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WYOMING COUNTY CIVIL SERVICE143 North Main Street, Warsaw NY 14569Phone: (585) 786-8830
CHANGE OF ADDRESS: You must notify this agency immediately of any change of address. The number and title of the examination or eligiblelist must also be included in this notification. FAILURE TO COMPLY MAY RESULT IN YOUR NAME BEING REMOVED FROM ANELIGIBLE LIST.Call this agency immediately if you do not receive a notice within seven days of the date of the examination informing you whether or not you areto be admitted.
(Non-citizens may be required to produce 1-151 or 1-1551 Alien Registration Card at time of appointment)
Please check the type of work you would be willing to accept.
Please check those agencies in which you would be willing to accept work.
(Omit any offense adjudicated in Juvenile Court or under a youthful offender law.) Convictions will not necessarily disqualify you from employement.
*If yes, you will be required to supply a work permit.
DO NOT SUSTITUTE A RESUME FOR THIS SECTION. Complete all information requested. Describe in detail all the duties performed which are relevant to the position for which you have applied. List most current employment first.
Full-time is 30+ hours/week
Part-time is rated as follows:
0-09 hours/week = 0
10-19 hours/week = 1/4
20-29 hours/week = 1/2
Month/Year to Month/Year
If you have served or are currently serving in the Armed Forces of the United States of America in a designated time of war, and wish to claim additional examination credits, you must file a separate "Application for Veteran's Credit" VC-1 form.
It is the policy of the Wyoming County Civil Service Office to provide accommodations in testing to individuals with disabilities and religious observers and to provide for and promote equal opportunity employment, compensation, and other terms and conditions of employment to all employees and applicants without regard to race, color, religion, creed, sex/gender, sexual orientation, predisposing genetic characteristics, national origin, age, physical and/or mental disability, marital status, and/or military status, arrest history or criminal conviction status, status as a domestic violence victim or covered veteran's status or status as a member of any other protected group in accordance with applicable federal, state and local laws.
All claims and grants of veterans' credits are tentative and must be verified through inspection of discharge papers and other related documents, prior to the establishment of the eligible list. You will be advised as to which documents must be produced for this verification. All statements you make in support of your claim for additional credits are subject to investigation by this agency. In the event of subsequent disclosure of any material misstatement or fraud in this claim, your appointment may be rescinded. You may also be disqualified from further appointment on which you have been granted additional credits as a result of material misstatement or fraud. Persons claiming credits as disabled war veterans may be contacted by this agency for additional information.
This section MUST BE completed. Failure to sign this section will result in disapproval of your application for employment or examinations.
Affidavit: I certify that the answers provided by me in this application are true and complete to the best of my knowledge, and I understand that any omission, falsification, or misrepresentation of information by me in this application is grounds for refusal to hire or, if I have been hired, for termination and I release Wyoming County from any liability if I am terminated because of any material misstatements, omissions, or false information provided on this application/ I hereby confirm that I have never had my professional license, registration or certifications revoked, suspended, denied, restricted, limited or placed in a probationary status, nor do I have any knowledge that my professional license, registration or certification is currently under investigation except as disclosed in this application.
I authorize the County to investigate my background, references, employment record, criminal conviction record, and other matters related to my suitability for employment. This specifically includes, without limitations, a criminal background check. I also authorize my former employers or any third part to disclose to the county all reports without giving me prior notice of such disclosure. I hereby release the County, former employers, and all references listed above from any and all claims, demands, or liabilities arising out of, or related to such investigation or disclosure. A copy of this Authorization shall have the same force and effect as the original.
I also understand that a conditional offer of employment may be based on the results of a later medical examination and drug screening to determine whether I meet the physical requirements of the job for which I am hired. In addition, if accepted for employment, I hereby agree to abide by the rules and policies of Wyoming County.
As we move through the process of applying for employment or applying for an exam, there will be other information that we ask you to provide.
This field is not part of the form submission.
* indicates a required field