TOMPKINS COUNTY APPLICATION FOR EMPLOYMENT

Tompkins County is an Equal Opportunity employer.
Please type or print clearly.  An original signature is required.
 

1.   JOB/EXAMINATION TITLE:

_____________________________________

EXAM NUMBER:

________

 

2. SOCIAL SECURITY NUMBER:

____________________________

 

3.  NAME AND LEGAL ADDRESS:

LAST____________________________     FIRST____________________________     MI____  MAILING ADDRESS____________________________________________________________  CITY_____________________________     STATE__________     ZIP CODE_______________  VILLAGE_________________________  TOWN___________________________      YEARS/MONTHS AT ADDRESS_______/_______  COUNTY_________________________  SCHOOL DISTRICT________________  HOME TELEPHONE________________     WORK TELEPHONE_________________________

Note:  You must keep your address and telephone numbers current.

4. VETERANS CREDIT (IF APPLICABLE, CHECK ONE):      VETERAN _______  DISABLED VETERAN______

5. INDICATE A YES OR NO RESPONSE TO EACH QUESTION LISTED BELOW:
A. Are you an American citizen or, if not, do you have the legal right to accept employment in the US?______
B. Do you require special arrangements for examination (Saturday Sabbath observer or disability)? *______
C. Do you now, or have you ever, worked for any agency under Tompkins County's jurisdiction?______
D. Have you filed for or taken an examination with Tompkins County within the last two years?______
E. Were you ever dismissed from any employment for reasons other than lack of work? *______
F. Have you ever forfeited a bail bond posted to guarantee your appearance in court? *______
G. Have you ever been convicted of any crime (felony or misdemeanor)? *______
H. Are you an exempt volunteer firefighter?______
I. Are you presently in default on any loan made or guaranteed by the New York State Higher * Education Services Corporation?______

*If yes, please use the space below to give a full explanation. A "yes" answer to E, F, G or I above, will not necessarily disqualify you. Each case is evaluated on an individual basis in relation to the duties and responsibilities of the position for which you have applied. You may omit parking violations.
 

6. Law enforcement positions and positions requiring a commercial driver's license have minimum age restrictions. If you are applying for one of these positions OR if you are under the age of 18, enter your date of birth here: ___/___/___.