WPC ɡ?A7>ZJ^R萛o]?s5+S #bQ16;@)-[<\,+|^siQrqtfX/hbL,q&d^,}/?@nLhoWjHϱwacZK3Ŀ¹Cqu*F~IR2Z9yIl`fgpWRHv_r$"Hϋk!ltثD̈́rY/<;# mQI! 7DktM;eH*FnV 1x*r$&^Bg,~ġ}ѷK fކ8#['-$fk e."=VCk,%Gؔ!'ƨKݔgWDpB"IZ$\HJt# XULc % 0( 4  UN T jT f f a f U > f h a f f a f a a f a f U> B?f\a^frftavaaa AMf 0D 0K D3\ B Cafafff D/ B%aBaVfjalfaafafafafaf D+a! h85 B7m C h^a2 CF B-`fa C D; hH R@ h h|F B AM, 0J h5< Cq C h hT hC hC hC^ h8 hC h hC hC hQ h% h3 h8 h h h%0 hCUUUw@HPLJ4_5AHPPCL5MS ,,,, 0.@F Z4GeoSlab703 Lt BT LightX($xsE%X3|x9 .7lAZ<EngraversGothic BT RegularGeneral Application for Examination/*Exam Application$Richard Rubin . TABLE A0 0qZ &Univers Regular       TABLE D TABLE DTABLE BTABLE C0 0qZ &Univers Regular dTABLE ITABLE ATABLE KTABLE F&'()A<< CLevel 1Level 2Level 3Level 4Level 5(3$ !  ( $ Figure  1  ****'dxd d2dTABLE FTABLE G33' dxdP PdTABLE HTABLE QTABLE ETABLE NTABLE LTABLE MTABLE NTABLE O'dxdTABLE P  TABLE A 3+0 d d d   dd    TABLE B TABLE R d)Hairline d\TABLE Sd7Hairlinedxd*@H)TABLE Fn@TABLE C dX'YDA<< BLevel 1Level 2Level 3Level 4Level 5(P$ Table  1  @ddd TABLE K4@TABLE I3@TABLE Q6@TABLE A%%TABLE F%--1@TABLE G-/ /////////002@TABLE E011@TABLE H16 66666666TABLE R68TABLE N8;;;;;;TABLE L;==TABLE M=? ????????TABLE N?AAAAAATABLE OACTABLE PCNN@TABLE SN 0 D1 U2 D3 4 5 V6 D7 V8 V9 U !  8XAXXX X2XXXA, %%X X2  TRY3' Letter3' 3' Letter3'THL*q M ddd Xdd Xdd X,&,&q,% +  +MMM , + \\% %$2<#`cdd  TheNewYorkStateHumanRightsLawprohibitsdiscriminationinemploymentbecauseofage,race,creed,color,nationalorigin,sex,disability,handicapormaritalstatus.Accordingly, d nothinginthisapplicationformshouldbeviewedasexpressing,directlyorindirectly,anylimitation,specificationordiscriminationastoage,race,creed,color,nationalorigin,sex,disability,handicapormaritalstatusinconnectionwithemploymentinthemunicipalserviceof# %%\ \# \\% %ԀUlster# %%\ \A# \\% %ԀCounty.ItisthepolicyofUlsterCountytoprovideequalopportunitytoallemployeesand | applicantsforemploymentwithoutregardtoage,race,creed,nationalorigin,sex,disability,handicap,maritalstatusoranyotherprotectedstatus.# %%\ \#$<2#dd`c/%#4 MMM /% fL% % s fL *O M dd% M ,&,&O,dd",dd",dd +  M  # fL s`# \\ fL LeavethisspaceblankDateReceived " M " @  X2X \COUNTYOFULSTER  T(  APPLICATIONFOR tH  EXAMINATIONOREMPLOYMENT  d8  # \\X X2#3 -  w\ \6- # \6\ w #3  fL\ \___________________________________________________________ TITLEOFPOSITIONAPPLYINGFOR,EXAM#IF# \\ fL # fL\ \APPLICABLE# \\ fL # s\ \  d # \\ s #LeavethisSpaceBlankApproved_______Disapproved_______Conditional_______  *qM dddd"dd"dd M,&,&q,dd ,dd +   p D   X2X\ \INSTRUCTIONSANDINFORMATION # \\X X2 # %  %  MAILORDELIVERTO:UlsterCountyPersonnelDepartment,CountyOfficeBuilding,   244FairSt.,Box1800,Kingston,NY124021800.Telephone(914)3403550.UlsterCountyisanequalopportunityaffirmativeactionhandicapemployer. .$  .6   COMPLETINGTHISAPPLICATION󀄀Thisapplicationispartofyourexamination.   Answerallquestionsfullyandcarefully.Printininkorusetypewriter.Attachadditionalsheetsifnecessaryinordertogivecompleteanddetailedinformation.Allstatementsaresubjecttoverification.ANNOUNCEMENTOFEXAMINATIONCarefullyreadtheexaminationannouncement  # beforefillingoutyourapplication.FILINGFEE󀄀Theremaybeafilingfeefortheexaminationforwhichyouareapplying. l@& Pleaserefertotheexaminationannouncement.Ifthereisafilingfee,itmaybewaivedasdescribedontheexaminationannouncement. 4*X( 4ADMISSIONTOEXAMINATION󀄀Ifyoudonotreceiveanoticewithinthreedaysofthe  ) examinationinformingyouwhetherornotyouaretobeadmittedtotheexamination,callorwireUlsterCountyPersonnelDepartmentimmediately.Donotinterpretanoticetoappearfor,oractualparticipationin,theexaminationtomeanthatyouhavebeenfoundtomeetfullytheannouncedrequirements.Dependingonthetimeavailablebeforethisexamination,applicantsmaybeadmittedtotheexaminationonthebasisofstatementsmadeontheapplicationorconditionallywithoutpriorreviewoftheapplication.Suchstatementsmaynotbereviewedand/orverifieduntilaftertheexaminationisheld.Atthattimethosecandidatesnotmeetingtherequirementsaredisqualified.Candidateswhoaresubsequentlydisqualifiedaftertakingthetestwillnotbenotifiedoftheirscore. X2X\ \"X3  "# \\X X2#(3{ 3{,&,&( v\ \Ԁ1.NAMEANDRESIDENCE @3 __________________________________________________LastName   4 FirstName  < Initial l6 __________________________________________________Address__________________________________________________PostOfficeorCity 4 State Zip T< # \\ v#  ImmediatewrittennoticeshouldbegivenofanychangeinPostOfficeaddressorlegal > residencebeforeorafterexamination.Thismustincludedateofchange. v\ \ 8 ? _________________________________________________DayPhone  EveningPhone T(B #^ vd# v^2.SocialSecurityNumber:_______________#^ vb# v^3.Checktheappropriatelinetotherightofeachquestion:# \\ v# v\ \ tHF A.WereyoueverdismissedordischargedforYesNoreasonsotherthanlackofworkorfunds? < ________ !H B.Haveyoueverbeenconvictedofanycrime(felonyormisdemeanor)?   < ________ "h!J C.IfyouservedintheArmedForcesoftheUnitedStates,didyoureceiveadischargewhichwasotherthanhonorable?   < ________ $#M   Ifyouanswered"Yes"toanyoftheabove,youmaygivespecificsunder"Remarks"onthelastpageofthisapplication.Ifyouelectnottoprovidespecifics,however,orifsuchexplanationisinsufficient,aconfidentialinvestigationsupplementwillbesenttoyou.Noneoftheabovecircumstancesrepresentsanautomaticbartoemployment.Eachcaseisconsideredandevaluatedonindividualmeritsinrelationtothedutiesandresponsibilitiesofthepositionforwhichyouareapplying.# \\ vV#^ v\ \  9  /-Z 9 4.Stateyourpermanentlegalresidenceforeachofthegeographicareasbelow,indicatingthelengthofcontinuousresidencetodate.*` M dddd dd M&&`,|dd ,dd ,dd +   l]  %^ % +MMMM_ +Yrs/Mos +MMM`MMMM +SchoolDistrict "X,aMMM "  X,b  MM X,c Town "dMM "  e  MM f Village "gMM "  h  MM i County "l@jMM "  l@k  MMM l@l State "mMMM "  n  o  # \\ v# v\ \5.AreyoucurrentlyaU.S.citizen?_____Yes_____No@Ifnot,givealienregistrationnumber:_____________________# \\ v"# v\ \6.# \\ v## u\ \ԀIfyouareunder18yearsofage,canyouprovideproofof  |t youreligibilitytowork?_____Yes______No@2#@7.Ifthepositionyouareapplyingforhasminimumormaximumagelimits(seeannouncement),pleaseenteryourbirthdate:Month_____Day_____Year_____# \\ u## v\ \ %^$y # \\ vt%#@$ v\ \@$# \\ v%# v\ \8.Doyoupossesscertificationasanexemptvolunteer ~'R&{ firefighter?______Yes______No@&#ddd9.IfyouhaveeverbeenemployedbytheCountyofUlster :*)~ orbyanycivildivisiontherein(city,town,village,schooldistrictorspecialdistrict),pleasestatelocation(s)anddate(s)____________________________________________# \\ v:&##ddd& v\ \_____ ,f+ ________________________________________________________8  "., 8 (3{ 3{,2,2(*qQM ,dd|dd dd dd M,&,&q,%dd +  ,MMMM , ,# \\ v'(# X2X\ \APPLICATIONFOREXAMINATIONOREMPLOYMENTPage2# \\X X2)# X2X\ \5+)," 0 MMMM 5# \\X X2>*# v\ \(X,&,&(10.Areyounowservingorhaveyoueverservedinthe L  ArmedForcesoftheUnitedStatesonafulltimeactivedutybasisotherthanactivedutyfortrainingpurposes?  ______Yes______NoIf"No",omitquestions11to1311.DidyouserveintheArmedForcesoftheUnitedStatesduringanyofthefollowingperiods?A.December7,1941toDecember31,1946B.June27,1950toJanuary31,1955C.December22,1961toMay7,1975D.August2,1990to"datetobedetermined"E.U.S.PublicHealthService:July29,1945toDecember31,1946,orJune27,1950toJuly3,1952  ______Yes______NoDidyoureceiveanexpeditionarymedalforanyofthefollowingconflicts?F.LebanonJune1,1983toDecember1,1987G.GrenadaOctober23,1983toNovember21,1983H.PanamaDecember20,1989toJanuary31,1990  ______Yes______NoI.Iamcurrentlyonactiveduty(forotherthantrainingpurposes).  ______Yes______No==12.SinceJanuary1,1951,haveyoueverusedadditionalcreditsasaveteranforappointmenttoanypositioninthepublicemploymentofNewYorkStateoranyofitscivildivisions?̀  ______Yes______No " =B/=# \\ v*# v\ \ @$ #^ v##\\^0# \\\\ v\ \*O# d,d%dd QM&&O,d , d +   L $ #^ v 1# v^# \\ v+1# v\ \13.Areyou:#^ v2##\\^T2# \\\\ v\ \  % #^ v2# v^# \\ v2# v\ \Anondisabledwarveteran______#^ v;3##\\^}3#'bXXX' \\\\ v\ \ z%  & #^ v,4# v^# \\ vK4# v\ \A#^ v4##\\^4# \\\\ v\ \disabledwarveteran#^ vY5##\\^x5# \\\\ v\ \Ԁ#^ v5##\\^6# \\\\ v\ \______#^ vv6##\\^6# \\\\ v\ \ xL' #^ v7##\\^7#^\\ v^Disabledandnondisabledwarveteranswhoareeligiblefor pD' additionalcreditsmustsubmitanapplicationforveterans'credits.Candidateswhowishtoclaimveterans'creditsonanexaminationshouldrequestthisapplicationfromtheUlsterCountyPersonnelDepartment.Thecompletedandnotarizedformsmustbereceivedintheofficebeforetheeligiblelistforthisexaminationisestablished.# \\ v7# v\ \0 0 1 1 14.FOREXAMINATIONPURPOSESONLY:Checkbelowifyoudesirespecialstatusbecauseyouarea:1._____SabbathObserverandcannotbetestedonSaturdaysforreligiousreasons.2._____DisabledPerson:#^ v7# v^# \\ v9# v\ \Indicatetypeofassistance `45 required#^ v:##\\^;#^\\ v^under"REMARKS"onthelastpageofthis (6 application.  7   8 15.DoyouhaveavalidlicensetooperateamotorvehicleinNewYorkState?______YesClass____#^ v;# v^# \\ v;# v\ \______#^ v<##\\^,=# \\\\ v\ \ԀNo#^ v=##\\^=#^\\ v^ H: 16.# \\ v># \ \EXAMINATIONSINOTHERJURISDICTIONS# \\ ># v\ \ԀCandidates < wishingtoparticipateinadditionalexaminationsforNewYorkStateorotherjurisdictionsonthesameday,mustapplyindividuallytoeachjurisdiction.Ifyouintendtodothisindicate,under"REMARKS"onthelastpageofthisapplication,thejurisdictionstowhichyouhaveapplied,andtheexaminationsiteatwhichyouplantocompete.NewYorkStateexaminationsmustbetakenatstateexaminationsites.Requestsforthistypeofconsiderationmaynotbeapprovedifreceivedaftertheannouncedlastfiledatefortheexamination.# \\ v?# v\ \2  HD 2  |F (X,,(# \\ vA# v\ \*`%M, ddd d #,&,&`,%dd +  & F &Thefollowingsectionsoneducationandworkexperiencemustbefilledincompletely.Aresumeisnotsufficient.5+)G 0  5*O-M. dd%dd %M,,&,&O,%dd +   G 33# \\ v%B# v\ \17.Haveyougraduatedfromhighschool?___Yes#^ v=># v^# \\ v\D# v\ \Ԁ___No#^ vD##\\^E#^\\ v^ԀEquivalencydiploma#:_______________________  dI ЀIfnot,whatgradedidyoucomplete?____̀Nameofschool/issuingagency___________________________# \\ vE# v\ \Address:___________________________# \\ vF# v\ \," n"B!K 0  ,# \\ vF#33'D v\ \*OM" ,dd%dd -M.,&,&O,dd ,dd ,dd ,dd , dd ,vdd ,dd ,Xdd ,gdd +  !MMM f#:"K !# \\ vsG# fL\ \ListBelowCollege,University,Professional,TechnicalandotherschoolsorspecialcoursesPleaseprovidecopiesoftranscripts# \\ fL"I##\\\ \E#^\\ v^ *MM#"LMMM  *# \\ v J#3  \ \6# \6\ K#3 #\\\ \)J# \\\\ fL\ \Nameofschoolanditslocation# \\ fL#K##\\\ \K# \\\\ 2MM!$#MMM 2DatesofAttendanceFrom:__/__To:__/__(month/year) ;MM*&t%Q"MM ;FullorPartTime ;MM*%\$S"MM ;No.ofyearscredited ;MM*&$V"MM ;DidyouGraduate? ;MM*%\$X"MM ;TypeofCourseorMajor ;MM*&t%\"MM ;No.ofCollegeCreditsReceived ;MM*&t%`"MM ;DegreeEarned ;MM*%\$b"MM ;DateofDegree 0MM!%\$d"MM 0#\\\ \K# \\\\E ,'&eMM ,From:______/______ ,'&f , ,'&g , ,'&h , ,'&i , ,'&j , ,'&k , ,'&l , 'MM'&m 'ND fL\ \  # \\ fLP#P#\\\ \N# \\\\,J "('nMM "To:______/______  ('o   ('p   ('q   ('r   ('s   ('t   ('u  MM ('v #\\\ \&Q#EQ \\\\L )*(wMM )#\\\ \vR# \\\\From:______/______#\\\ \R# \\\\ )*(x ) )*(y ) )*(z ) )*({ ) )*(| ) )*(} ) )*(~ ) 'MM*( '4  \ \6# \6\ V#4 #\\\ \KS#R \\\\"O " +)MM "#\\\ \5U# \\\\To:______/______#\\\ \U# \\\\   +)    +)    +)    +)    +)    +)    +)  MM  +)  fL\ \  # \\ fLV##\\\ \V#TU \\\\R )@,+MM )#\\\ \WW# \\\\From:______/______#\\\ \W# \\\\ )@,+ ) )@,+ ) )@,+ ) )@,+ ) )@,+ ) )@,+ ) )@,+ ) 'MM@,+ ' fL\ \  # \\ fLY##\\\ \,X#vW \\\\BT "`-4,MM "#\\\ \Z# \\\\To:______/______#\\\ \Z# \\\\  `-4,   `-4,   `-4,   `-4,   `-4,   `-4,   `-4, 4 MM -^,  \ \6  # \6\ ^#4 #\\\ \Z#7Z4  \6\\\&W )/-MM )#\\\ \6_# \6\\\From:______/______#\\\ \6`# \6\\\ )/- ) )/- ) )/- ) )/- ) )/- ) )/- ) )/- )4 3 FMM7J.,  0F \ \6  # \6\ i# \ \63 4 #\\\ \6Y`#4 3  \6\\\# \6\ *j# \ \6  # \6\ j##%\\##% lj# \6\\\# \6\ k# \ \6  # \6\ k##%\\##% Ik# \6\\\# \6\ k# \ \6  # \6\ _l##%\\##% l# \6\\\# \6\ l# \ \6  # \6\ 2m##\\\ \6l#3 4 _4 3  \6\\\bY A75d  0 MM A#\\\ \67n# \6\\\To:______/______#\\\ \6:o#3  \\\\3  d   d   d   d    d    d    d  n3  C\ \ `-4,  # \\ Cld# v\ \5  .- 5 *1QM4,d ,ddd dd dd dd dd vdd dd Xdd gdd M",&,&,%dd +  (MMMM  (# \\ vd# X2X\ \APPLICATIONFOREXAMINATIONOREMPLOYMENTPage3# \\X X2^f# X2X\ \/%#X," MMMM /# \\X X2f#   v\ \*O0M7 d,d%dd 1QM4,&,&O,%dd +  " xL  "# \\ vVg# v\ \18.DESCRIPTIONOFEXPERIENCE# \\ v@h# fL\ \:Inlistingyourexperience,bemorespecificindescribingthosewhichrelatetothepositionforwhichyouare  applying.Beginwithyourmostrecentemployment.Youareresponsibleforsubmittinganaccurate,adequateandcleardescriptionofyourexperience.Omissionsorvaguenesswillnotberesolvedinyourfavor.Includemilitaryserviceexperiencewhenappropriate.Relevantvolunteer(unpaid)experiencewillbeconsideredifverifiedandfullydocumented(unlessotherwisestatedontheexaminationannouncement).Ifyourtitleordutieschangedmateriallyinthecourseofyourserviceinanyoneorganization,indicatesuchchangeclearlyandasaseparateemployment.(Ifmorespaceisneeded,attach8"x11"sheetsofpaperusingthesameformat.)# \\ fLh# v\ \/%#tH   /# \\ vk#Jg h  #\\\ \c#\\\\*O/M: dd%dd 0M7,&,&O,dd",dd",dd",dd",dd",7dd"+  (MM B (fL\\LengthofEmployment z  (Mo/Yr) @MM-$ "MM @FirmName @MM-z "MM @Address @MM-z "MM @CityandState @MM-z "MM @Earnings(CircleOne) :M-z"MM :TypeofBusiness @M-z"M  @#\\fLn#From____/____To____/____ @M-V *" M  @ @M-V *" M  @ @M-V *" M  @ @M-V *" M  @$__________,hH,\\(Wk/Mo/Yr)#\\,,hHfq# 7-V *" M  7/%#V *"    /#\\\\l#\\\\*;M< dddd"dd"dd"dd"dd"7dd"/M:,&,&, dd ,dd ,D dd , dd +     YourExactTitle %v J  %NameofyourSupervisor %v J  %Supervisor'sTitle %v J  %No.ofhoursworkedperweek "v J  "   j     j     j  (exclusiveofovertime)________  j   #\\\\;r#*=M> dd dd dd D dd  dd ;M<,&,&,%dd +  \\\\  R &  l  #\\\\u# \\\\DUTIES:Describethenatureoftheworkpersonallyperformedbyyou,withestimatesofpercentagesoftimespentoneachtypeofwork.   Statesizeandkindofworkingforce,ifany,supervisedbyyouandtheextentofsuchsupervision.#\\\ \,v#\\\\ 0&&    0lu (F     ( f:!     Z"    w6i z#    oxcY$    #\\\\lw#\\\\*O?M@ dd%dd =M>,&,&O,dd",dd",dd",dd",dd",Udd"+  (MM % (fL\\LengthofEmployment V*& (Mo/Yr) @MM-'"MM @FirmName @MM-V*("MM @Address @MM-V*)"MM @CityandState @MM-V**"MM @Earnings(CircleOne) :M-V*+"MM :TypeofBusiness @M-V*,"M  @#\\fLTz#From____/____To____/____ @M--" M  @ @M-." M  @ @M-/" M  @ @M-0" M  @$__________,hH,\\(Wk/Mo/Yr)#\\,,hH}# 7-1" M  7/%#2"    /#\\\\y#\\\\*AMB dddd"dd"dd"dd"dd"Udd"?M@,&,&, dd ,dd ,D dd , dd +   23 YourExactTitle %j4 %NameofyourSupervisor %j5 %Supervisor'sTitle %j6 %No.ofhoursworkedperweek "j7 "  8   9   : (exclusiveofovertime)________ ;  #\\\\~#*CME ,dd dd dd D dd  dd AMB,&,&,%dd +  \\\\  rF;   <     =     >     6 ?    V*@    #\\\\#\\\\*OM d,d%dd CME,&,&O,dd",dd",dd",dd",dd",sdd"+  (MM @ (fL\\LengthofEmployment vJA (Mo/Yr) @MM-B"MM @FirmName @MM-vJC"MM @Address @MM-vJD"MM @CityandState @MM-vJE"MM @Earnings(CircleOne) :M-vJF"MM :TypeofBusiness @M-vJG"M  @#\\fL4#From____/____To____/____ @M-&!H" M  @ @M-&!I" M  @ @M-&!J" M  @ @M-&!K" M  @$__________,hH,\\(Wk/Mo/Yr)#\\,,hH# 7-&!L" M  7/%#&!M"    /#\\\\#\\\\*M! dddd"dd"dd"dd"dd"sdd"M,&,&, dd ,dd ,D dd , dd +   R"&!N YourExactTitle %"!O %NameofyourSupervisor %"!P %Supervisor'sTitle %"!Q %No.ofhoursworkedperweek ""!R "  #"S   #"T   #"U (exclusiveofovertime)________ #"V  #\\\\`#\\\\*8M9 ,dd dd dd D dd  dd M!,&,&,%dd +   %#W   ,"f%:$X     , &Z%Y     'z&Z     ('[    )(\    #\\\\4#x\\\\#\\\\#\\\\3 HL    3 v\\DONOTWRITEINTHISSPACE#\\v# +*^ N3 HL  3 7  .-d HL  7 7 HL  7 6 6 5 HL  5 6 6 #\\\\<# \\\\6 6 *UNQMO,d,d%dd 8M9,&,&U,%dd +  (MMMM p ( X2X\ \APPLICATIONFOREXAMINATIONOREMPLOYMENTPage4# \\X X2 # X2X\ \/%#<" MMMM /#XAXX X2>#h#\\XXA#*OM5 d,d%dd NQMO,&,&O,%dd +   \    \\\\ v\ \19.Licenses# \\ v#:Ifalicense,certificateorotherauthorizationtopracticeatradeorprofessionislistedasarequirementontheannouncementoftheexamination(s)orposition(s) X forwhichyouareapplying,completethefollowing.Ifnotcurrentlylicensedcheckthisboxr#\\\ \֑# \\\\/%#   /*O6MK dd%dd M5,&,&O,` dd ,` dd ,` dd ,` dd +   D Nameoftradeorprofession %@  %LicenseNumber %@  %Grantedby(LicensingAgency) %@ % "@  "  `    `   "`  "  `  CityorState %  %Specialty % %DateLicenseFirstIssued % %Registered(Mo/Yr) " "            #\\\ \섓# \\\\From:#\\\ \?# \\\\Ԁ_____/_____To:_____/_____    #\\\ \솗# \\\\*)Mdd` dd ` dd ` dd ` dd 6MK,&,&,dd ,dd +  %M  \ % v\ \20.REMARKS: :M-( M : :M-( M : :M-  M : :M-  M : :M- x M : :M- x M : :M-< M : :M-< M : :M-0M : :M-0M : :M-M : :M- M : :M-P!M : :M-P"M : :M-D#M : :M-D$M : :M-%M : :M-&M : :M-d'M : :M-d(M : :M-X)M : :M-X*M : :M-+M : :M-,M : :M-x-M :/%#x. M /ʑ  21.AFFIRMATIONANDAUTHORIZATIONTORELEASE#^ v# v^Iaffirmthatthestatementsmadeonthisapplicationandanyattachedpapersordocumentsaretrueunderthepenaltiesof d1 perjury.IherebyauthorizetheUlsterCountyPersonnelDepartment,oranypersonactingontheirbehalf,toinvestigateandreceiveinformationaboutmerelatedtotheverificationofmyqualificationsandeligibilityfortheexaminationorthepositionforwhichIamapplying.Further,Iauthorizeanypersonwhoreceivesarequesttodiscloseinformationrelatedtothisapplication,toreleaseanyorallinformationaboutmetowhichsuchpersonmayhaveaccess.Ispecificallyauthorizesuchdisclosuresandagreetoholdharmlessallcorporations,agentsorpersonswhorequestorreleasesuchinformation.#^ v# v^SIGNATURE______________________________________________________________DATE____________Checkheretoindicatethatyoudonotwishyourpresentemployertobecontactedatthistime. %D$< Stateanyothernameyouhaveusedineducationoremployment:___________________________________π  *`* d ddd dd )M,&,&`,%dd +  %V (<'@  %f fL v22.APPLICATIONSUPPLEMENT )'A Section50boftheNewYorkStateCivilServiceLawrequiresthatallapplicantsforexaminationbeaskedthefollowingquestions:1.HaveyouanyloansmadeorguaranteedbytheNewYorkStateHigherEducationServicesCorporationwhicharecurrentlyoutstanding?̀Yes  No +f*F 2.Ifso,areyoupresentlyindefaultonanysuchloan?YesNo ,+H Name___________________________________________________________Address% S Ԁ_________________________________________________________________Signature_________________________________________________________Date_____________________________________________________________________# v fL8#/%#>0.N  V /f&