Career Opportunities in Hyde Park, NY

Application For Employment

Name

Address

AN EQUAL OPPORTUNITY EMPLOYER

Indicate language you speak, read, and/or write.

List professional, trade, business or civic activities and offices held. (You may exclude membership which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status):

Give name, address and telephone number of three references who are not related to you and are not previous employers.

Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals With Physical Or Mental Handicaps.

Government contractors are subject to 38 USC 2012 of the Viet Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.

If you are a disabled veterans, or have a physical or mental handicap you are invited to volunteer this information which will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.

Emplyment Experience

Start with your present or last job. Include military service assignment and volunteer activities. You may exclude organization names which indicate race, color, religion, gender, national origin, handicap or other protected status.

1

Dates Employed

Hourly Rate/Salary

2

Dates Employed

Hourly Rate/Salary

3

Dates Employed

Hourly Rate/Salary

4

Dates Employed

Hourly Rate/Salary

If you need additional space, please continue on a separate sheet of paper.

Special Skills and Qualifications

Education

Years Completed/Degree

Applicant's Statement

I certify that answers given herein are true and comlete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employmeny shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applicants are being accepted at that time.

The applicant understands that neither this document nor any offer of emplyment from the employer constitute an employment contract uness a specific document to that affect is executed by the employer and employee in writing.

In the event of employment. I understand that false or misleading information given in any application or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations of the employer.

For Personnel Department Use Only

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