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Home My Public Portal AboutCrossing GuardEric MarshallCONTRACT FOR SERVICES THIS CONTRACT, made and entered this a3 day of /4"-Pi ( , 2019 between the CITY of Crestview, hereinafter called CITY and Ev., C. Il'te,rSha g hereinafter called SCHOOL CROSSING GUARD for a period of the remainder of the 2018 / 2019 and duration of the 2019 / 2020 school year, unless terminated by either party. WITNESSETH: WHEREAS, the CITY Council has directed the Police Department to establish and implement a School Crossing Guard Program. WHEREAS, incumbent CITY personnel resources cannot provide the manpower required to implement this program. WHEREAS, it is deemed prudent, wise and beneficial for the CITY to utilize the services of local residents that possess the capacity to function in a part-time contractual work environment. NOW, THEREFORE, THE PARTIES HERETO AGREE AS FOLLOWS: ARTICLE I The SCHOOL CROSSING GUARD shall be responsible to provide services for the CITY to wit: 1. To ensure the safety of children and pedestrians crossing the streets and highways at designated intersections and/or school crossings. 2. To be on the crossing at the prescribed times and not to leave the crossing unattended unless in an extreme emergency. 3. Compliance with uniform regulations with respect to attire, equipment and appearance. 4. Providing their own transportation to and from the assigned crossing. 5. Maintaining an accurate record of arrival, departure and any unusual occurrences on the assigned school crossing. 6. The immediate notification of the Police Department in the event a person is injured or a motor vehicle accident occurs. 7. Operates communications devices as directed by the Chief of Police. 8. Operate CITY owned equipment as directed by the Chief of Police. 9. Possess a valid Florida Driver's license. 10. Display and employ tact, firmness and communication skills with the public and department members. ARTICLE II GENERAL REQUIREMENTS OF SCHOOL CROSSING GUARD 1. Provide services on a scheduled basis, determined by the Chief of Police: 2. Accept the sum of $30.00 daily paid each Friday; CITY shall not withhold or match Social Security, Federal withholding tax or any other amount requested by SCHOOL CROSSING GUARD; IRS Form 1099 to be provided at the end of a taxable year. 3. Attend any required training sessions. 4. Receive direction and supervision from the Chief of Police or his designate. 5. Agree to be evaluated by written documentation on CITY evaluation forms as required. 6. Arrive punctually for work and be properly attired. 7. Acknowledge the fact that should a vacancy occur within the regular CITY workforce, training achieved under this contract is one of the basis whereby SCHOOL CROSSING GUARD may enhance his/her selection opportunity notwithstanding personnel and procedures of Crestview, Florida currently in effect. 8. Provisions of this contract may be amended by either party subject to written notification and agreement by the other party. 9. The sum per day is $30.00. -/(. -, 5/4 SCHOOL CROSSING GUARD IGNATURE Executed and witnessed our hands and seal this day of Notary Public (SEAL) i-d : P7 LGO a i-C? Sio //,, t1 47 NOTARY PUBLIC (Printed) 2019. Elizabeth M. Roy City Clerk Date _ / r Date CITY OF CRESTVIEW Office of the City Clerk P.O. Box 1209 Crestview, Florida 32536 APPLICATION FOR EMPLOYMENT "AN EQUAL OPPORTUNITY EMPLOYER" Position Applied For: 6495S/4/4 {Duty PERSONAL Date: -✓ - l Full Name: /1/47Z5b ,,41 /e. S Last First MI / Address: 2T' 7`,e... �e .47. Street Address ApmKment/UnitIt city 6e-5-6%�/-1Nj State re. Zip Code 325-50r Phone: ( •yD % )6405 - ? /849 C- ��- E-mail Address: ��12/ 32r2 �-C_DX, Ai£j Date Available: /', jjOC) Social Security No.: Z63 - 9/ - Y3gY Are you a citizen of the United States? YES NO If no, are you authorized to work in the O � U.S.? Have you ever worked for the City of Crestview? YES - NO If yes, C'--/-z-2k"-sN7"4-y Vatiftlkerg&R II I when? /i!) Are you related to anyone working at the City of Crestview YES If yes, give: Relationship: r L Have you ever been convicted of any offense against the law, or pleaded guilty, nolo contendere (no contest), or had adjudication withheld, or entered a court sponsored program, or forfeited collateral, or are you now under charges for any offense against the law? You may omit: (1) If yes, explain Traffic Violations, (2) Parking Violations; and (3) any offense committed before your 18th birthday which was finally adjudicated in a Juvenile Corot or under a Youth YES Offender law? 1 �NOy lJ HIiHR012 112rv0121 List any special skills, software or abilities that would qualify you for this position. Please submit copies of any valid professional or occupational license(s), registration(s) or membership(s) relevant to the position. For example: Florida Certificate in Water/Wastewater Treatment; Florida Professional Engineering Registration; etc. .s Win-, u1,440ti rL y 772 TV ✓4s -71/12e24� � T� eX€57-1/1t4 AL.ct._ 11- i - ii/fr_ ,46.1i✓ 140Zzza iW.Cea_74S /may 77,1E 4,57' -3 5ciroo� y Please list three professional references, other than relatives who have knowledge of your work experience and/or education. Acid.4 Relationship: 6Z/f_dpj Full Name: fjbbib,9- Occupation: e-0797,9/ di/1/l of f e t c/�� d.��/ tZ,, Phone: ( 650) 30,5 -2ja 5 / Address: d) / ,:jr) 14,4)t .- ✓3Z-Va , d a_s rdd� /-L d • 9Z-5:9 Full Name: .J4777 /C d"/J7,02,enis Relationship: ra-/-.(iis Occupation: e-0/11,074,&)/ 46e_s: Cyfiice_lz, Phone: ( 05O) 305 -783/ / Address: ��aa Relationship: 62_,.Edtl4\ Full Name: /�!� C d92A5-T7- Occupation: At/C__ /e44,4drL 7774-ri Phone: (esb ) 7515'6Z2a Address: MAI- EDUCATION High School: ;:egve- /1>.5 - e--.,3 Address: NA - From: N/A To: Ai/Did Degree: �. � A, you graduate? College: , E, 4, f, Address: Af/4- From: N A- To: �% Did .R4111 Degree: 12,47-iret f6-c r772erce 4 you graduate? Other Training: At/4- Address: ,A0- HRHR012 (Rea 012) Employer: 721 - en-7 z‘cirzie Phone: f ) N��- Address: N/4 - / Supe } visor: %119 kg.enxi✓e Lur(S Job Title: Fad 62/047,74 / 7160174 Starting Salary: $ 741 /K Ending Salary: $ eij< Responsibilities: OW-2._ sze.:7Nt- /acji -cc ,4 2i 5�- ar-pee rr �yl,eweezeic From: /9,2) To: �Jl' J p,Cv/U / . vv i / Reason for ) ' Leavint: alNtrii3“ ya Yit'isc4=ra .6461 -'43 492t May we contact your previous supervisor for a reference? YY�' NO I �( Employer: 4074/-ki-/NY 16131.)/- amz Phone: ( ) AY.4- Address: /Tl/4-- Supe visor: ,4- Job Job Title: /Iv/ di-ger//ef Starting Salary: $ f/). vo 4de.e9 Ending Salary: $ / 2- 4714 6el Responsibilities: 11/4-4 yam;) "Pz(eLr( &Lin/c4,4_r_ 520415 via re.0 age,"7 air Ziz From: / 9eS To: /99D Reason for J Leavitt:: 7D Z-gitie / .4- %7°4as �gtF'e/ciiiti May we contact your p -evious supervisor for a reference? YES NO ---- ,te-.C. 5 .- d-7-0se9 X Employer: L` .4//IG ,,,%Gal Phone: ( ) 1144- Address: /1//i.L- / Supervisor: ll/AL6- Job Title: e,/i/ZTs �ev4 Starting Salary: $ j °'° i77.,/ q / Ending Salary: $ . ` 9,/,r„r Responsibilities: bi— U4/ przr5 `f-c-) gat b 94,-i' eT- -/ 5W--1 37� c-rr--gip ' From: / 86 To: LIS8 1.0. eason for .+�� ✓ ' Leavin : 4+2e,e/t e4/' zr 4?-1/.� `mod4/7 May we contact your previous supervisor for a reference? /3„,,N G z,,,„. n m If you are eligible for veteran's preference, please provide form DD-214 at the tine of the application. Check the appropriate block if you are claiming veteran's preference: I. A veteran with a service -connected disability who is eligible for or receiving compensation, disability retirement, or pension under public laws administered by the U.S. Department of Veteran's Affairs and the Department of Defense, or 12. The spouse of veteran who cannot qualify for employment because of a total and permanent disability, or the spouse of a veteran missing in action, Captnred, or forcibly detained by a foreign power, or 3. A veteran who has served on active duty for one day or more during a wartime period, excluding active duty for training, and who was discharged under Honorable conditions from the Armed forces of the United States of America, or 4. The unmarried widow or widower of a veteran who died of a service -related disability. 5. Any Armed Forces Expeditionary Medal is qualifying for veteran's preference. The Global War on Terrorism Expeditionary Medal is qualifying for veteran's preference, provided the individual is otherwise eligible. NOTE: Under Florida law, preference in sppoinlment shalt be given by the state to those persons included in I and 2 above, and second to Muse persons included in 3 eW 4 above Ban applicant claiming veterans' preference for a vacant position is nor selected, Irdshe may file a complaint with the Department of Veterans' Afpairs, P.O. Box 31003 St. Petersburg, Flndda, 33731. A complaint mast be filed Within 21 days of the applicant receiving notice of the hiring decision made by the employing agency or within 3 months of the date the application is filed with the employer if no notice is given. ,melo HRIIRn12 ( Rev 012) APPLICANTS CERTIFICATION AND AGREEMENT: CERTIFICATION: 1 certify that answers given herein are true to the best of my knowledge, l authorize investigation or all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of my employment, I understand that false or misleading information given in my application: interviews) or any part of the employment process may result in my discharge. I understand that if offered employment with the City of Crestview, I will be required to provide proof of eligibility to work in the United States and will be required to abide by all City of Crestview rules and regulations. AGREEMENTS: l am furnishing my Social Security Number on a voluntary basis with the understanding that law or regulation does not require such. I have been advised that the City of Crestview will utilize this number only to facilitate the location of my recorcls in order to conduct background investigations. PHYSICAL EXAMINATION: 1 understand I must take and pass a physical examination before the decision to hire me is complete. I understand that the physical examination will include a drug screening test. Any illegal or unprescribed controlled substance which shows in my test results will cause my immediate disqualification for employment with the City of Crestview, DRUG FREE WORKPLACE: I understand and agree that the City of Crestview is a drug free workplace. The City of Crestview may conduct drug screenings for: Job applicant testing, routine fitness for duty testing, reasonable suspicion testing, post accident and injury testing, follow-up testing and return to duty testing. Disclosure Statement: By this document, the City of Crestview discloses to you that various reports may be obtained for employment purposes as part of the pre -employment background investigation and at any time during your employment. I understand that these reports will not be used for any purpose other than employment. Please sign below to signify acknowledgement of this disclosure and authorization for the City of Crestview to request copies of such reports. Upon termination of employment, I understand the City may hold my final paycheck until a final accounting is made for any City of Crestview property in my custody, or any monies owed the City of Crestview. Applicants needing accommodations to complete this application should contact the City Clerk's Office — Payroll Division at 682-1560 ext. 268. 3 29-/g Date Thant: you for your interest in the City of Crestview. Because of the volume of applications the receive each day, we are unable to contact applicants unless they are selected for interviews. VISIT OUR WEBSITE FOR AVAILABLE OPENINGS: www.eltvoferestview.org FOR OFFICE USE ONLY College Transcripts Driver License High School Diploma/GED Certilicate State Certifications Received by Date(s): Incompltle Posithm applied - Da. r >Cnl to Departn DD214 (military discharge) Deparimenl EMPLOYMENT APPLICATION SUPPLEMENT To: Applicants for Employment The Uniform Guidelines on Employee Selection Procedures require records to be kept by sex and the five race/ethnic categories defined by the Equal Employment Opportunity Commission. The Uniform Guidelines on Employee Selection Procedures have been adopted as final rules by the Equal Employment Opportunity Commission, the Office of Personnel Management, the Department of Justice, the Department of Labor and the Treasury Department. The City of Crestview City Clerk's Department has adopted safeguards to insure that the records required are only used for appropriate purposes within the Payroll Division. The information requested below is needed to satisfy Federal Equal Employment Opportunity reporting and research requirements. This information will NOT be used to evaluate your application and will be filed separately. Although the following is not mandatory, it is requested to aid the City of Crestview in its commitment to Equal Employment Opportunity. It is unlawful for an employer to fail or refuse to hire any individuals or deprive any individual for employment opportunities because of race, color, religion, sex, national origin, age, marital status, or disability. Applicants who believe they have been discriminated against may file a complaint with the Florida Commission on Human Relations, Building F, Suite 240, 325 John Knox Road, Tallahassee, FL 32303. (Please print) Name: 7.7l oy-7e.5 YJ-G Ce/e Last First Mi Date: 3-2.9-/9 Birth Date: %l— d -6 y Zip Code: 3 2-5-3(„ Social Security Number: 24,3 r S f -13 g 9 Sex: Veteran: IP/Ma I Female Yes �No Please check the box next to the ethnic group you belong (select only one): u American Indian or Alaskan Native (the original people of North America and who maintain cultural identification through tribal affiliation or community recognition) Asian or Pacific Islanders (the original people of the Far East, Southeast Asia, the Indian Subcontinent of the Pacific Islands) Hispanic (all persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin regardless of race) nBlack ('not of Hispanic origin) i lute (not of Hispanic origin) HIiAIRU12 (Rev 0121 V CITY OF CRESTVIEW Office of the City Clerk P.O. Box 1209 Crestview, Florida 32536 APPLICATION FOR EMPLOYMENT "AN EQUAL OPPORTUNITY EMPLOYER" RECEIVEA MARI.20:13P Position Applied For: ee055//L PERSONAL l77(z - - Date: P7 Full Name: 51 c rife' -/ E;te Lost First MI. Address: aae �CJ 77Z/ s'!1 2)/4 , Street Addresses AparnuenNUnit N City C11-,/L,nd / Stare ,...6 Zip Code .g.1,32 5 Phone: (//07) �-- 4- /oh E-mail Address: tl i [� (� n/%?Qe0,1( o/12,0 Date Available: ff� NO� Social Security No.: �a& 3- %f - psi) Are you a citizen of the United States? YE NO If no, are you authorized to work in the I///y(� T_E n U.S.? Have you ever worked for the City of Crestview? 1 ES NO If yes, j ea ,1g ,v F / e g Voo iiirnif Ce..giyvp when? rate-- Are you related to anyone working at the City of Crestview YES .5� If yes, give: Relationship: Have you ever been convicted of any offense against the law, or pleaded guilty, nolo contendere (no contest), or had adjudication withheld, or entered a court sponsored program, or forfeited collateral, or are you now under charges for any offense against the law? You may omit: (1) Traffic Violations, (2) Parking Violations; and (3) any offense committed before your 18`h birthday which was finally adjudicated in a Juvenile Court or under a Youth Offender law? YES If yes, explain Tao FIRFI@ll] Me,. 0121 Employer: PC/ ^`�/iY 12-C.C, Phone: ( ) Address: / f°i _ own- c.v.*.y-f � Sups visor: Job Title: Few,' agin44-rich) j itt � Starting Salary: $ 7g, C< Ending Salary: $ g Z14 Responsib lilies: 4,29"QA,544/a /4-// 1065 Imf y yam_ ,��744,,vdi From: f l fey To: 20/0 Reason for Leaving. my 4o,,ae 10,4/A421 May we contact your p -evious supervisor for a reference? YES(( NO IZI Employer: �!J/4� f `d 'C�f Phone: ( ) Address: / Supe visor: Job Title: Starting Salary: $ Ending Salary: $ Responsibilities: From: /q¢f, To: f %� Reason for / Leaving: 4„, �aaf6iN�f May we contact your p -eviot s supervisorfora reference? YES NO I I Employer: /9TTlC'- AJ %Egc�v Phone: ( ) Address: ! Supervisor: Job Title: Starting Salary: $ Ending Salary: $ y, a Responsibilities: .�`72-i"3. .4," Dr IA From: j9 To: Reason for p Leaving: N0 L-0/V4 t,{ 1/4/ 6J' t/5a//vg5( May we contact your previous supervisor for a reference? n ei If you are eligible for veteran's preference, please provide form DD-214 at the time of the application. Check the appropriate block if you are claiming veteran's preference: I. A veteran with a service -connected disability who is eligible for or receiving compensation, disability retirement, or pension under public laws administered by the U.S. Department of Veteran's Affairs and the Department of Defense, or I2. The spouse of veteran who cannot qualify for employment because of a total and permanent disability, or the spouse of a veteran missing in action, Captured, or forcibly detained by a foreign power, or 3. A veteran who has served on active duty for one day or more during a wartime period, excluding active duty for training, and who was discharged under Honorable conditions from the Armed Forces of the United States of America, or 4. The unmarried tvidow or widotver ore veteran who died of a service -related disability. 5, Any Armed Forces Expeditionary kledal is qualifying for veteran's preference. The Global war on Terrorism Expeditionary &lode] is qualifying for veteran's preference, provided the individual is otherwise eligible. NOTE: (fader Florida law, preference in appointment shall be given by the sine m those persons included in 1 and : above, and second ne those persons included in 3 and d above. Van applicant claiming veterans' preference for a vacant position is net selected, heshe may file a complaint with the Department of Veteran Affairs, P.O. nos 31003 St, Petersburg, Florida. 33731. A complaint must be tiled within 2; dots of the applicant receiving notice er the hiring decision made by the employing agency or within 3 momhs of the dote the application is filed with the employer if no noliee Is given. tIR11Ra¢ (Pei 012) APPLICANT'S CERTIFICATION AND AGREEMENT: CERTIFICATION: 1 certify that answers given herein are true 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. In the event of my employment, I understand that false or misleading information given in my application: interview(s)or any part of the employment process may result in my discharge. I understand that if offered employment with the City of Crestview, f will be required to provide proof of eligibility to work in the United States and will be required to abide by all City of Crestview rules and regulations. AGREEMENTS: 1 am furnishing my Social Security Number on a voluntary basis with the understanding that law or regulation does not require such. I have been advised that the City of Crestview will utilize this number only to facilitate the location of my records in order to conduct background investigations. PHYSICAL E%ANIINATION: I understand I must take and pass a physical examination before the decision to hire me is complete. I understand that the physical examination will include a drug screening test. Any illegal or unprescribed controlled substance which shows in my test results will cause my immediate disqualification for employment with the City of Crestview. DRUG FREE WORKPLACE: I understand and agree that the City of Crestview is a drug free workplace. The City of Crestview may conduct drug screenings for: Job applicant testing, routine fitness for duty testing, reasonable suspicion testing, post accident and injury testing, follow-up testing and rerun to duty testing. Disclosure Statement: By this document, the City of Crestview discloses to you that various reports may be obtained for employment purposes as part of the pre -employment background investigation and at any time during your employment. I understand that these reports will not be used for any purpose other than employment. Please sign below to signify acknowledgement of this disclosure and authorization for the City of Crestview to request copies of such reports. Upon termination of employment, I understand the City may hold my final paycheck until a final accounting is made for any City of Crestview property in my custody, or any monies owed the City of Crestview. Applicants needing accommodations to complete this application should contact the City Cle,rk's Office — Payroll Division at 682-1560 ext. 268, f Date Thank you for your interest in the City of Crestview. Because of the volume of applications we receive each day, we are unable to contact applicants unless they are selected for interviews. VISIT OUR WEBSITE FOR AVAILABLE OPENINGS: www.citvofcrestview.org FOR OFFICE USE ONLY College Transcripts Driver License _ DD214(military discharge) High School DiplomalGED Certificate State Certifications Received by Date(s): - Incomplete Positmnapph d. Dalc,sent to15