Name of: ~true papers) are under thewith penalties perjury. County martial status inBlank connection thediscrimination State of New York. Months Years Title ofapplication Examination City, Village Position or TownFirst or No Yes Date: Date Leave This Soace State in this form should beemploymentby viewed as expressing directly orin indirectly, any limitation, M.L Exam No. Have you ever taken other by this _Yes The New York State Human Rights Lawofprohibits employmentbecause of _No Zip Code Examination Title agency by examinationsgiven no__ later than the last date for filing forand this Franklin County is an Equal Opportunity Employer Non-Disabled War Veteran )Religious )Handicapped Observer (this ( any ) application. State your actual legal resident and indicate how long you have __to No __Franklin Yes honorably discharged check thedepartment? appropriate box below and )veteran, special arrangements required. State County Civil Service Personnel Department Signature of Applicant I affmn that the statements This Affirmation made on this must application be completed. (including the Approved any By:attached Disapproved By: ___ of the United States? specification.,or discriminationas to age, race, creed, color, national origin, sex, disability or age, race, creed, color, national origin.,sex, disability or marital status. Accordingly, nothing Special Arran!!ements: If you need special arrangements because employment in the United States? _Yes _No specifics on an additional sbeet wbicb will be kept confidential. None oftbe Note whether: duties and responsibilities ofthe position for which you are applying. APPLICA If, for nON this examination, FOR EXAMINA PLEASE you wish nON to PRINT OR claim EMPLOYMENT additional credit as an __ Disabled War Veteran resided continually, and including the this type examination. Your request must Exam Form. #Person and date Title you are for athere Religious orto a include Handicapped youofand must writeof to ask this Application form Observer ). change complete the forup Veteran's Credit (You will need B. C.you Did ever you resign ever receive fiom any dishonorable employment rather discharge than fiom dismissal? Armed you Forces D.Did Have you ever been convicted ofoftbe any crime (felony or misdemeanor)? Uyou answered "YES' to aany questions Aface - Fthe above, Veteran's Credits must give theaccept to are or have been known I
Major Subjects /// // // _No (Licensing Agency) Telephone Number: No. of hours worked per week (exclusive of overtime): City/State/Zip: a trade or profession? _Ves City/State/Zip: Telephone Number: City/State/Zip: Telephone Number: No. of hours worked per week (exclusive ofofovertime): overtime): . No.of of hours Telephone worked Number: perweek week(exclusive (exclusiveof overtime): ___ $$ $ City/State/Zip: No. hours worked per Applicants may be required to which furnish satisfactory proof ofthat experience IF IS soul!ht, NEEDED WORK EXPERIENCE, ATTACH ADDITIONAL occupation you have ever had includes exoerience tends toclaimed. Qualify youMORE for theROOM position andFOR as far as possible, every otherPLEASE employment,including war service.SHEETS. YOU MUST SUBMIT A COPY OF LICENSE AND/OR CERTIFICATE FOR VERIFICIATION! Job Duties: ID Number: Job Duties: When showing dates MUST use Month/Day/Year Other Sources of backward consecntivelv to your first one. Describe under the headings given below any employment or College or Univer. Equivalency Graduate? Course or To RÂŤeived Date Number of of Credits ofTo Roc. Years College Degree Degree /ofhave Class: Job To: T o: Licensed Title: Did Type you / No. From: Job To: Job Title: Title: Dates of Completed Attendance Expiration Date: City/State Granted By Do you aper license, certificate or other authorization to practice week/monthlylyear Earnings: per week/monthly/year week/monthly/year (circle (circle one) one) Earnings: per week/monthly/year (circle one) Earnings: Technical Professional School or Special Courses EDUCATION: Ifmore space is required for full
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Published on Aug 8, 2011
~ specifics on anadditional sbeet wbicb will bekept confidential. None oftbe This Affirmation must becompleted. Iaffmn thatthestatements mad...