NYS Office of Parks, Recreation and Historic Preservation Employment Application - Free Download
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NYS Office of Parks, Recreation and Historic Preservation Employment Application
NYS Office of Parks, Recreation and Historic Preservation Employment Application
Are there any jobs that you have had in the last 5 years that are not listed on the Application
or your resume No Yes
If Yes, please explain:
Have you ever been discharged or asked to resign from any position in the past 5 years
No Yes
If Yes, please explain:
Are you currently awaiting trial on any criminal charge No Yes
If Yes, please explain:
Are you currently awaiting dismissal on a charge that has been adjourned in con-
templation of dismissal (ACOD) No Yes
If Yes, please explain:
Except for minor traffic violations, have you ever been convicted of a violation of the law
(A YES answer does not necessarily preclude you from employment with this agency.) You
must disclose violations, misdemeanors, and felony convictions including all DWI and DWAI
convictions. You should answer NO if you have had a conviction sealed by a court, the
offense resulted in a youthful offender adjudication, or if it was adjourned in contemplation
of dismissal (ACOD) and the adjournment period has ended. No Yes
If you answered yes, please provide the following information:
List ALL violations(s) or crime(s) of which you were convicted and the date(s) of
the convictions below: (attach additional sheet of paper if more space is needed)
Yes No
OVER
ADDITIONAL WORK HISTORY
College(s)
Other
Job Related Skills/Licenses/Certificates
Yes No Class
EDUCATION
Circle the last grade level you have completed K 1 2 3 4 5 6 7 8 9 10 11 12 GED Graduate
Yes No
Are you legally eligible to work
in the United States
City
Employer Address Salary Employed From and To
Company
NYS Office of Parks, Recreation and Historic Preservation
Employment Application
Name
Street
State Zip Code
Telephone:
Day Evening
Are you 18 years of age or older
Yes No If no, age
Seasonal/Temporary Positions (Hourly)
Annual Salaried Positions
Location Dates Employed
Salary
Employer Address Salary Employed From and To
Explain Duties
Reason for Leaving
Explain Duties
Reason for Leaving
CURRENT / MOST RECENT JOB
Attach resume if available
Explain Duties – Include reason for leaving if no longer employed.
E-Mail: Home
Will you now, or in the future, require sponsorship for employment visa status
(eg H-1B visa status)
Yes
No
NYS Driver's License:
Work/School
Work Location(s) Desired
Type of Work/Position Desired
Have you worked for
this agency before Yes Year No
Any dates not available
If yes, please list
Date Available to Begin Available to Work Until (Date)
Available (Check all that apply)
Full Time Part Time Weekends
Yes No
Do you currently
work for any other
NYS agency
If Yes, where
Credits
Major Subject
Degree Received
Phone No.
Supervisor
ADM-113
Supervisor:
Phone No.:
Supervisor:
Phone No.:
Are you currently on parole or probation No Yes
If Yes, please explain:
I affirm under penalty of perjury that all statements made on this application are true.
I understand that all statements made by me in connection with this application for
employment are subject to investigation and verification which may include checking
any and all public records to verify the accuracy of information provided. An omission,
material misstatement or fraudulent representation may disqualify me from appointment
and/or lead to revocation of my appointment.
Signature Date
OPRHP Reviewer Name Date Reviewed
Is any relative, including, but not limited to, spouse, children, parents, siblings or in-laws
currently employed by this agency (A yes answer does not necessarily preclude employment)
Yes No
Cell
Yes No
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