Application For Seasonal Employment Form (Page 2 of 4) in pdf

Length of Employment

Firm Name

Address

City and State

From

Earnings

(Circle One)

Duties:

/WK/MO/YR

Type of Business

Your Exact Title

Name of Your Supervisor

Supervisor’s Title

No. of hours worked per wk.

NOTE: Please attach additional sheets if you have additional work experience.

11.

Lifeguard Applicants ONLY: Please indicate your total experience (in years) for each of the following:

Pool

Waterfront

Swim Instructor

12.

References: Please list three references for us to contact

Name:

Relationship:

Email address:

Phone Number:

(

)

Address:

Name:

Relationship:

Email address:

Phone Number:

(

)

Address:

Name:

Relationship:

Email address:

Phone Number:

(

)

Address:

The New York State Human Rights Law prohibits discrimination in employment because of age, race, creed, color, national origin, sex, disability,

religion, marital status or criminal record. Additionally, the City of Ithaca Fair Practices Ordinance prohibits discrimination in employment

because of sexual orientation or affectional preference. 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, religion, marital status,

criminal record, sexual orientation or affectional preference in connection with employment in the municipal service of the City of Ithaca.

REMARKS:

(Use this space to provide any special skills, hobbies or additional information, as necessary. If more space is required, attach additional 8

½” x 11” sheet.)

BACKGROUND INVESTIGATION: Applicants may be required to undergo a State and national criminal history background investigation, which will include

a fingerprint check, to determine suitability for appointment. Failure to meet the standards for the background investigation may result in disqualification.

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.

Signature of applicant

Date

Please return this Application for Seasonal Employment to any of the following locations:

Ithaca Youth Bureau, 1 James L. Gibbs Drive, Ithaca, NY 14850

GIAC , 318 North Albany Street, Ithaca, NY 14850

Phone: (607) 273-8364

Fax: (607) 273-2817

Phone: (607) 272-3622

Fax: (607) 272-0250

Cass Park, 701 Taughannock Blvd., Ithaca NY 14850