Fillable FORM ECPO-330: APPLICATION FOR EXAMINATION OR EMPLOYMENT Es

Fill Online, Printable, Fillable, Blank FORM ECPO-330: APPLICATION FOR EXAMINATION OR EMPLOYMENT Es Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FORM ECPO-330: APPLICATION FOR EXAMINATION OR EMPLOYMENT Es

On average this form takes 47 minutes to complete

The FORM ECPO-330: APPLICATION FOR EXAMINATION OR EMPLOYMENT Es form is 4 pages long and contains:

  • 0 signatures
  • 43 check-boxes
  • 167 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Please Leave This Space Blank
ESSEX COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER
Number:
Es s ex County De partm e nt o f Pe rs o nne l and Civil Service
7551 Court S treet, PO Box 217, Elizabe thtown NY 12932
Phone : (518) 873-3360 / Fax: (518) 873-3372
Application
Approved:
Conditional:
Disapproved:
APPLICATION FOR EXAMINATION OR EMPLOYMENT
For County, Towns, Villages and School Districts
Title of Position Applying For Exam No. (if applicable)
This application is part of your examination, ANSWER ALL QUESTIONS FULLY AND CAREFULLY. Print in ink or
type. Attach additional sheets if necessary in order to give complete and detailed information.
ALL STATEMENTS ARE SUBJECT TO VERIFICATION.
1. Name:
PO Box and/or Street Town/City State Zip Code:
Address:
Immediate Notice should be given if any changes in address before or after examination.
5. State your actual permanent legal residence and indicate for how long you
have resided there continuously, up to and including date of this application:
2.
Social Security Number:
Years Months
3.
Date of Birth:
6. Check appropriate box to the right of each question:
A. Were you ever dismissed or discharged from any employment for reasons other than lack
of work or funds?
B. Have you ever been convicted of any crime, (Felony or Misdemeanor)?
C. Are you now under any charges for any crime?
If "yes", give particulars and disposition of each charge on separate sheet and attach same.
NONE OF THE ABOVE CIRCUMSTANCES REPRESENT AN AUTOMATIC BAR TO EMPLOYMENT. EACH CASE IS
CONSIDERED AND EVALUATED ON INDIVIDUAL MERITS IN RELATION TO THE DUTIES AND RESPONSIBILITIES OF
THE POSITION(S) FOR WHICH YOU ARE APPLYING.
7. Check appropriate box to the right of each question:
A. Are you currently a U.S. Citizen?
(Citizenship is no longer a requirement for employment except for public officer positions)
B. If not a U.S. Citizen, do you have a legal right to accept employment in the United States?
Please give alien registration number:
C.
Are you a retiree from New York State or any civil division thereof?
Page 1 of 4
No:Yes:
No:Yes:
No:Yes:
No:Yes:
No:Yes:
No:Yes:
School District:
Village or City of:
Town of:
County of:
State of:
Email Address
4.
Home Phone #:
Last Name First Name Middle Name
Are you an exempt Volunteer Fireman?
D.
Yes: No:
Cell Phone #:
E. Do you have a valid license to operate a motor vehicle in New York State?
F. If Yes, please provide the following:
Note: If a driver's license is required for the position applying for, a copy must accompany your application.
No:Yes:
Class: Number: Date of Expiration:
FORM ECPO-330
8.
Are you a veteran?
If "Yes" you must complete an Application for Veteran's Credits and provide a copy of your DD-214 form to
claim credit.
9. EDUCATION: If credit is claimed for partially completed college curriculum or correspondence course, attach a list of
courses and credits or semester hours completed. Indicate how many credit hours or courses are required for
graduation. DO NOT send transcripts unless required by announcement or to be used to meet minimum
qualifications.
Have you graduated from high school? If yes, give name and location of high school:
If "Yes", give year graduated:
If "No", give highest grade completed:
Have you successfully completed a typing course?
If you have a high school equivalency diploma: Number and/or Date of Issue:
Page 2 of 4
No:Yes:
No:Yes:
No:Yes:
COLLEGE, UNIVERSITY, PROFESSIONAL OR
TECHNICAL SCHOOL(S)
Name & Address:
Name & Address:
Name & Address
Name & Address:
Date(s) of
Attendance
(Month & Year)
From - To
Type of
Course or
Major
Number of
College Credits
Earned
Degree
Received
Date of
Degree
Veterans Credits:
Do you claim additional credits on this examination as an honorably discharged veteran?
Yes: No:
Since January 1, 1951, have you ever used additional credits as a disabled or non-disabled
veteran for appointment to any position in the public employment of New York State or any
of its civil divisions?
If "No", skip to number 9.
Yes: No:
Disabled War Veteran Credit? Non-Disabled War Veteran Credit? Yes: No:
If not currently licensed, check this box:
LICENSES: If a license, certificate or other authorization to practice a trade or profession is listed as a requirement on the
announcement or the examination(s) for which you are applying, complete the following:
TRADE OR PROFESSION: DATE LICENSE
FIRST ISSUED:
LICENSE NUMBER: REGISTRATION PERIOD:
FROM (MM/YY) TO (MM/YY)
SPECIALTY: LICENSING AGENCY NAME AND ADDRESS:
10.
DUTIES: Describe below the nature of the work performed by you, with estimated percentage of time on each type of work. State size
and kind of working force supervised by you and extent of such supervision (if any).
Page 3 of 4
13. EXPERIENCE: Beginning with the most recent, list all employment, military service, or volunteer experience that
proves you meet the minimum qualifications for the position you are applying for. We cannot interpret omissions or
vagueness in your favor. You are responsible for an accurate and clear description of your experience. For DUTIES
describe the nature of the work which you personally performed including the estimated percentage of time spent on
each type of activity. If you supervised, state how many people and the nature of such supervision.
EXPERIENCE MUST BE COMPLETED ON THE APPLICATION FORM. CREDIT WILL NOT BE GIVEN FOR WORK
EXPERIENCE SUBMITTED ON A RESUME.
Have you any objections to this department making inquiry regarding your character and qualifications
or contacting your former or present employers?
Yes: No:
APPLICANTS MAY BE REQUIRED TO FURNISH SATISFACTORY PROOF OF EXPERIENCE CLAIMED.
Month
Length of Employment
From To
Year Month Year
Paid
Volunteer
Check One
Hours Per Week
(No Overtime)
Employer Name Address City/State/Zip
Supervisor's Name Supervisor's TitlePhone Number Your Title
Type of Business
Reason for Leaving
% of time
on each duty
Employer Name
Phone Number
Length of Employment
From
Month Year
% of time
on each duty
To
Month Year
DUTIES: Describe below the nature of the work performed by you, with estimated percentage of time on each type of work. State size
and kind of working force supervised by you and extent of such supervision (if any).
Volunteer
Paid
Check One
Supervisor's Name
Address City/State/Zip
Supervisor's Title Your Title
Hours Per Week
(No Overtime)
Type of Business
Reason for Leaving
12.
Check box below if you desire special accommodations because you are a:
Sabbath Observer - For religious reasons cannot be tested on Saturdays
Handicapped Person
Yes No
11.
Please indicate type of assistance required
If "Yes", please give particulars
Yes No
IF MORE SPACE IS REQUIRED, USE ADDITIONAL SHEETS ARRANGED IN THE SAME MANNER. ATTACH SUCH SHEETS AT TOP OF PAGE.
NOTE: When filling out your application form, check to make sure that all questions have been answered. An
incomplete application may result in its disapproval. A resume may not be substituted.
THIS AFFIRMATION MUST BE COMPLETED FOR ACCEPTANCE OF APPLICATION FORM
I affirm that the statements made on this application ( including any attached papers)
are true under the PENALTIES OF PERJURY.
The New York State Human Rights Law prohibits discrimination in employment because of age, race, creed, national
origin, sex, disability, marital status, or criminal record. Accordingly, nothing in this application form should be viewed
as expressing, directly or indirectly, any limitation, specification or discrimination as to age, race, greed, color, national
origin, sex, disability, marital status or criminal record in connection with employment in the municipal service of the
County of Essex.
Page 4 of 4
Employer Name Address City/State/Zip
Supervisor's Name Supervisor's Title Your Title
DUTIES: Describe below the nature of the work performed by you, with estimated percentage of time on each type of work. State size
and kind of working force supervised by you and extent of such supervision (if any).
From
Supervisor's Name Supervisor's TitlePhone Number Your Title
Length of Employment
Month
To
Year Month Year
Paid
Volunteer
Check One
Hours Per Week
(No Overtime)
Type of Business
Reason for Leaving
Signature of Applicant Date
Provide any other name you have used in education or employment
Check One
YearMonthYear
ToFrom
Month
Length of Employment
Reason for Leaving
Type of Business
Hours Per Week
(No Overtime)
Volunteer
Paid
DUTIES: Describe below the nature of the work performed by you, with estimated percentage of time on each type of work. State size
and kind of working force supervised by you and extent of such supervision (if any).
City/State/ZipAddressEmployer Name
Phone Number
% of time
on each duty
% of time
on each duty
PRINT
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FORM ECPO-330: APPLICATION FOR EXAMINATION OR EMPLOYMENT Es

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 4 March 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document