Application For Examination Or Employment Form Page 3
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418. EXPERIENCE:
Describe here all relevant experience (including volunteer or military) starting with the most recent. Include all employment for the last five years, as well as any relevant
experience prior to that. (If not employed during part or all of last 5 yrs., so state) In addition, you MUST:
1. Under “Duties” describe work personally done by you.
4. If more than one title at same employer, list as separate employment.
2. Estimate percentage of time spent on all work.
5. If more space is needed, attach extra 8 1/2 x 11 sheets of paper.
3. Indicate size & type of workforce supervised, if any, and extent of supervision.
6. THIS SECTION MUST BE COMPLETED EVEN IF A RESUME IS SUBMITTED.
(a) Employer - Name/address
Type of
Dates you worked there
Weekly salary
Hours worked
Name and title of
Business
From(Mo./Yr.)
To(Mo./Yr.)
(starting)
(last)
Per Week
your supervisor
Duties:
Your title:
Reason for Leaving:
(b) Employer - Name/address
Type of
Dates you worked there
Weekly salary
Hours worked
Name and title of
Business
From(Mo./Yr.)
To(Mo./Yr.)
(starting)
(last)
Per Week
your supervisor
Duties:
Your title:
Reason for Leaving:
(c) Employer - Name/address
Type of
Dates you worked there
Weekly salary
Hours worked
Name and title of
Business
From(Mo./Yr. )
To(Mo./Yr.)
(starting)
(last)
Per Week
your supervisor
Duties:
Your title:
Reason for Leaving:
(d) Employer - Name/address
Type of
Dates you worked there
Weekly salary
Hours worked
Name and title of
Business
From(Mo./Yr.)
To(Mo./Yr.)
(starting)
(last)
Per Week
your supervisor
Duties:
Your title:
Reason for Leaving:
NOTE: Your application cannot be processed until Form CSX2.1 or CSX 2.2 is filed. Submit
19. DECLARATION: I declare, subject to the penalties of perjury, that all statements
appropriate form directly to this office. (Do NOT submit form CSX 2.2 to appointing officer)
made in this application (including statements made in any accompanying papers) have
Each application is reviewed in relation to the employment or examination involved.
been examined by me and to the best of my knowledge are true and correct.
_______________________________________________
.
(Applicant Signature)
(Date)
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