General Employment Application Form Page 2

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EMPLOYMENT HISTORY. The Examination Announcement includes the minimum work experience required to compete in this test.

Describe below all work experience which shows that you meet these stated minimum requirements.

8a. Name, Address & Business of Employer

No. of Hrs per Week – Employed from – Mo. – Yr.

To Mo. – Yr.

____________________________________________________________________________________________________________

Title & Duties________________________________________________________________________________________________

8b. Name, Address & Business of Employer_______________No. of Hrs per Week_- Employed from – Mo. - Yr.__ To Mo. – Yr.

____________________________________________________________________________________________________________

Title & Duties ______________________________________________________________________________________________

8c. Name, Address & Business of Employer_______________No. of Hrs. per Week – Employed from – Mo. – Yr.__To__Mo. – Yr.

___________________________________________________________________________________________________________

Title & Duties________________________________________________________________________________________________

Veteran's Credits If you have served in the Armed Forces, do you claim veteran's credits as a:

___Non-disabled Veteran

___Disabled Veteran

DD214 must be attached

For the purpose of claiming Veteran's Credits on a competitive examination, an applicant must

A. Have been honorably discharged or separated from the Armed Forces of the United States;

B. Have been on active duty in the Armed Forces of the United States during any of the following periods:

World War II - December 7, 1941 to and including December 31, 1946

Korean Conflict – June 27, 1950 to and including January 31, 1955

Vietnam Conflict – December 22, 1961 to and including May 7, 1975

Hostilities in Granata * – Oct. 23, 1983 – Nov. 21, 1983 ------------------ Hostilities in Lebanon * - June 1, 1983 - Dec. 1, 1987

Hostilities in Panama * - Dec. 20, 1989 – Jan. 31, 1990------------ Persian Gulf Conflict – August 2, 1990 to an unspecified period

* For hostilities in Lebanon, Grenada & Panama, the individual must HAVE RECEIVED THE ARMED FORCES, NAVY, OR

MARINE CORPS EXPEDITIONARY MEDAL. Without appropriate medal, service is treated as under May 8, 1975 – Aug. 1, 1990.

10. If you possess a motor vehicle license fill in the following:

Class: __________

Operator______________

ID Number:_____________________ Date of Expiration____________

REMARKS: (Use this space to provide any additional information as necessary. If more space is required, attach additional 8-1/2" x

11" sheets.) Any applicant wishing to claim Veteran's Credits must do so at the time of filing application. Ask for form (MSB-332

VP-1) 'APPLICATION FOR VETERANS CREDITS."

Note: Please check to make sure that all appropriate questions have been answered. An incomplete application may result in its

Disapproval. All statements are subject to verification.

AFFIRMATION: I affirm that the statements made on this application, including any attached papers, are true. (Withholding

relevant information or supplying inaccurate information, will result in your disqualification. Notice to appear for the test constitutes

only conditional approval of your application. Individuals appointed from the resultant eligible list will be called upon to document

any information provided on this application.)

________________________

_________________________________________________

Date

Signature

The New York State Human Rights Law prohibits discrimination in employment because of age, race, creed, color, national origin, sex, disability,

marital status or criminal record. Accordingly, nothing in this application form should be viewed as expressing directly or indirectly, any limitation,

specification, or discrimination as to age, race, creed, color, national origin, sex, disability, marital status, or criminal record in connection with

employment.

ONLINE FORMS ODavis/2001