DIVISION OF HUMAN RESOURCES
APPLICATION FOR EMPLOYMENT
Office of Personnel Administration
An Equal Opportunity Employer
CS-14 Rev. 12/17/13
THIS SECTION IS TO BE FILLED IN BY APPOINTING AGENCY
Class Title and Number
Identify below the license or certificate required by the class specification and held by the applicant
Type of License _____________________________________
License Number _______________ Date Issued __________
PRE-EMPLOYMENT INFORMATION – TO BE FILLED OUT BY APPLICANT
Applicants selected for an interview will be required to complete the Criminal Record Supplemental Form (CS-14B) at the
time of initial interview or anytime thereafter. A conviction is not necessarily a bar to employment. See RIGL §28-5-7(7).
1. Print Name (as you wish it to appear on payroll check and official records)
2. Telephone Number
3. Print Actual Address (Street and Number, City, State and Zip Code)
4. Mailing Address (if different)
ELEMENTARY AND SECONDARY EDUCATION
Highest school grade completed
Type of High School Course
1 2 3 4 5 6 7 8 9 10 11 12
Name and address of elementary or secondary school last attended
Did you graduate?
COLLEGE, BUSINESS SCHOOL, TRADE SCHOOL AND OTHER EDUCATION
Type of Diploma
If No Degree,
Name of School
Major and/or Course of Study
# of Credits
5. Have you ever worked for the State before?
6. Have you ever been dismissed from any position? If your answer is yes, give
details on an attached sheet.
YES - Name of agency/organization:
7. Describe below all the positions you have held in the past ten years. In addition, describe any other experience which you think may qualify you for
this job. Include all previous employment with the State of Rhode Island. Begin with your present or most recent employment.
Name of Employer
Type of Business
Lowest Weekly Salary
Address of Employer
Title of Position
Highest Weekly Salary