises contained herein the
County and Employee set forth herein, it is mutually agreed as follows:
1. EMPLOYMENT. Employee is hereby employed by the County as executive
assistant to County Commissioner Sylvia J. Murphy ("Commissioner "). Upon ratification by the
Board of County Commissioners, the status of the Employee will be a Contract Employee as that
term is defined in Section 2.03 of the Personnel Policies & Procedures Manual ( "Manual ").
2. DUTIES. Duties of the Employee will be as set forth in the Job Description
attached hereto as Exhibit A, the provisions of which are incorporated herein by reference.
3. COMPENSATION. In return for performance of the duties set forth in Exhibit A,
including but not limited to specific duties assigned by the Commissioner from time to time,
Employee shall receive an annual base salary in the amount of $50,000.00 (`Base Pay "). Except
as otherwise set forth herein, the Employee shall also continue to receive an annual base salary in
the amount of $8,000.00 in addition to the Base Pay for duties associated with Upper Keys
Health Care Taxing District ( "UKHCTD" or Trauma District "). In the event the Trauma District
is eliminated the Employee shall no longer be compensated the $8,000.00 and shall only receive
the Base Pay. The Employee will also receive all benefits set forth in the Monroe County
Personnel Policies & Procedures Manual ("Manual ") as said Manual may be amended from time
to time. County and Employee agree that the position of Executive Assistant will be a full -time
position deemed non - exempt under the Fair Labor Standards Act. Work hours performed,
annual leave, personal leave, and sick leave hours taken will be documented on a form or forms
to be provided by County.
4. SOLE EMPLOYMENT. The Employee agrees that he or she will not perform
any work, consulting services, or other activities for any other person or entity, whether for
remuneration or at no charge, without the prior express written approval of the Commissioner.
5. TERM OF AGREEMENT; TERMINATION; CANCELLATION; GENERAL
RELEASE. The Employee understands that the appointment is a relationship that is highly
dependent upon the personal and confidential relationship between the Employee and the
Commissioner. In entering into this Agreement, the Employee therefore understands that he or
she serves at the pleasure of the Commissioner; that there is no set term to this Agreement; and
that the Employee can be terminated at any time upon twenty -four hours' written notice by the
Commissioner, with or without cause, but that in any event the Agreement will terminate at the
conclusion of the term of current office of the Commissioner. The Employee further understands
that in the event of termination, the Employee is free to apply to the County for any other
position then currently open and the County is free to consider the Employee for any open
position, but that County has no obligation to place the Employee in another position, and
specifically has no obligation to place the Employee in a position of equivalent or comparable
salary, grade, or benefits. In entering into this Agreement, the Employee therefore specifically
waives the right to utilize the grievance procedure set forth in Sections 9 and 10 of the Manual;
House Bill No. 2658, Chapter 69 -1321, the Monroe County Career Service Council; as well as
any rights to which a Monroe County employee would otherwise be entitled under Chapter 447,
Florida Statutes. As used in this paragraph, the term "for cause" will mean (a) dishonesty with
respect to the business and operation of the County; (b) confirmed violation of the County's drug
policy; (c) refusal to cooperate in an investigation regarding any aspect of the business or
operation of the County, including but not limited to an investigation which is conducted by or at
the express direction of the BOCC; (d) conviction of a crime which is classified as a felony or a
crime involving moral turpitude; (e) gross neglect or willful and intentional misconduct; (f)
conviction of a crime; (g) violation of a provision of the Monroe County Code; or (h) breach of
any material term or condition of this Agreement by the Employee.
6. ATTORNEYS' FEES AND COSTS. In the event of any litigation initiated by
either party, the prevailing party shall receive reasonable attorneys' fees, costs of litigation, and
related expenses, both at the trial and appellate levels.
7. GOVERNING LAW; ATTORNEY'S FEES AND COSTS; VENUE. This
Agreement is made in the State of Florida and will be governed by Florida law. This Agreement
may be signed in more than one counterpart, in which case each counterpart will constitute an
original of this Agreement. Paragraph headings are for convenience only and are not intended to
expand or restrict the scope or substance of the provisions of this Agreement. Wherever used
herein, the singular will include the plural, the plural will include the singular, and pronouns will
be read as masculine, feminine, or neuter as the context requires. Monroe County, Florida will
be the proper venue for any litigation involving this Agreement. This Agreement is not subject
to arbitration.
8. OTHER TERMS AND CONDITIONS.
A. Except as set forth herein, the Employee is subject to all terms and
conditions set forth in the Monroe County Personnel Policies & Procedures Manual ("Manual ")
-2-
as may be amended from time to time. To the extent there is a conflict between the terms of this
Agreement and the Manual, the terms of this Agreement shall prevail.
B. If any provision, term, or portion of this Agreement shall be held to be
unconstitutional, illegal, invalid, or enforceable by a court of competent jurisdiction, the
remaining terms, conditions, and portions shall remain in full force and effect as if originally
agreed to without the term, condition, or portion that has been determined to be unconstitutional,
illegal, invalid or unenforceable.
C. The waiver by either the County or the Employee of a breach or violation
of any term or provision of this Agreement by the other party shall not operate or be construed as
a waiver of any subsequent breach or violation by the other party.
D. The County and Employee acknowledge that each has shared equally in
the review of this Agreement and, accordingly, no court or administrative hearing officer shall
construe any provision of this Agreement more strictly against one party over the other party,
and every term, condition, covenant, and provision of this Agreement shall be construed simply
according to its fair meaning. Employee further acknowledges that she or he has had the
Agreement reviewed by an attorney, or has been given the opportunity to do so and has waived
that opportunity.
E. This Agreement incorporates and supersedes all prior negotiations,
correspondence, conversations, agreements, and /or understandings applicable to the matters
contained herein. It is further agreed that there are no commitments, agreements, inducements,
or understandings concerning the subject matter of this Agreement that are not contained herein,
and no deviation from the terms hereof shall be predicated upon any prior representations, offers,
promises, inducements, or agreements, whether oral or written, and by whomever made.
F. The text herein constitutes the entire agreement between the Employee
and the County, and this agreement cannot be amended except by a written document mutually
agreed to and executed with the same formalities as this Agreement. The rights and obligations
of this Agreement are personal to the Employee and cannot be assigned or transferred.
%I
IN WITNESS WHEREOF, the parties hereto have set their hands and seals, in the
County of Monroe, Florida, this day of December, 2012.
On behalf of Monroe County, Florida
WITNESS:
By: E�D 2461----9W
[Print Name:]
By:
Roman Gastesi, County Administrator
Employee
By: ccr� Gt .tv
Pamela A. J nson
MONROE COUNTY ATTORNEY
A'RO �ED� $ TO FORMY L. AL�L
ASSISTANT COUNTY ATTORNEY
Date /I - , )- C► 'x
-4-
MONROE COUNTY ADMINISTRATIVE SERVICES
QUALIFICATION FORM
(GRADE "9" Or Above)
NAME OF APPLICANT: Pam Johnson
POSITION APPLIED FOR: Executive Assistant - District 5
DEPARTMENT: BOCC
AREA: Key Largo
MEETS BASIC REQUIREMENTS ®
DOES NOT MEET BASIC REQUIREMENTS ❑
CLAIMING VETERANS PREFERENCE ❑
IS NOT CLAIMING VETERANS PREFERENCE El
DATE OF REVIEW: 10/29/12
❑
ACCORDING TO THE JOB DESCRIPTION, THESE
ARE THE MINIMUM QUALIFICATIONS:
MEETS THE
MINIMUM
QUALIFICATIONS
DOES NOT MEET
THE MINIMUM
QUALIFICATIONS
DOES NOT MEET THE MINIMUM
QUALIFICATIONS; HOWEVER DOES
POSSESS COMPARABLE
UALIFICATIONS AS LISTED
H.S. diploma or GED
❑
❑
3 to 5 yrL. ex p.
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
COMMENTS:
�F�
HR REPRESENTATIVE Y✓1 V � DATE
��l �Ul'�
w ,,
Z
m
m
a
m
n�
a
a
O
O
M
S
7
OQ
7
m
m
m
3
a'
M
Ci
3
Ol
(D
m
C
N
C7
C
m
a
a
O
N
N
N
O
7
o,
Ln
c
m
0
7
A
m °, K o
O 3 Ln
7 3 K
W �
0 OQ N Vi d'
' "
Ln c m
000 0 Ij Q M
n n
n Ln
O m w
3 3
• a N
7 y Gl
: 7 `�
°* °_ o LA
CU
c m 'A
r S C Ln
LA a
Ol 1 7'
N
<' =r
7 rD
�^ m O
O c C
c = cu
Q. m cu
Q d '7•►
a ? i
y n i
Q1 ?
N �
3 X 7
O) 3' N
= OQ 3
O '. 7
-h A N
* O
S 7
r N O
y r« 3
S m
N m N
CU r•.
cu O
O rt
7
d H '
0 O
In m �?
N if
0) m
v N
o D
0i CL
n 3
O
3
C C
3 7 <
w r► m
0 S _D
U
v a
CL D
Q N
ri 7'
O m
y :E
_ cu n
y 3 0
rD c -*
f1 .7•r 7
of c
O m
m -h
O : E o
o D-
o o
=r 7-
0 =
N � m
3 = �
7 m O
d a g
n 0 o
CD-
0
c 7
n
N -1 Co - n
com
A
N C C C
.* 3 cD
-� cna
0 cr
CD
W
O
N
O
N
co
T
K
'C
C UNTY oMONROE
KEY WEST FLORIDA 33040
(305) 294 -4641
Employee Services Division
Human Resources
The Historic GATO Cigar Factory
1100 Simonton Street, 2n Floor
Key West, FL 33040
BOARD OF COUNTY COMMISSIONERS
Mayor David Rice, District 4
Mayor Pro Tern Kim Wigington, District 1
George Neugent, District 2
Heather Carruthers, District 3
Sylvia Murphy, District 5
b .e- 30. 2ol Z.
Posting Date
MONROE COUNT PROMOTIONALOPPORTUNITYNOTICE
THE POSITION OF EXECUTIVE ASS ISTANT(COMMISSIONER AIDE) BOCC DISTRICT 5 KEY LARGO IS NOW OPEN
AT PAY GRADE 9 SALARY, $41,678.24 - $60,433.90/40 HPW (CONTRACT POSITION)
(DEPENDING ON QUALIFICATIONS)
• VETERANS PREFERENCE AVAILABLE: ®YES ❑ NO
• SAFETY SENSITIVE POSITION: ❑ YES ® NO
• GRANT POSITION (IF GRANT ENDS, POSITION WILL NOT BE CONTINUED) ❑ YES ® NO
THIS POSITION: ❑ IS A CAREER SERVICE STATUS POSITION
® IS NOT A CAREER SERVICE S TATUS POSITION
In accordance with the Monroe County Personnel Policies and Procedures, it is the policy of the Board of County
Commissioners to consider employees for promotional opportunities before applicants from the general public are
considered.
Promotional Opportunity Notices will be posted for a minimum of seven (7) calendar days (including the date of posting)
during which time employees under the auspices of the County Administrator will have the right to apply for these
positions before anyone outside the County service will be considered.
An employee wishing to apply for a position through the Promotional Opportunity process will complete the
Promotional Opportunity Application and submit it to the Personnel Representative in the lower, middle, or upper
keys for a date stamp to insure timely referral within the 7 day period. Supervisor and /or Department Head
signature can then be obtained by the employee or routed by the Personnel Representative, whichever is more
feasible.
Job interviews will be based on information on file and /or submitted with an application.
The County reserves the right to reject any applicatir not ubmitted on a timely basis.
IT
1
EMPLOYEES RVI S VISION DIRECTOR
MONROE COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER
CCCCO05
MONROE COUNTY
JOB DESCRIPTION
Position Title: EXECUTIVE ASSISTANT Date: 04/15/99
Position Level: 9 FLSA Status: Nonexempt Class Code:
rrimary tunction is to perform highly specialized office and administrative work in supporting a Division
Director or Commissioner.
L *Act as personal secretary and or administrative aide.
2. *Prepare and/or research agenda items.
3. Assist in drafting and production of complex written correspondence and presentations.
4. Read, sort, and distribute all incoming and outgoing mail, as well as receive and screen callers.
5. Maintain supervisor's calendar and schedule, and make travel arrangements.
6. Help prepare annual budget and perform daily routine budgetary functions.
7. Take and transcribe dictation, i.e., letters, memos, and independently prepare routine letters, etc.
8. Take and transcribe minutes of meetings.
9. Perform routine clerical functions (typing, filing, copying documents).
* Indicates an "essential" job function.
The information on this description has been designed to indicate the general nature and level of work
performed by employees within this classification. It is not designed to contain or be interpreted as a
comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this
iob.
Position Title: EXECUTIVE ASSISTANT Class Code: Position Level: 9
Department Head:
Name:
Division Director:
Name:
County Administrator:
( � L
Name:
ALS
Signature:
Date:
Signature: Date:
Signature: L _ Date:
On this date I have received a copy of my job description relating to my employment with Monroe
County.
Name: Signature: Date:
KEY JOB REQUIREMENTS
Education:
H.S. Diploma or GED required.
Experience:
3 to 5 years.
Impact of Actions:
Makes decisions and final recommendations which routinely affect the activities of an
entire department. Position duties may include responsibility for developing strategic
plans for one or more divisions.
Complexity:
Analytic: Work is non - standardized and widely varied requiring the interpretation and
application of a substantial variety of procedures, policies, and/or precedents used in
combination. Frequently, the application of multiple, technical activities is employed;
therefore, analytical ability and inductive thinking are required. Problem solving
involves identification and analysis of diverse issues.
Decision Making:
Analytic: Supervision is present to establish and review broad objectives relative to basic
position duties or departmental responsibilities. Independent judgment is required to
study previously established, often partially relevant guidelines; plan for various
interrelated activities; and coordinate such activities within a work unit or while
completing a project.
Communication
Requires regular contacts to carry out programs and to explain specialized matters. Also
with Others:
requires continuing contacts with officials at higher levels on matters requiring
cooperation, explanation and persuasion, as well as with the public involving the
enforcement of regulations, policies and procedures.
Managerial Skills:
Has responsibility or authority which is limited to the direction of temporary workers.
Working Conditions/
Work requires only minor physical exertion and/or physical strain. Work environment
Physical Effort:
involves only infrequent exposure to disagreeable elements.
On Call
None.
Requirements:
Department Head:
Name:
Division Director:
Name:
County Administrator:
( � L
Name:
ALS
Signature:
Date:
Signature: Date:
Signature: L _ Date:
On this date I have received a copy of my job description relating to my employment with Monroe
County.
Name: Signature: Date:
APPLICATION /RESUME CHECKLIST
NAME JOHNSON, PAMELA
POSITION TITLE: EXECUTIVE ASSISI ANT LOCATION: DISTRICT 5, KEY
LARGO POSITION #: CCCCO05
DATE SUBMITTED /RESUBMITTED: 11/01/12
I• ® DATE STAMP APPLICATION OR RESUME
® (insure that Promo Oppty has 3 page attachment: Safety Sens, EEO, Vet Pref Forms)
2. ❑ LAST 3 PAGES OF APPLICATION (Pg 13 —15) TO THE APPLICANT FOR REFERENCE.
Explain to applicant — Important to Read — It explains our procedures
3. ❑ COPY OF DRIVERS LICENSE AND SS CARD:
4. ❑ MENTION TO APPLICANT - IF POSITION APPLYING REQUIRES A DEGREE, MUST
REQUEST FROM SCHOOL (see pg 14).
® N/A
5. ❑ IF REQUESTING VETER PREF (Pg 8) MUST SUBMIT DD -214 (or comparable document)
❑ N/A
6. ❑ ORIGINAL SIGNED AUTHORIZATION OF CREDENTIALS CHECK FORM
7. ❑ IF APPLYING FOR SAFETY SENSITIVE JOB (as noted on back of this form)
❑ CHECKED `YES' ON Attach 5 -Pa 10 MUST FILL OUT `Alcohol & Control Substances
Authorization To Release Form'.
® N/A
8. ® LICENSE CLASS: (N /A) - ®; (CDL A) - ❑; (CDL B) - ❑ ; (CDL C) - ❑
9. ® How did you team about the position`? ❑ Newspaper
Relative ❑Employment Agency ❑Friend
❑ ❑ Walk -in ❑ Channel 76 ❑ Internet Website ® Other
NOTES
❑NEW APPLICATIONS: 1-9
❑RESUBMITTALS: -I, 5, 6, 7, 8, 9
❑RESUNIE: I
®IN- HOUSE: 1, -t, 7, 8
li-EY WEST HR OFFICE USE ONLY
NEW APPLICATIONS: ❑Scan ❑pull EEO form ❑Email or Letter ( SS card/FL DL/3 yr DL record/Transcrints /Credentials Check)
RESUBMIML — Complete & Scan new checklist with application
1N- HOUSE: ®Scan ®pull EEO form
RESUME: ❑Scan ❑mail out/email application
IfunanResources RevOT12
EmImm (O PROMOTIONAL OPPORTUNTTYnXMSFER APPLICAT� ft
MCA hISL 47'05.12 MON110E COITNZ BOCC II t(;
Meaeh 2012 14, HUIKAN RMURCES SEC'T'ION
P to Monroe County
Human Resources
im Date
Time initial_c ��
NAME:
/ ANTE
c j 4 EC ✓J(Y t
DEPARTMENT: -
a IK e a
0 6 r
U .. jal H e Ito Cg re *ta ; 0 ; s +f; c f-
ti��ciel
CATION:
ru,r-se .:t r .1- 1 rh,+ rc srr tico:r. n Orac.•sn,ry c
. nri. r; rr tr lyr.•un! t.r�L n,.l nc One rcr. ron;; unr. +�dl h^ usrd v,
EMPLOYMENT DATE:
1 o _ 7
WORK PHONE:
PRESENT JOB TITLE:
BULLETIN DA'L'E:
A_ d1ufwL L jrqff ve
pssf 4k
N OF JOB CLASSIFICATION APPLYING FOR, DEPARTti1ENT, AND LOCATION.
/ ANTE
c j 4 EC ✓J(Y t
f�SSiS f er N� �� /N+wli l3iok�/ /1, -) 'goeCt IJ13 5 � el � .gf p
BMEF DESCKIPTION OF YOUR QUALIFICATION FOR I liIS POSITION:
Ill/v� �
04 I�tit��
l/►f srS G " it R/ r i i� p �r� s r! f 0-4 �I�1N� MI S fYR t1 ✓i s ill w/ sN� ' 400 r
dvf� •s. Fit tilt I Jijt 4 Newts Vve w.,Aq f f *ke lck 3 & /t! P& •�F�c e
f /k ua? *wi
- y . -....- j.. /I , - -
FMPLOYEE'S SIGNATURE V
SLTPE- RVISOR'S SIGNATURE _
DEPARTMENT HEAD'S SIGNATURE
V i —PkTw b mwiY Is oNda dw Wpm Om K no now
b of 1 Irmwm ,ir10 a y
BZLD FOR IlYTER nT PAW
a� Irrtryt rs eFnea�q� NM�w.sw�! prr�
DATE+. AND TIME OF VMRVIEW
INTERVIEWER'S NAME, PHONE dt LOCATION
REMARKS:
DATE 1 0 - 31 - 12-
DATE
DATE
a dm* Imetme , the a tiodtl rw do EW*bd bm the
Mostrilmls
jlftk with oldph
VD HUMAN VJWURM US1t ONLY
rh "w "MPIVII'm r- a s d*QV +yuai
RECEIVING DEPARTMENT' HEAD'S SIGNATURE DATE
If selected for position and if the employee has been in present Positial kss than 6 months, Prior approval of die Division
Duactor(s) sod County Administrator must be obtained w aocordanoe with Section 2.12 Personnel Policies and Procedural.
Current Division Dimctor Division Director of position applied County Administrator
JOB IIYI=VTL M WILL BE BARED ON INFORMATION ON FILE AND" SU13 Orr WPIH TM AMjCA ION
.aFI'I:R SFLE(..71ON IS MADE
V COPY EMPLOYEE
(- ORIGINAI.• PERSONNI'I. FI1.6
15
EFF 0&03/07
HR Farm Rm 08/ i l
I:ncl :cure l5) PROMOTIONiAL OPPORTUNITYITRANSFER APPLICA F
° M.C.A. 1". 4705.12 M1IONROE COUNTY BOCC E il D
March 14, 2012 NUMAN RESOURCES SECTION
Page 10 Monroe County
HIAman resources
Date
Time jd)0
NAM V:
�a
1)Ei ".%R1'.NIENT:
Me
'1N
Q t)N
L /
U )e, Pe S fIP�,�Ik Co o' e ret i U 5 F
ti +x ial 'ic ctrl ill \'aitrlict`
, ,_ ... » ,:.. ,,,. ,. ,... ,• .
LOCATION:
EINI131.,0VMEN r 0XI E:
�v(>RK }tii :
yS - ttl-
"RFSFNT Jon TITIx:
13111,1,E HN I)r1TE-
"�I
C �Ct'tu + tv� fi ssts�av+f Cer�euw,ryS,'o��� , ��J lint - C, I� +sf ), 1��7 ha�j1
1111'1!O1 ( a rt }(;K t)(.!: 1 .
11 (i� tl :11�1t)� t�i )R t 1 I1
2' NN c �l �Fij rf "A I LI;' e wt C aS an ettt'wn n,'Stia tee r aids 4./
Ili s +ta� �4�,�5. �/� tGt I)d3r �l yfA r'./ i
(..t k It i T e ,,AA
J 1. f c J t o
P: t )�a / i u lint IJ i / e Anil �i +l(�+' r ul1 .0 'h e,- d1�t'!l � f'� �t e d ill T
- , - (A IA 61 / —'-
1.111'[,OY [crN,lrt!R) [_ATI 0 3� - �1
SI iKRVIS()1t - S S1(;NA 111AF DATE
[ - )FP- NWr\.9Fti 1' I if AD'S DATE
If the employ" Is amble to obtain the %*pvrv*k t• or nepar I"d fled signatere(s) in a timely roawoer, the nap" sinuld hove the orl,, hod form char
itamped by the Hamm Reseuerea Representat wh o_witl make a cony to emare c omldei a_ rot the posklon in wcotdoace with pidkkiea
BELOW FOR INTERVIEWIN DEPARTMENT AND HUMAN RESOURCES USE ONLY
' FeaiwWera I mW i'won Vo 7h9 Comma Wi & 22.3. emv7tw dmWxaled blue cellar enWlofew, requires Ike( the en*4ojze net have any di 4finary
actions (written wwwng or greater) daring the preceding three-month period Senior employees hors lireference - 0 ehingr being equal
DATE AND TIME OF INTERVIEW
INTERVIEWER'S NAME, PHONE & LOCA`I'lON
REMARKS:
RECEIVING DEPARTMENT HEAD'S SIGNATURE
DATE
If selected for position and if the employee has been in present position less than 6 months, prior approval of the Division
Dirwor(s) and Countv Administrator must be obtainod in accordance with Section 2.12 Personnel Policies and Procedures.
Current Division Director Division Director of position applied Countv Administrator
.JOB [NrMWIEWS WILY, BF Waif) ON INFORMA'[lON ON Filth AND /OR 91m,tI'('I!� WI'III 'ITILS APP[.IC A'110N
V`1 1'R �- I':f_i_( I1(iN i5 11,11)(::
FJ
FFF 04x'03/)7
I1R Form R4v: ow I
r ricresure (5)
M.C.A. r4A 4705.12
P&rch IA, 2012
Pa II
Safety Sensitive
APPLICANTS APPLYING FOR SAFETY SENSITIVE POSITIONS ONLY
APPLICANT NAME
POSITION APPLYING
DATE
ATTACHMENT I
IN t - RJUSE FKUMOTiONAL OPPORTUNITY APPLICANT
Only fill out below if you are NOT currently in a safety sensitive position.
HAVE YOU HELD OR PREVIOUSLY APPLIED FOR A SAFE'T'Y SENSITIVE POSITION, AS DEFINED
BELOW, WITHIN THE PAST 3 YEARS OTHER THAN MONROE COUNTY EMPLOYMENT?
[]YES [ONO
*If YES, have employee sign authorization to release form
OUTSIDE APPLICANT
HAVE YOU HELD OR PREVIOUSLY APPLIED FOR A SAFETY SENSITIVE POSITION, AS DEFINED
BELOW, WITHIN THE PAST 3 YEARS?
[]YES ❑NO
*If YES, have employee sign authorization to release form
DF.FiNiTION OF SAFETY SENSITIVE A MOTOR VEHICLE OR COMBINATION OF MOTOR
VEHICLES USED TO TRANSPORT PASSENGERS OR PROPERTY OF THE MOTOR VEHICLE:
HAS A GROSS COMBINATION WEIGHT RATING OF 26,80IOR MORE POUNDS, INCLUSIVE OF
A TOWED UNIT WITH A GROSS VEHICLE WEIGHT RATING OF MORE THAN 10,000 POUNDS;
OR, HAS A GROSS VEHICLE WEIGHT RA'Z'ING OF 26,001 OR MORE POUNDS; OR, IS
DESIGNED TO TRANSPORT SIXTEEN (16) OR MORE PASSENGERS, INCLUDING THE DRIVER;
OR, IS OF ANY SIZE AND IS USED 1N THE TRANSPORTATION OF MATERIALS FOUND TO BE
HAZARDOUS FOR THE PURPOSES OF THE HAZARDOUS MATERIALS TRANSPORTATION
ACT AND WHICH REQUIRE THE MOTOR VEHICLE TO BE PLACARDED UNDER THE
HAZARDOUS MATERIALS REGULATIONS (49 C.F.R. part 172, subpart F).
FF., 08/0?/0
I IR Form Rcw: 08111