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Demotown Application for Employment

The following form takes about 20 minutes to complete.

Application for Employment

PERSONAL INFORMATION

POSITION APPLYING FOR (required)

First Name (required)

Middle Initial

Last Name (required)

SOCIAL SECURITY NUMBER:

E-MAIL ADDRESS:

(Area Code) Home Phone

(Area Code) Business Phone

Permanent Legal Address

Apartment

City/Town

State

Zip Code

My mailing address is different.

Mailing Address

Apartment

City/Town

State

Zip Code

Referring to your PERMANENT LEGAL ADDRESS, complete all items which apply to where you live.

What School District do you live in and for how long?

Years

Months

What County do you live in and for how long?

Years

Months

Are you a citizen of the United States? (required)

Yes

Are you or were you an exempt volunteer firefighter? (required)

Yes

SPECIAL ARRANGEMENTS

Religious Accommodation

Military

Disability

Please explain:

Were you ever dismissed or discharged from any employment for reasons other than lack of work, funds, disability or medical condition? (required)

Yes

Did you ever resign from any employment rather than face dismissal? (required)

Yes

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? (required)

Yes

Are you now under charges for any crime? (required)

Yes

If you answered “YES” to any of the questions above, you may give specifics under “Remarks” in the last section of this application. If you elect not to provide specifics, 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.

Have you ever been convicted of any crime (felony or misdemeanor)? (required)

Yes

Are you currently or have you ever served in the Armed Forces of the United States? (required)

Yes

VETERANS’ CREDITS

Disabled War Veteran (10 Points)

Non-disabled War Veteran (5 Points)

If you wish to claim additional credits complete questions 1-4 and submit the member 4 of your DD-214. If you are a Disabled War Veteran, also submit a copy of your benefits letter.

1. Did you receive a discharge which was honorable or were you released under honorable circumstances?

Yes

2. Did you serve in the Armed Forces of the United States during any of the following periods? (12/7/41 – 12/31/46) (6/27/50 – 1/31/55) (02/28/61 – 5/7/75) (Persian Gulf: 8/2/90--present) (Lebanon: 6/1/83 – 12/1/87) (Grenada: 10/23/83 – 11/21/83) (Panama: 12/20/89 – 1/31/90) NOTE: Credits for Lebanon, Grenada, and Panama will be limited to those who received the following Expeditionary Medals: Armed Forces, Navy, or Marine Corps (U.S. Public Health Service: (7/29/45– 12/31/46) OR (6/27/50 – 7/3/52)

Yes

3. Since January 1, 1951, have you received a permanent appointment in New York State using your veterans credits?

Yes

4. At the time of this application are you currently a New York State Resident?

Yes

Click the button below to upload your DD-214 and Benefits Letter.

Choose File

EDUCATION

Read examination announcement for educational requirements. If required, attach transcripts showing the date degree received, major subject, and/or required credit hours.

Have you graduated from high school? (required)

Yes

Do you have a high school equivalency diploma?

Yes

Name and location of high school

Issuing Governmental Authority:

Year Graduated

Do you have any college, university, professional or technical schooling to submit? (required)

Yes

College University, Professional or Technical School

1.

Name of School OR College and Address

Dates of Attendance (Month and Year) From-To

Type of Course or Major Subject

Number of College Credits Rec’d

Type of Degree Rec'd

Date Degree Rec'd

Add a second school?

Yes

2.

Name of School OR College and Address

Dates of Attendance (Month and Year) From-To

Type of Course or Major Subject

Number of College Credits Rec’d

Type of Degree Rec'd

Date Degree Rec'd

Add a third school?

Yes

3.

Name of School OR College and Address

Dates of Attendance (Month and Year) From-To

Type of Course or Major Subject

Number of College Credits Rec’d

Type of Degree Rec'd

Date Degree Rec'd

Are there any education classes or special courses that you'd like to specify?

Yes

Other Classes Or Special Courses

1.

Name of School and Address

Dates of Attendance (Month and Year) From-To

Type of Course or Major Subject

Number of College Credits Rec’d

Type of Degree Rec'd

Date Degree Rec'd

Add another?

Yes

2.

Name of School and Address

Dates of Attendance (Month and Year) From-To

Type of Course or Major Subject

Number of College Credits Rec’d

Type of Degree Rec'd

Date Degree Rec'd

EDUCATIONAL TRANSCRIPTS

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PROFESSIONAL LICENSES

If a license, or other authorization to practice trade or profession is listed as a requirement on the Job Posting or Examination Announcement for which you are applying, complete the following and submit a copy of the license with this application:

Do you have any trade or professional licenses?

Yes

Name of Trade or Profession

License Number

Granted by (licensing agency)

City or State of

Specialty

Date of License First Issued

Registered From: Month/Year to Month/Year

LICENSE

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DRIVER'S LICENSE

Do you have a valid license to operate a motor vehicle in New York State?

Yes

Do you have a Commercial Driver’s License (CDL)?

Yes

File Upload

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WORK EXPERIENCE

Beginning with your most recent employer, list all employment, military service, or volunteer experience that shows you meet the minimum qualifications for the examination. We cannot interpret omissions or vagueness in your favor. You are responsible for an accurate and clear description of your experience. (Do not send your resume). Describe the work which you personally performed. If you supervised, state how many people and the nature of such supervision.

Employment 1

Dates Employed: Month/Year to Month/Year

Employer

Address

City and State

Hours per week

Job Title

Supervisor's Name

Supervisor's Title

Type of Business

Describe specific work performed and job responsibilities:

Add a second employment?

Yes

Employment 2

Dates Employed: Month/Year to Month/Year

Employer

Address

City and State

Hours per week

Job Title

Supervisor's Name

Supervisor's Title

Type of Business

Describe specific work performed and job responsibilities:

Add a third employment?

Yes

Employment 3

Dates Employed: Month/Year to Month/Year

Employer

Address

City and State

Hours per week

Job Title

Supervisor's Name

Supervisor's Title

Type of Business

Describe specific work performed and job responsibilities:

Add a fourth employment?

Yes

Employment 4

Dates Employed: Month/Year to Month/Year

Employer

Address

City and State

Hours per week

Job Title

Supervisor's Name

Supervisor's Title

Type of Business

Describe specific work performed and job responsibilities:

REMARKS

Use this space to provide any additional information, as necessary.

Please add any additional information in this space:

THIS AFFIRMATION MUST BE COMPLETED

I affirm that the statements made on this application (including any attached documents) are true under the penalties of perjury.

Indicate any other surname (last name) by which you are or have been known

Date

By typing your initials here you are signing this document and are attesting that the Information entered is accurate to the best of your knowledge. This is required.