EMPLOYMENT HISTORY List your current and previous employment, beginning with the most recent. Attach supplement if necessary. Date From Date To Name Salary Position Reason for Leaving EDUCATION

Do you have a valid Florida Drivers License? Yes No Have you ever worked or attended school under another name? Yes No If yes, under what name? _________________________________________________________________________ Have you ever been formerly convicted of a crime? Yes * No If yes, give details, including dates: ______________________________________________________________________________________________ ______________________________________________________________________________________________ *A “yes ” answer will not automatically disqualify you from employment. SWFD will consider the nature and date of the offense and the job for which you are applying for job related purposes only, and only to the extent permitted by applicable law