Classified Staff Employment Application
Position you are applying for _____________________________________________Date of Application ______________________
Where did you hear about this position? ___________________________________________________________________________
Type of position you are looking for (check all you are willing to accept): Permanent Temporary Full-time Part-time
Name ___________________________________________________ E-mail Address _____________________________________
Address _________________________________________________ City, State, Zip _____________________________________
Primary phone Number _____________________________________ Other phone _______________________________________
Have you ever worked for Cobleskill or SUNY? No Yes If Yes, give particulars: __________________________________
List any other names you may have gone to school or worked under: ____________________________________________________
Do you have a valid driver’s license? No Yes, class _______ Do you have a high school diploma or GED? Yes No
College degree? No YesIf yes, state what type of degree _________, where obtained _____________, and when __________
Are you a US citizen or otherwise legally eligible to work in the US? Yes No Are you 18 years of age or older? Yes No
List any certifications, licenses, other education or specialized training you have received: ___________________________________
Check and describe all skills that you possess:
Keyboarding…Approximate speed _________ Dictation Word Processing Microsoft Office
Maintenance and skilled trades Skills…List: ______________________________________________________________________
Machine Skills…List: _______________________________________________________________________________________
Other _____________________________________________________________________________________________________
Civil Service Examinations you have taken:
Type of Exam
Date of Exam
Your score on exam
Date of appointment (if any)
Job Data (List from most current)
Current/Last Employer ______________________________________________________Dates of Service ___________________
Job Title and/or Summary of duties _______________________________________________________________________________
Employer __________________________________________________________________Dates of Service ___________________
Job Title and/or Summary of duties _______________________________________________________________________________
Employer __________________________________________________________________Dates of Service ___________________
Job Title and/or Summary of duties _______________________________________________________________________________
Individuals with disabilities requiring accommodation during the hiring process should notify
the Human Resources Office at (518) 255-5514 by the filing deadline.
Para la traducción de, o ayuda con, cualquier material de esta solicitud, pongasé en contacto
con el departamento de Recursos Humanos al (518) 255-5514
Human Resources Department
126 Knapp Hall
Cobleskill, NY 12043
(518) 255-5423 (voice)
(518) 255-5657 (fax)
References and Pre-employment Certification
for Classified Staff Application
Name ______________________________________________ Date of Application ____________________
(List name and contact info for at least three individuals who can speak to your professional work-related behaviors)
1: Current or latest supervisor: ___________________________________________________________________________________
2: Former supervisor: __________________________________________________________________________________________
3: _________________________________________________________________________________________________________
4: _________________________________________________________________________________________________________
5: _________________________________________________________________________________________________________
Comments (include here any employer you do NOT wish us to contact and why): _________________________________________
Incomplete applications may disqualify you from consideration for employment
Certification of Qualifications
I certify that everything I have listed in this application is a true, accurate, and complete representation of my qualifications for the
position for which I have applied. I understand that any falsification, misrepresentation, or material omission in my application
materials (including this certification) or making other false or fraudulent representations in securing employment may be grounds for
disqualification of my candidacy or may be grounds for termination if discovered after the date of hire.
Acknowledgement of Responsibility to Obtain/Maintain Eligibility to Work in the United States
I understand SUNY Cobleskill employs only individuals who are lawfully eligible to work in the United States and that employment
eligibility will be verified upon employment. If I do not currently have permanent eligibility to work in the U.S., I understand that it is
my responsibility to obtain and/or maintain eligibility to work and that loss of eligibility to work at any future date will invalidate my
employment relationship and result in concurrent separation from employment without recourse or appeal.
Certification or Disclosure Pertaining to Criminal Convictions
I understand that in selected circumstances, convictions for a misdemeanor, gross misdemeanor, or felony related to the duties and
responsibilities of a given position may influence consideration for employment. I certify that unless I have listed below a statement
about the dates, charges, and circumstances of any such convictions, I have not been convicted of a misdemeanor, gross misdemeanor,
or felony in any jurisdiction inside or outside the U.S. ________________________________________________________________
Acknowledgment of SUNY Cobleskill Application Process
Cobleskill considers only those applications submitted for a specific posted position. I understand that if I applied for a job not
currently posted, my application materials may be discarded after 30 days.
Authorization to Verify Application Materials
My signature below authorizes SUNY Cobleskill to verify all of my application materials including contacting listed references as
well as validating educational and employment records, with the understanding that facsimiles or photocopies of this authorization
shall be deemed as valid as the original. If submitted electronically, I acknowledge and agree that by typing my name on the
signature line, I am authorizing and validating the statements above to the same degree as my original signature.
Signature of Applicant: __________________________________________________________________
Printed Name of Applicant: _______________________________________________ Date: ______________________________
SUNY Cobleskill is an Affirmative Action/Equal Opportunity educational institution. It is guided by the principle that equal
opportunity means more than equal employment opportunity, and that access to facilities and services shall be available to all people
regardless of their race, color, religion, sex, national origin, age, veteran status, disability, marital status, or sexual orientation.
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Equal Employment Opportunity Data Collection Sheet
Completion of this form is optional and will in no way affect your application.
To help us comply with federal/state equal employment opportunity reporting requirements, we ask that
applicants complete the following questions. This pre-employment form is not part of the application for
employment and is maintained in a confidential file separate from the application. Data is used for
statistical purposes and to measure effectiveness of recruitment efforts.
Title of Job Applied for: _________________________________Date of Application: _____________
Name _______________________________________________Social Security # ___________________
Please complete as indicated:
GENDER: Male Female
AGE: Date of Birth: ___________________________
RACE: White ( Not of Hispanic Origin) - All persons having origins in any of the original peoples of
Europe, North Africa, or the Middle East.
Black (Not of Hispanic Origin) - All persons having origins in any of the Black racial groups of
Hispanic - All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other
Spanish culture or origin, regardless of race.
Asian or Pacific Islander - All persons having origins in any of the original peoples of the Far
East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for
example: China, India, Japan, Korea, the Philippine Islands, Samoa and Hawaii.
American Indian or Alaskan Native All persons having origins in any of the original indigenous
peoples of North America, and who maintain cultural identification through tribal affiliation or
community recognition.
No Yes I consider myself to be an individual with a disability.
Please check any and all categories that apply to you.
1. A veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to
compensation under laws administered by the Department of Veteran Affairs for a disability.
a. Rated at 30 percent or more; or
b. Rated at 10 or 20 percent in the case of a veteran who has been determined under section 1506 of Title 38,
U.S.C., to have a serious employment handicap: or
2. A person who was discharged or released from active duty because of a service-connected disability.
1. A person who served more than 180 days of active military, naval, or air service, any part of which was during the period
of August 5, 1964 through May 7, 1975; and
2. Was discharged or released with other than a dishonorable discharge, or
3. Was discharged or released from active duty because of a service-connected disability.