Seasonal Employment Application - Niagara County Civil Service Page 2
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2License/Certification – Submit a copy of the license/certification with your application
Do you have a license, certification, or other authorization to practice a trade or profession?
Yes
No
Is this license/certification permanent?
Yes
No
Name of trade or profession: ___________________________________
License/Certificate Number: ______________________
Licensing Agency: ___________________________________________
Licensed from: ________________ to: _____________
High School Education
Have you received a High School Diploma?
Yes
No Check the highest grade completed
8
9
10
11
12
If yes, provide name & location of the high school or issuing government authority: ________________________________________
If no, have you received a General Equivalency Diploma (GED)?
Yes
No Submit a Copy or Indicate #________________
Education above high school level – Official college transcripts must be submitted if not already on file
Name of School
Location (State)
Course or Major
Credits Completed
Type of Degree/Certificate Received
Sem. Hrs. Qtr. Hrs.
____________________________
_______________
___________________________
_______ _______
______________________________
____________________________
_______________
___________________________
_______ _______
______________________________
Training
Other training you received (i.e. work training programs, Armed Forces training). Please estimate training hours received.
Course/Program
Hours
__________________________________________________________________________________________________
__________________________
__________________________________________________________________________________________________
__________________________
Work History – List your complete post-high school work history. Include dates, all employers, & reason for
leaving. Attach additional sheets if necessary.
Have ever worked for Niagara County?
Yes
No Date: __________ Department:____________________________________
Start Date(M/D/Y) End Date(M/D/Y)
Employer
Reason for Leaving
I declare that the statements made in this application (including statements made in my accompanying papers) have been examined
by me and to the best of my knowledge and belief are true and correct. Any false statements made are punishable as a Class A
Misdemeanor under Section 210.45 of the Penal Law and may result in termination of employment. I further understand, and will
otherwise submit thereto, that in accordance with existing pre-employment physical and drug testing policy, I may be required to
submit to a physical examination and urinalysis test as a condition for employment. Applicants may also be required to undergo a
State and national criminal history background investigation, which will include a fingerprint check, to determine suitability for
appointment. Failure to meet the standards for the background investigation may result in disqualification.
_____________________________________________________
_________________________________________
Signature
Date
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
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