Fillable WARREN COUNTY APPLICATION FOR EXAMINATION OR EMPLOYMENT Warren (Warren County)

Fill Online, Printable, Fillable, Blank WARREN COUNTY APPLICATION FOR EXAMINATION OR EMPLOYMENT Warren (Warren County) Form

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

WARREN COUNTY APPLICATION FOR EXAMINATION OR EMPLOYMENT Warren (Warren County)

On average this form takes 53 minutes to complete

The WARREN COUNTY APPLICATION FOR EXAMINATION OR EMPLOYMENT Warren (Warren County) form is 4 pages long and contains:

  • 2 signatures
  • 7 check-boxes
  • 200 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Warren County

BROWSE WARREN COUNTY (NY) 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
 
WARREN COUNTY APPLICATION FOR EXAMINATION OR EMPLOYMENT
Warren County Department of Civil Service Administration
1340 State Route 9 Lake George, New York 12845
Phone: (518) 761-6440 Fax: (518) 761-6509
Web: www.warrencountyny.gov/civilservice
Submit an original application for each title along with a non-refundable examination fee (if applicable). Make
check or money order payable to Warren County Treasurer (no cash accepted). Carefully read announcements
for minimum qualification requirements. (You must sign the affirmation at the bottom of page 4).
EXAM Title or Position: __________ Exam Number: (if applicable): _____
NAME AND LEGAL RESIDENCE:: (Please notify Warren County Civil Service immediately of any information changes )
LAST NAME FIRST NAME MIDDLE INITIAL
STREET CITY STATE ZIP
MAILING ADDRESS:
(if different from above) STREET CITY STATE ZIP
PHONE NUMBER: ( ) ( ) ( )
Home Business Cell
EMAIL ADDRESS:
SOCIAL SECURITY NUMBER:________________________________________________________________________
SPECIFY THE FOLLOWING PERTAINING TO YOUR PERMANENT LEGAL RESIDENCE:
I currently reside (indicate one of the three) in the: (1) City of
OR (2) Town of , OR (3) Village of
in the School District of located in the County of in the
State of . Have you lived in your current County for at least four months?________________________.
VETERANS 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 Credit” form and supporting documentation.
Check appropriate box if claiming additional credits: Non-Disabled Wartime Veteran or Disabled Wartime Veteran
TESTING ACCOMMODATIONS:
Warren County Civil Service provides reasonable accommodations in testing for reasons of disability, religious observance or military
service. If you require special arrangements, a written request must be attached or submitted no later than the last filing date for the
exam.
Yes, I am requesting testing accommodations for: Disability Religious Observance Military Service.
EXAMS IN OTHER JURISDICTIONS:
Yes, No Have you applied for any other examinations to be held on the same date with NYS or other jurisdictions?
(If yes, please attach a completed cross filer form available at Warren County Civil Service Office or online at:
https://www.warrencountyny.gov/civilservice/docs/exams/cross_filer_app.pdf
OTHER PERSONAL INFORMATION:
Are you 18 years of age or older? YES NO If no, you must supply a work permit.
Are you legally eligible to work in the United States? YES NO In compliance with federal law, all persons hired will
be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification
form upon hire.
Are you a retiree from New York State or any civil division thereof? YES NO
If minimum or maximum age limits are established for the position applied for (including uniformed services or peace officers), enter
date of birth here:__________..
If Citizenship is required for exam or appointment (including uniformed services or peace officers), are you a Citizen?
YES NO
Page 1/4
NAME:
LAST FIRST MIDDLE
EDUCATION:
Do you have a High School diploma? YES NO
If YES, NAME AND LOCATION OF HIGH SCHOOL:
Or, a High School Equivalency Diploma (GED)? YES NO
If YES, GOVERNMENT AUTHORITY (GED) NUMBER:
EDUCATION: (beyond high school)
Read the exam announcement for educational requirements, if any. If specialized coursework is required, attach a copy
of your transcript or a list of the required courses and the number of credit hours you have completed.
INDICATE COLLEGE, UNIVERSITY, PROFESSIONAL or
TECHNICAL SCHOOL(S) IN SPACE BELOW:
TOTAL
CREDITS
EARNED
TYPE OF
DEGREE
EARNED
MAJOR SUBJECT OR
COURSE
DID YOU
GRADUATE
DEGREE
EXPECTED
NAME OF SCHOOL:
YES
NO
MO YR
/
Address (City, State):
NAME OF SCHOOL:
YES
NO
MO YR
/
Address (City, State):
NAME OF SCHOOL:
YES
NO
MO YR
/
Address (City, State):
IF REQUIRED FOR POSITION, LIST MOST RELEVANT COURSE WORK(see announcement minimum qualifications)t:
NAME OF COURSE DIVISION CREDIT HRS. NAME OF COURSE DIVISION CREDIT HRS.
LICENSES/CERTIFICATES OR OTHER AUTHORIZATIONS TO PRACTICE A SKILL, TRADE, OR PROFESSION:
Skill, Trade or Profession
License or
Certificate
Number
Issued by:
(Name of City,
State, or Agency)
License Dates
(Mo/Day/Yr)
From To
Permanent
From To
Driver’s License (Complete only if the position for which you are applying requires one.) Number: State:
Date of Expiration: Class of License: Endorsements: Restrictions:
Page 2/4
NAME:
LAST FIRST MIDDLE
EXPERIENCE: Carefully read the minimum qualifications for the position/exam for which you are applying.
Fee(s) will not be refunded if you do not meet the minimum qualifications. List below all relevant work experience. A
resume is not a substitute. Be more specific in describing your work experiences relating to the minimum qualifications.
You are responsible for submitting an accurate, adequate and clear description of your experience. Paid part-time
experience will be prorated unless otherwise stated on the announcement. Verified and documented volunteer (unpaid)
experience will only be credited when specifically allowed by the job posting or exam announcement. If more space is
needed, attach 8 ½ x 11 sheets of paper. Sheets must contain all information as requested on this form. (E.g. number of
hours worked per week, dates of employment, etc.)
LENGTH OF EMPLOYMENT
Month/Year to Month/Year
l
EMPLOYER ADDRESS CITY, STATE, ZIP CODE
HOURS WORKED PER WEEK DUTIES:
YOUR TITLE
TYPE OF BUSINESS
NAME AND TITLE OF SUPERVISOR
REASON FOR LEAVING
LENGTH OF EMPLOYMENT
Month/Year to Month/Year
|
EMPLOYER ADDRESS CITY, STATE, ZIP CODE
HOURS WORKED PER WEEK DUTIES:
YOUR TITLE
TYPE OF BUSINESS
NAME AND TITLE OF SUPERVISOR
REASON FOR LEAVING
LENGTH OF EMPLOYMENT
Month/Year to Month/Year
|
EMPLOYER ADDRESS CITY, STATE, ZIP CODE
HOURS WORKED PER WEEK DUTIES:
YOUR TITLE
TYPE OF BUSINESS
NAME AND TITLE OF SUPERVISOR
REASON FOR LEAVING
LENGTH OF EMPLOYMENT
Month/Year to Month/Year
l
EMPLOYER ADDRESS CITY, STATE, ZIP CODE
HOURS WORKED PER WEEK DUTIES:
YOUR TITLE
TYPE OF BUSINESS
NAME AND TITLE OF SUPERVISOR
REASON FOR LEAVING
Page 3/4
NAME:
LAST FIRST MIDDLE
COMPLETE ALL QUESTIONS:
YES NO Were you ever discharged from any employment except for lack of work or funds, disability or medical condition?
YES NO Did you ever resign from any employment rather than face discharge?
If you answered (YES) to any of these questions, you may provide details on a separate 8 ½ x 11 sheet of paper attached to this application.
Note : None of the above is an automatic bar to employment. Each case is considered and evaluated on individual merits in relation to the
duties and responsibilities of the position to which you are applying.
BACKGROUND INVESTIGATION:
Applicants for certain positions may be required to undergo a State and national criminal history background investigation,
which may include a fingerprint check, to determine suitability for appointment. Failure to meet the standards for the
background investigation may result in disqualification.
COMPLETE THIS SECTION ONLY IF YOU QUALIFY TO HAVE THE EXAM FEE WAIVED:
Section 50.5(b) of the NYS Civil Service Law allows exam fees to be waived for candidates who certify that they are currently in one of the
following categories. Please check box that applies to you:
Unemployed and primarily responsible for support of a household
Eligible to receive Medicaid
Receiving Supplemental Security Income (SSI)
Receiving Temporary Assistance for Needy Families (TANF)
A certified eligible under the Workforce Investment Act (WIA)
I certify that I am qualified to receive an exam fee waiver because of my current status indicated above. I understand that my waiver claim
may be investigated and that I may be disqualified from the civil service exam(s) if I make a false statement regarding my eligibility for the
exam fee waiver.
Signature (if eligible) Date
ALTERNATE TEST DATE:
If you cannot take the test on the announced test date, it may be possible for arrangements to be made for you to take the test on an
alternate test date. If applicable, check the box below and attach supporting documentation with this application. In case of emergency,
please notify this office the NEXT business day following the exam date. You will be required to submit documentation of your emergency.
Yes, I need an alternate test date and have attached a Request for Alternate Test Date form.
PERSONAL PRIVACY PROTECTION LAW NOTIFICATION:
The information which you are providing on this application is being requested pursuant to Section 50.3 of the New York State Civil
Service Law for the principal purpose of determining the eligibility of applicants to participate in the examination(s) for which they
have applied. This information will be used in accordance with Section 96(1) of the Personal Privacy Protection Law, particularly
subdivisions (b), (e), and (f). Failure to provide this information may result in disapproval of the application. This information will be
maintained by the Warren County Department of Civil Service.
STATEMENT:
I affirm under penalties of perjury that all statements made on this application, and any accompanying attachments are true and complete to
the best of my knowledge. I understand that all statements made by me in conjunction with this application are subject to investigation and
verification and that a material misstatement or fraud may disqualify me from appointment and/or lead to revocation of my appointment. I
authorize Warren County to contact schools/colleges and former employers cited in this application or attachments in order to verify work
record and/or educational credentials. I understand that acceptance of this application for employment by Warren County does not
constitute or imply a commitment or willingness to offer employment to me in this or any other position.
Signature Date
WARREN COUNTY IS
A
N EQUAL OPPORTUNITY/AFFIRMATIVE
A
CTION EMPLOYER
It is the policy of Warren County to provide for and promote the equal opportunity of employment, compensation, and other terms and
conditions of employment without discrimination because of age, race, color, religion, disability, national origin, gender, sex, sexual
orientation, marital status, veteran or military service status, domestic violence victim status, genetic predisposition or carrier status, criminal
or arrest record or any other category protected by law, unless based on a bona-fide occupational qualification or other exception.
Page 4/4
click to sign
signature
click to edit
click to sign
signature
click to edit
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

WARREN COUNTY APPLICATION FOR EXAMINATION OR EMPLOYMENT Warren (Warren County)

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 6 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document