General Employment Application Form
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1
2Online Application
City of Mount Vernon
Accepted by:___________
Municipal Civil Service Commission
Roosevelt Square
Rejected by:___________
Mount Vernon, New York 10550
Date:_________________
(914) 665-2357
Application No. ___________
Application for Examination or Employment
Position Title
Exam No.
Please read the instructions on all pages of the application and the examination announcement carefully before filling out
your application. PLEASE PRINT IN BLACK OR BLUE INK.
--------------------------------------------------------------------------------------------------------------------------------------------------
1. Last Name
First Name
Middle Initial
Social Security Number
Street Address
City
County
State
Zip Code
NY
________________________________________________________________________________________________________________________
E-Mail Address:
Contact Telephone Number:
2. Date of Birth: Month _______ Day________ Year______________
3. U.S. Citizen:
______Yes
_______No
(for Police Officer exam only)
________________________________________________________________________________________________________________________
4, Check below if you desire special arrangements for testing because you are a:
_____SABBATH OBSERVER
_____HANDICAPPED PERSON (indicate type of assistance requested)
(for religious reasons cannot be tested on Saturday)
PLEASE ATTACH A SEPARATE NOTE
________________________________________________________________________________________________________________________
5. Have you a license, certificate or other authorization to practice the trade or profession for which you are applying? _____Yes
No________
If 'YES' answer the following:
Name of Trade or Profession___________________________ Granted by licensing Agency_________________ City or State of_____________
6.
Answer all questions by placing 'X' in the appropriate column.
Yes
No
A) Were you ever dismissed or discharged from any employment for reasons other than lack of work or funds?………
_____
_____
B) Did you ever resign from any employment rather than face dismissal?……………………………………………….
_____
_____
C) Did you ever receive a discharge from the Armed Forces of the United States which was other than "honorable" or
which was issued under other than honorable circumstances?………………………………………………………….. ______
_____
D) Have you ever been convicted of an offense against the law? …………………………………………………………
______
_____
E) Have you ever forfeited bail or other collateral?………………………………………………………………………… ______
_____
F) Do you now have any criminal charges pending against you?…………………………………………………………... ______
_____
If you answered 'YES' to any of the questions in 6 A-F above, you may give specifica under "Remarks" on page 2 of application. If you elect not to
provide specifics, however, or if such explanation is insufficient, you may be required to submit further information. None of the above
circumstances represents an automatic bar to employment. Each case is considered and evaluated on individual merits in relation to the duties and
responsibilities of the position(s) for which you are applying.
7. Education
Name of School and
Dates of Attendance
Did you
No of
Date
Type of
City in which located
From
to
Graduate?
College
Degree
Type of
Course/Major
Credits
received or
degree
Subject
Received
expected
received
High School or
Equivalency
Diploma
College, University,
Professional or
Technical School
Other School
Or
Special Courses
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