Get NY ACS-21 2023-2024

Albany County Civil Service 112 State Street Room 900 Albany New York 12207 APPLICATION FOR EXAMINATION OR EMPLOYMENT FormACC14-R1 ACS-21 Rev 11-17 Form www. albanycounty. com Title and Exam Number of Position applying for This application is part of your examination* Answer all questions fully and carefully in ink or in typewriter. Some questions can be answered with an x in the box which applies to you. Attach additional sheets if necessary in order to give complete and detailed information* 5. Are you taking exams with NYS State or any other County Town or City that are being 1. SOCIAL SECURITY NUMBER held on the same date as the exam s you are applying for with Albany County - Yes No If yes please attach the Cross-file Application and list all examinations. This can be found on our website. 2. FULL NAME AND ADDRESS 6. Are you requesting special testing accommodation s such as Last Name First Name M. I. Mailing Address For a disability An alternate test date Please submit your request s for accommodations in writing on an attached sheet. You will have to provide documentation to support your request s. If you request an alternate test date please complete the Alternate Test Date Application* City State Zip Code 2a* RESIDENT STREET ADDRESS if different from above 7. CHECK APPROPRIATE BOXES A. Were you ever dismissed or discharged from any Employment for reasons other than lack of work or funds B. Did you ever resign from any employment rather than face dismissal Forces of the United States which was other than Honorable or which was issued under other than honorable circumstances 2b. PHONE NUMBER include area code Home Other Specify work cell etc* 2c* E-MAIL 3. RESIDENCE If you are applying for an open-competitive examination please indicate below the municipality/district in which you will be a legal resident prior to the examination date. City or Village If you answer YES to any of questions above you must give specifics. Attach 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. Town County 8. SERVICE IN ARMED FORCES Have you ever served in the armed forces of the United States Name of School District 4. CITIZENSHIP AGE If you are not a citizen of the United States do you have the legal right to accept employment in the United States If your answer is yes please go to item 9. 9. VETERAN S CREDITS Do you claim additional credits as an honorably discharged war veteran Yes as a Non-disabled war veteran Yes as a Disabled war veteran Non-citizens may be required to produce Alien Registration Card at time of appointment Are you under 18 If the answer is yes then see form ACS-21a page 3 If yes or if minimum and/or maximum age limits are established for the position applied for enter your date of birth here Mo. Day If a motor vehicle license is required for the position for which you are applying please give the following Chauffeur Year Class Operator Date of Expiration Number THIS DECLARATION MUST BE COMPLETED I declare subject to the penalties of perjury that the statements made in this application including statements made in any accompanying papers have been examined by me and to the best of my knowledge and belief are true and correct.