D. Are you an exempt Volunteer Fireman? Yes: No:
Check appropriate box to the right of each question:
A. Do you have a valid license to operate a motor
vehicle in New York State?
B. If Yes, please provide the following:
Class: Number: Date of Expiration:
Have you ever served in the Armed Forces of the United States
on a full time active duty basis - other than active duty for
If Not: Omit Questions 9-13.
If "Yes" did you receive a discharge that was honorable or
were you release under honorable circumstances?
Have you any objections to this department making inquiry
regarding your character and qualifications?
Did you serve in active duty in the Armed Forces of the United States
during any of the following periods?
December 7, 1941 to December 31, 1946;
June 27, 1950 to January 31, 1955;
December 22, 1961 to May 7, 1975
US Public Health Service: July 29, 1945 to September2, 1945 or June 26, 1950 to July 3, 1952;
August 2, 1990 - the date upon which such hostilities end.
Hostilities in Lebanon - June 1, 1983 - December 1, 1987 *
Hostilities in Grenada - October 23, 1983 - November 21, 1983 *
Hostilities in Panama - December 20, 1989 - January 31,1990 *
* denotes - Must have received the armed forces, navy or marine corps expeditionary medal.
Veterans Credits. Do you claim additional credits on this examination as an honorably discharged veteran?
Yes: No:As a disabled war veteran?
Yes: No:As a non-disabled war veteran?
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?
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.
Yes: No: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:
Yes: No:Have you successfully completed a typing course?
If you have a high school equivalency diploma: Number and/or Date of Issue:
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