Fillable Request For Certification Of Eligibles printable pdf download

REQUEST FOR CERTIFICATION OF ELIGIBLES

(For Appointing Authority Use Only)

REQUESTING AGENCY: __________________________________________________________________________

__________________________________________________________________________

1. Please forward a certification of eligibles for: ______________________________________________________

(Title of Position)

Residents Only

Entire List

Please certify/precanvass to include: _____________________________________________________________

2. The number of vacancies to be filled from this certification is/are:

__________Permanent, __________Contingent Permanent, __________Temporary (Maximum Duration)

3. This position is for:

Days

Nights

Rotating Shifts

Steady Shifts

Library

(may include some day, night & weekend hours).

4. This position is for ______ months per year, at a salary of _______________ per year.

MUST

NOT

(A SPECIFIC ANNUAL SALARY

BE STATED. SALARY RANGE OR HOURLY SALARY IS

ACCEPTABLE)

5. This position is located at: _____________________________________________________________________

6. This certification will be used to fill:

A. New Position Duties Statement # _________________ or Position Control # ________________

B. This position formerly held by ________________________________________________________________

who has

resigned,

been promoted,

been granted leave for ________ months.

INSTRUCTIONS FOR USE OF THIS FORM

1. Use this form for requesting the certification of names from an eligible list for the purpose of making

permanent, contingent permanent, or temporary appointments to positions in the competitive class.

2. Submit this form in DUPLICATE to:

Suffolk County Department of Civil Service

PO Box 6100

725 Veterans Memorial Highway, North County Complex, Bldg 158

Hauppauge, NY 11788-0099

3. Use a separate set of forms for each TITLE for which a certification is requested.

4. Use a separate set of forms for positions which vary in salary, location or shifts.

5. A duties statement must be submitted on all NEW positions, whether or not a position of similar duties and

responsibilities already exists in your jurisdiction. Duties statements may be made up for a single position or a

group of positions having like duties and responsibilities. If you prepare a duties statement for a group of

positions, you must indicate the number of positions on the form. Duties statement forms will be sent upon

request.

SIGNATURE

DATE

TITLE

DO NOT WRITE BELOW THIS LINE

( ) Transaction Approval

( ) There is no eligible list available for the position of __________________________________________________.

You may submit a nomination for provisional(s) for review by the Civil Service Department pending the establishment

of an eligible list for the position.

( ) You currently have a certification of eligibles dated ___________________________. You must return this

certification showing what action has been taken before a new certification will be sent to you.

Request For Certification Of Eligibles

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