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2. 
3. City of New Smyrna Beach
   Equal Employment Opportunities (EEO)
5. Equal Employment Opportunities (EEO)
   The City of New Smyrna Beach provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, The City of New Smyrna Beach complies with applicable state and local laws governing nondiscrimination in employment in every location in which the City has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. The information below will be used only in the compilation of data for required reporting to the Federal Government. Completion of this form is voluntary and will be kept confidential. It will not affect your opportunity for employment, or terms and conditions of employment, if hired. A photocopy of your Driver License or State ID is also required. This information will not be included with the application when it is submitted for review.
7. Name *
8. Date
   Date
10. Position Applied for/Dept:
11. Gender

    1. Male
    2. Female
13. Race (check one)

    1. African American or Black (not Hispanic origin)
    2. Alaskan Native American Indian
    3. Asian or Pacific Islander
    4. Hispanic
    5. White (not Hispanic orgin)
    6. Other
14. If Other, Please Specify
16. Date of Birth
    Date of Birth
17. *Social Security Number*
    *Social Security numbers will be used for the purpose of background checks, and payroll information if hired.
19. Driver's License or State ID
21. State
22. Number *
23. Class
25. CDL

    1. Yes
    2. No
26. Expiration Date
    Expiration Date
28. The City of New Smyrna Beach expressly prohibits any forms of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, nation origin, age, genetic information, disability, or veteran status.
    Thank you for your interest in working at the City of New Smyrna Beach.
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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