(Non-Citizens may be required to produce 1-151 or 1-551 Alien Registration Cards at time of appointment.)
If you answered "Yes" to any of the Questions 4A-E above, you may give specifics by uploading a document below. If you elect not to provide specifics, however, or if such explanation is insufficient, you may be required to submit further information.
None of the above circumstances represents an automatic bar to employment. Each case is considered and evaluated on individual merits in relation to the duties and responsibilities of the position for which you are applying.
State your actual permanent legal residence and indicate for how long you have resided there continually, up to and including the date of this application.
Check all that apply
When filling out your application form, check to make sure that all appropriate questions have been answered. An incomplete application may result in disapproval.
ALL STATEMENTS ARE SUBJECT TO VERIFICATION
THIS AFFIRMATION MUST BE COMPLETED. I affirm that the statements made on this application (including any attached papers) are true under the penalties of perjury. I understand that all statements made by me in connection with this application are subject to investigation and verification and that a material mistatement, omission, or fraud may disqualify me from appointment or lead to revocation of my appointment.
THE NEW YORK STATE HUMAN RIGHTS LAW PROHIBITS DISCRIMINATION IN EMPLOYMENT BECAUSE OF AGE, RACE, CREED, COLOR, 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, CREED, COLOR, NATIONAL ORIGIN, SEX, DISABILITY, MATERIAL STATUS, OR CRIMINAL RECORD IN CONNECTION WITH EMPLOYMENT.
Beginning with the most recent, describe below in detail ALL employment. You are responsible for submitting an accurate, adequate and clear description of your experience. Omission or vagueness will NOT be interpreted in your favor. Under "Duties" for each employment describe the nature of the work personally performed by you, with estimated percentage of time spent on each type of work. State size and kind of working force, if any, supervised by you and the extent of supervision.
If you have military service, describe such experience as separate employment. If your title or duties changed materially in the course of your service in any one organization, indicate such charge clearly and as separate employment.
This field is not part of the form submission.
* indicates a required field