Application For Examination Or Employment Form Page 2
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4VETERANS CREDITS
(“YES” answers to the following questions must be explained under number 20)
Complete this section ONLY if you wish to claim veterans credits AND if you
have not used veterans credits for appointment to a position in NY State
7. Do you object to this commission making inquiry about your
since 1/1/51.
character and qualifications from your present employer?
Yes
No
For the purpose of claiming veterans credits on a civil service examination, you must
8. Have you ever had a drivers license suspended or revoked?
Yes
No
have served, or currently serve, on active duty - for purposes other than training - in the
Armed forces of the United States at any time during the following “time of war” periods:
9. Have you received any summons for traffic violations within
the past three years?
Yes
No
WWII - 12/7/41 - 12/31/46
*Lebanon - 6/1/83 - 12/1/87
Korea - 6/27/50 - 1/31/55
*Grenada - 10/23/83 - 11/21/83
10. Except for the above traffic offenses, have you ever been
Vietnam - 12/22/61 - 5/7/75
*Panama - 12/20/89 - 1/31/90
convicted of any violation, misdemeanor, or felony?
Yes
No
Persian Gulf - 8/2/90 -
*Limited to those who received the Armed Forces,
U.S. Public Health Service
Navy or Marine Corps expeditionary medal.
11. Are there any criminal charges pending against you at this time?
Yes
No
7/29/45 - 12/31/46
6/27/50 - 7/03/52
2.
1
Were you ever dismissed from employment for reasons
In addition, you must:
other than reduction in staff?
Yes
No
Be an Honorably Discharged Veteran - or released under honorable conditions.
(a)
(You must submit proof via form #DD214)
NOTE: IF YOU WERE EVER FINGERPRINTED OR INVESTIGATED BY THIS COMMISSION,
YOU MUST GIVE DETAILS (DATE AND POSITION APPLIED FOR) UNDER # 20
OR;
Be currently on active duty - for purposes other than training. (Proof must be by
(b)
military ID or orders). You will be notified later as to how to provide proof of
Honorable Discharge or release under honorable conditions.
13. DO YOU HAVE A LICENSE OR CERTIFICATE TO PRACTICE A TRADE OR PROFESSION:
(If Yes, and if required for this position/exam, you must attach a photocopy)
Yes
No
15. Have you used veterans credits for appointment
Yes
No
to a position in N.Y. State since 1/1/51?
14. EDUCATION:
Note: If special coursework is required for this position/exam, you
(If so, you may not claim them again!)
must give details (Title, date completed, school/agency attended,etc.)
under question # 20 .
16. Do you wish to claim regular veterans credits?
Yes
No
Do you have a High School or Equivalency Diploma?
17. Do you wish to claim DISABLED veterans credits?
Yes
No
A.
(You must be receiving payments from the U.S. Dept
Yes - Name & Location of H.S. or issuing authority
________________________
of Veterans Affairs for a service-connected disability
rated at 10% or more, and incurred during a
________________
No - indicate grade completed
“time of war” period listed above).
Was proof ever submitted to this office?
Yes
No
B.
NOTE: Where college education is required, if not already on file, you must
College education from a foreign country must be evaluated by an accredited
have your school send an official transcript directly to this office.
evaluation service, and an original report sent by them to this office.
Type of School
Name and Location
Dates Attended
Type of
Did you
Date Degree/
No of
Type of
Was Proof Submitted
From
To
Course/Major
Graduate?
Diploma
Credits
Degree
to This Office?
(Mo./Yr.) - (Mo./Yr.)
Received
Received
Yes (date) or No
Y or N
Y or N
-
College,
No
No
University,
Y or N
Y or N
-
Professional,
No
No
Technical ,or Trade
-
Y or N
Y or N
No
No
-
Y or N
Y or N
No
No
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