STATE OF NEW YORK
UNIFIED COURT SYSTEM
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UCS5 (Revised 10/98) |
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APPLICATION FOR EMPLOYMENT |
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Title of Position: |
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Announcement # |
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Geographic Location of Position: |
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1. Last Name |
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First Name |
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Initial |
2. AGE: Are you at least 18 years of age? |
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Yes |
No |
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Mailing Address |
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If no, indicate your date of birth |
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. |
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City or Post Office |
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State |
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Zip Code |
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3. CITIZENSHIP: |
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Form 19 attached |
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Telephone Number |
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Social Security Number |
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Are you a citizen of the United States? Yes |
No |
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Home: |
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If no, do you have a legal right to work in the |
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Business: |
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United States? |
Yes |
No |
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ANSWER ALL QUESTIONS BY PLACING ''X'' IN THE APPROPRIATE COLUMN |
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YES |
NO |
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If your answer is ''YES'' to any of these questions, give details on an attached sheet.
a) Except for minor traffic offenses and adjudications as youthful offender, wayward minor or juvenile delinquent: i. Have you ever been convicted of an offense against the law?
ii. Have you ever forfeited bail or other collateral?
iii. Do you now have any criminal charges pending against you?
b) Have you ever been dismissed from any employment for reasons other than lack of work or funds?
c) Have you ever received a discharge from the Armed Forces which was other than honorable
d) Are you currently in violation of a court order in any state for child or spousal support?
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5. EDUCATION NAME OF SCHOOL AND |
Full |
No. of |
Were You |
Type of |
No. of |
Degree |
CITY IN WHICH LOCATED |
or |
years |
Graduated |
Course or Major Subject |
Credits |
Received |
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PartTime |
Credited |
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Received |
Or Expected |
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High School* |
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College, Univ. |
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Professional or |
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Technical School |
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Other Schools or
Special Courses
*If you have a high school equivalency diploma, give number and year of issue:
6.EXPERIENCE (List your most recent employment first, including volunteer work, military service, internship, work
study, etc. Attach a resume if available.)
NAME, ADDRESS AND BUSINESS OF EMPLOYER
EMPLOYED
FROM TO
Mo./Yr Mo./Yr
TITLE AND DUTIES OF YOUR POSITION
Describe the kind of Work performed and supervisory experience if any
7. REMARKS: ATTACH A RESUME OR ADDITIONAL SHEETS OF PAPER IF MORE SPACE IS NEEDED. PLEASE COMPLETE THIS AFFIRMATION
I affirm that the statements on this application (including any attached papers) are true. False statements made in this application are punishable under Penal Law ( ''§210.45)
X
Signature of Applicant |
Date |
THE STATE OF NEW YORK UNIFIED COURT SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER
(Use of this second page is optional.)
STATE OF NEW YORK
UNIFIED COURT SYSTEM
UCS5 (Revised 10/98)
APPLICATION FOR EMPLOYMENT
Title of Position: |
Announcement # |
Geographic Location of Position: |
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1. Last Name |
First Name |
Initial |
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ADDITIONAL INFORMATION
(This page may be used to add any additional information which would not fit on the first page such as explanations to ''YES'' answers for questions ad or information regarding experience.)
I affirm that the statements on this application (including any attached papers) are true. False statements made in this application are punishable under Penal Law ( ''§210.45)
X
Signature of Applicant |
Date |
THE STATE OF NE W YORK UNIFIED COURT SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER