Seasonal Employment Application - Niagara County Civil Service

ADVERTISEMENT

Niagara County Civil Service
Seasonal Employment Application
If experience is required to qualify for the position, applicants
should complete the full-length civil service employment application.
NCCS Revised 2/1/2016
Position applying for: _______________________________________________
Municipality: ___________________________
Name: ____________________________________________________________________________________________________
Last
First
Middle Initial
Is additional information relative to a change of name, use of an assumed name, or nickname necessary to enable a check on
your work or school record? If yes, please provide any such additional names. ________________________________________
Mailing Address: _____________________________________________________________________________________________
Street (or PO Box)
City
State
Zip Code
Residence Address: ___________________________________________________________________________________________
Street (P.O. Box will not be accepted, must use current home address)
City
State
Zip Code
County
Have you been a resident of Niagara County for the past one (1) month?
Yes
No
Home Telephone Number: ______________________________ Other Telephone Number: _______________________________
Email address: ________________________________________ Social Security Number (complete): ______--_____--__________
Have you served in the U.S. Armed Forces on active duty?
Yes
No Dates of active service: From__________To__________
Are you a citizen of the United States?
Yes
No
If no, do you have a legal right to work in the U.S.?
Yes
No
Do you have a valid NY State Driver’s License?
Yes
No
If yes, what class? ______________________________
An answer of YES to any of the following questions does not represent an automatic bar to employment. Each case
is considered and evaluated in relation to the duties and responsibilities of the position for which you are applying:
Were you ever dismissed from any employment for reasons other than lack of work or funds?
Yes
No _______
Did you ever resign from any employment rather than face dismissal?
Yes
No _______
Were you ever convicted of any violation of law other than a minor traffic violation?
Yes
No _______
Do you currently have any criminal charges pending?
Yes
No _______
Did you ever receive discharge from the U.S. Armed Forces which was “dishonorable?”
Yes
No _______
Did you ever forfeit bail or bond posted to guarantee your appearance in court to answer a criminal charge?
Yes
No _______
Provide an explanation to any of the above for which you marked “Yes.”_____________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
For Office Use Only
Qualified:
Yes
No Conditional: ______________
Reviewed by:________________ Date: ___________________
Comments: _________________________________________________________________________________________________
Niagara County Human Resources Department * 111 Main Street – Suite G2 * Lockport, NY 14094
Phone: (716) 438-4071 * Exam Information: (716) 439-7281 * Web-site:
Niagara County policy prohibits discrimination in employment, program activities, contracting, and procurement against any person due to such person’s age, marital status,
disability, genetic predisposition or carrier status, race, color, creed, sexual orientation or national origin.
An Equal Opportunity Employer
Page 1

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2