Application For Examination Or Employment Form Page 4
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420. Use this space to explain “yes” answers to questions 7-12, and for details of special coursework, where required.
Do not use for additional information regarding experience. Rather, attach additional 8 1/2 x 11 sheets of paper for that purpose.
APPOINTING AUTHORITY INFORMATION
1. Name and Address: County Department, Town, Village, School or Special District.
3. Jurisdictional Classification: (per CS-4):
Competitive
Non-Competitive
Labor
Exempt
2. I have reviewed the qualifications listed above by the applicant whose signature
4.
Type of Appointment
appears in item 19, and I nominate the applicant for appointment to
COMPETITIVE:
Part time
Provisional Appointment
Seasonal
Full time
Title of Position
Date Employment Begins
Provisional Promotion
Other __________
Temporary
$
Cs-4(#)
EL-2(DATE)
GRADE
STEP
SALARY
5. EDP CODES:
NOTE: IF candidate is currently employed by another governmental
jurisdiction in Nassau County give details under number 20, above.
TITLE _______________ DEPARTMENT__________________
6.
________________ _______________________________________________
____________________________________________________________________
(DATE)
SIGNATURE OF APPOINTING OFFICER
NAME & TITLE OF APPOINTING OFFICER (PRINT)
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