City School District of Albany
Office of Human Resources | 1 Academy Park | Albany, NY 12207
(518) 475-6055 | humanresources@albany.k12.ny.us
Position applying for
Years of experience in this work
Personal information
Please print.
Last name
First name
Middle initial
Present address
Social Security number
Phone number
Are you eligible to work in the United States?
Please indicate any special accommodations required for you to perform the duties for this position applying for:
School name/location
Dates attended
High school
College (undergraduate)
College (graduate)
Other programs/sessions
Current employment
Last employer
Employer’s address
Employer’s phone number
Name of supervisor
Start date
End date
Type of work performed:
Reason for leaving:
Previous work experience
Employer Start date End date Type of work
Name of supervisor
Please list other skills relevant to the position applying for:
Have you ever been dismissed from a position? If yes, please explain.
Give the names of three persons who have closely observed your work and who have first-hand knowledge of your character,
personality and work habits who may be contacted as references.
Name Address (Street, city, state, zip) Phone number
Have you had any experience working with children? If yes, please explain.
Applicant’s statement
Please give any additional information which you think might be helpful to us in evaluating your application, and state your reason for
seeking employment with the City School District of Albany.
I certify that the information contained in this application is true and correct to the best of my knowledge, and I understand that false or
incorrect information in this application is grounds for disqualification from further consideration or for subsequent dismissal from
employment if I am hired.
I also agree to notify the City School District of Albany of any material changes in the information provided on this application. I hereby
consent to have the City School District of Albany contact anyone it deems appropriate to investigate or verify any information I have
given or to discuss my background, past performance, or suitability for employment.
Further, I hereby authorize my former employer(s), reference(s) and any other individual or organization to provide information solicited
by the City School District of Albany, and hereby release and discharge each of the above, including the City School District of Albany,
from any liability of any kind or nature and waive all rights to bring any action for defamation, invasion of privacy, or any similar course
of action against anyone contacted as a result of what he or she may say about me.
Applications may be returned to:
City School District of Albany
Office of Human Resources
1 Academy Park
Albany, NY 12207
(518) 475-6055
The City School District of the City of Albany, New York, does not discriminate on the basis of Age, Race, Color, National Origin, Sex,
Disability or Marital Status in Employment or any of the educational programs and activities which it offers or operates, as it is required
to do by Title VI of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, Section 504 of the Rehabilitation Act of
1973, the Age Discrimination Act of 1975, and the New York State Human Rights Laws.
Signature of applicant