High School Human Rights

Date Received ONEONTA MUNICIPAL CIVIL SERVICE COMMISSION

C/O CITY HALL, 258 MAIN STREET

ONEONTA, NY 13820

PHONE: 607-***-****; WEB: www.oneonta.ny.us/personnel APPLICATION FOR EXAMINATION OR EMPLOYMENT

Approval

Approved:

Fee Received Conditionally

Approved:

$ Disapproved:

By: By:

Please answer all questions fully and carefully. This application is part of your examination. Print in black or blue ink or type. Attach additional 8 x 11 sheets if necessary in order to give complete and detailed information. All statements are subject to verification. THE ONEONTA MUNICIPAL CIVIL SERVICE COMMISSION IS AN EQUAL OPPORTUNITY ORGANIZATION NEW YORK STATE PROHIBITS DISCRIMINATION IN EMPLOYMENT BECAUSE OF VARIOUS PROTECTED STATUSES AS DEFINED IN HUMAN RIGHTS LAW, ARTICLE 15. ACCORDINGLY, NOTHING IN THIS APPLICATION FORM SHOULD BE VIEWED AS EXPRESSING, DIRECTLY OR INDIRECTLY, ANY LIMITATION, SPECIFICATION, OR DISCRIMINATION AS TO THE DEFINED PROTECTED STATUSES IN CONNECTION WITH EMPLOYMENT. A LIST OF PROTECTED STATUSES IS DETAILED AT WWW.ONEONTA.NY.US/PERSONNEL. POSITION TITLE AND EXAM NUMBER (if relevant)

PERSONAL INFORMATION:

Last Name First Name Middle Initial

Physical Address: Street City State Zip

Mailing Address (if different): Street City State Zip Home Phone Cell Phone Email Address

Were you ever dismissed from any employment for reasons other than lack of work or funds or have you ever resigned in lieu of termination? Yes No If yes, please provide details on separate sheet.

Social Security No. (required for exam applications) Are you a resident of the City of Oneonta? Yes No Please state below your permanent legal residence and indicate for how long you have resided there continuously.

Are you legally eligible to work in the United

States? Yes No

Name of Municipality No. of

Years

No. of

Months

Are you retired from NYS or any civil division

thereof? Yes No

Village/Town/City:

Are you a volunteer firefighter?

Yes No If yes, years of service:

County: Are you 18 years of age or older? Yes No State: If you are applying for a job with a minimum or maximum age restriction, please provide your

School District: date of birth:

DECLARATION:

I declare, subject to the penalties of perjury, that the statements made in this application (including statements made in any accompanying papers) have been examined by me and to the best of my knowledge and belief are true and correct. Signature Date State maiden or any other name by which you have been known EDUCATION AND CERTIFICATIONS:

Have you graduated from high school?

Yes No

High school name City State

If no, do you have a high school equivalency

diploma? Yes No

Issuing authority Date of issue

POST-HIGH SCHOOL EDUCATION

Name and location (city and state) of college,

university, professional or technical school Major course of study No. of

years

credited

Type of

degree

Year

received/

expected

LICENSES/CERTIFICATIONS

Name of certification/license Issuing authority Effective date

Expiration

date

DRIVER’S LICENSE

Please complete this section if the job which you are applying for requires a driver’s license. State: Number: Class: Endorsements: Expiration date: Drug and Alcohol Testing: Candidates are subject to a pre-employment drug screen. Additionally, appointees to certain positions will be required to participate in a drug and alcohol testing program which will include random testing. This includes but is in limited to any position which requires a commercial driver’s license. SERVICE IN ARMED FORCES:

Have you served in the U.S. armed forces?

Yes No

–

Date of entry into active service Discharge date

If yes, did you ever receive a discharge which was other than “Honorable” or which was issued under other than honorable conditions? Yes No If yes, please provide details on separate sheet. APPLICATIONS FOR EXAMINATION:

The following questions apply only to candidates applying to take a civil service examination. Veteran Credits: Veterans of the Armed Forces wishing to claim additional credits as a Veteran or Disabled Veteran must also submit a separate “Application for Veteran’s Credits” form and supporting documentation. Please indicate if you will be applying for additional credits as a: Veteran Disabled Veteran Cross-filing: Have you applied or will be applying to take examinations with other civil service jurisdictions on the same date as this examination? Yes No If yes, please submit a “Notice of Cross-filing” form. Alternate Test Date: The commission’s alternate test date policy is included as part of the announcement for this exam. If you need to request an alternate test date, you must submit a request in writing. Special Accommodations: Disabled candidates may request special accommodations to take an exam. A request for such accommodations should accompany this application.

WORK EXPERIENCE:

Beginning with the most recent, describe below in detail your employment history. List all employment or military service that shows you meet the minimum qualifications for the position which you are applying. If your title or duties changed materially in the course of your service in any one organization, indicate such change clearly and as a separate employment. You may include a resume, but do not substitute a resume. This section must be completed in full. Under “duties” for each employment, describe the nature of the work personally performed by you. State the size and kind of working force, if any, supervised by you and the extent of such supervision. If more space is needed you may attach additional copies of this page of the application. Length of Employment Firm name Address, City, State From

(Mo./Yr.)

To

(Mo./Yr.)

Duties:

Type of Business

Your Exact Title

Name of Supervisor

Supervisor’s Title

Reason for leaving

Was this experience:

Paid Service

Voluntary Service

Hours per

week:

Length of Employment Firm name Address, City, State From

(Mo./Yr.)

To

(Mo./Yr.)

Duties:

Type of Business

Your Exact Title

Name of Supervisor

Supervisor’s Title

Reason for leaving

Was this experience:

Paid Service

Voluntary Service

Hours per

week:

Background Investigation: Applicants for certain positions may be required to undergo a background investigation which may include a fingerprint check. Failure to meet the standards of the background investigation may be cause for disqualification. WORK EXPERIENCE:

Length of Employment Firm name Address, City, State From

(Mo./Yr.)

To

(Mo./Yr.)

Duties:

Type of Business

Your Exact Title

Name of Supervisor

Supervisor’s Title

Reason for leaving

Was this experience:

Paid Service

Voluntary Service

Hours per week:

Length of Employment Firm name Address, City, State From

(Mo./Yr.)

To

(Mo./Yr.)

Duties:

Type of Business

Your Exact Title

Name of Supervisor

Supervisor’s Title

Reason for leaving

Was this experience:

Paid Service

Voluntary Service

Hours per week:

Background Investigation: Applicants for certain positions may be required to undergo a background investigation which may include a fingerprint check. Failure to meet the standards of the background investigation may be cause for disqualification.

Contact this candidate