80 Adm Form PDF Details

In an era where equal employment opportunities are increasingly recognized as both a legal and moral imperative, the State of New York has embodied this principle through its Office of Mental Health's FORM 80 ADM (MH). Crafted to streamline the application process for employment within this sector, the form serves as a crucial first step for candidates. It emphasizes the state's commitment to offering an unbiased platform that welcomes applicants irrespective of race, color, gender, religion, age, national origin, disability, marital status, sexual orientation, or Vietnam Era Veteran status. At its core, the form requests comprehensive personal information, details about desired positions, employment history, and other pertinent data such as educational background, driving license status, and military service, providing a thorough overview of the applicant's qualifications and eligibility. Moreover, it includes sections on additional information seeking disclosures on age, legal work status, and past criminal convictions, aiming to ensure a safe and competent workforce. True to its purpose, the form aligns with the procedural norms for employment applications while reaffirming the state's adherence to principles of equality and fairness in its recruitment processes.

QuestionAnswer
Form Name80 Adm Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other names80 application, nys omh forms, pdf who moved my cheese, pdf who am i

Form Preview Example

FORM 80 ADM (MH) (7/02)

State of New York

 

OFFICE OF MENTAL HEALTH

Facility Stamp

APPLICATION FOR EMPLOYMENT

It is the policy of the New York State Office of Mental Health to provide an equal employment opportunity to all people without regard to race, color, gender, religion, age, national origin, disability, marital status, sexual orientation or Vietnam Era Veteran Status.

INSTRUCTIONS: All questions are to be answered by the applicant. False statements may be grounds for dismissal.

A. PERSONAL INFORMATION

Last Name

First Name

Middle Initial

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residence — Street Address

 

 

 

 

Home Telephone Number

 

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

 

 

 

City/Town/Village

 

State

 

Zip Code

Business Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. POSITION(S) DESIRED (If Known)

Date Available

Are you available

q YES

Are you on a state civil service list

q YES

 

for full time work?

for the position for which you

 

 

q NO

are applying?

q NO

 

 

 

 

 

C. EMPLOYMENT HISTORY (Start with Most Recent/Current Employment)

Is additional information concerning change of name or use of assumed name/nickname necessary to check on your employment history?

q NO

q YES

If YES, Explain ______________________________________________________________________________

May we contact your current employer for a reference?

q NO

q YES

q NOT APPLICABLE

From (Mo/Yr)

To (Mo/Yr)

Salary

From (Mo/Yr)

To (Mo/Yr)

Salary

From (Mo/Yr)

To (Mo/Yr)

Salary

Name of Employer

Employer’s Address

Name of Supervisor

Name of Employer

Employer’s Address

Name of Supervisor

Name of Employer

Employer’s Address

Name of Supervisor

Reason for Leaving

Reason for Leaving

Reason for Leaving

Title

Duties

Title

Duties

Title

Duties

If appropriate, attach a resume or separate sheet to describe all other employment, volunteer work, or experience relevant to the position you are seeking.

D. MILITARY SERVICE

Have you ever served in the Armed Forces of the United States?

q Yes

q No

Branch _____________________________

Are you claiming Veteran’s Credits?

q Yes

q No If YES, and you are hired, you will be required to furnish a copy of your DD214.

 

q Yes

q No

(*A NO answer is not an automatic bar to employment. Each response will be

Did you receive an honorable discharge?*

reviewed on an individual basis in relation to ability to perform job duties.

Explain in “Remarks” on page 2.)

— AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER —

E. EDUCATION

Circle highest grade completed

1 2 3 4 5 6

7 8 9 10 11 12

College: 1 2

3 4 4+

 

Do you have a High School Equivalency Diploma?

q YES (If YES, specify issuing body and number _______________________ )

q NO

 

 

 

 

DIPLOMA OR

 

 

 

 

 

DEGREE

 

SCHOOL

NAME

 

CITY AND STATE

RECEIVED

MAJOR

High

 

 

 

 

 

School

 

 

 

 

 

College,

 

 

 

 

 

Technical or

 

 

 

 

 

Business School

 

 

 

 

 

Graduate

 

 

 

 

 

School or

 

 

 

 

 

Additional

 

 

 

 

 

Training

 

 

 

 

 

 

 

 

 

 

 

F. ADDITIONAL INFORMATION (Answer all questions)

1.Are you 18 years of age or older?

2.Do you possess a current Drivers License?

3.Except for minor traffic violations, have you ever been convicted of a crime (Felony or Misdemeanor)?*

4.Are you now under charges for any crime?*

5.Are you a citizen of the United States or do you have the legal right to accept employment in the United States?

6.Have you ever been employed by New York State?

7.Have you ever been employed by this facility?

8.Have you previously applied to this Facility/Agency for employment?

9.Were you ever discharged from employment except for lack of work or funds, disability or medical condition?*

10.Have you ever resigned from any employment in lieu of disciplinary action or termination?*

11.Are you an exempt volunteer fire fighter?

qYES

qYES

qYES

qYES

qYES

qYES

qYES

qYES

qYES

qYES

qYES

(Explain Under “Remarks” below)

(Explain Under Remarks” below)

(Explain Under “Remarks” below)

(Explain Under “Remarks” below)

qNO

qNO

qNO

qNO

qNO

qNO If YES, from ________ to ________

qNO If YES, from _______ to ________

qNO

qNO

qNO

qNO

*A YES answer is NOT an automatic ban to employment. Each response will be reviewed on an individual basis in relation to the specific job for which you are applying.

G.REMARKS (Attach additional sheets if necessary)

H. PERSONAL REFERENCES (Not relatives)

Name

Address

Name

Address

 

 

BY MY SIGNATURE I AGREE TO TAKE A PRE-EMPLOYMENT PHYSICAL EXAMINATION, AND IF EMPLOYED, I AGREE:

1.To treat patients with kindness and consideration;

2.To report improper treatment of patients;

3.To follow established rules and regulations;

4.To work any assigned shift on any day, including overtime as necessary;

5.To take necessary immunization against contagious diseases;and,

6.To permit inspection of my belongings and containers by proper facility authorities, when deemed appropriate.

I certify that all questions answered and all information provided by me on the employment application are true and correct to the best of my knowledge and belief. I also authorize investigation of all information provided.

_______________________________________________________________________ _________________________________

SIGNATURE

DATE

FORM 80 ADM (MH) (7/02)State of New York

OFFICE OF MENTAL HEALTH

SUPPLEMENT: PERSONAL HISTORY AND APPLICATION FOR EMPLOYMENT

DATE:___________________________

LICENSES

If a license, certificate, registration or other authorization to practice a trade or profession is required for the position for which you are applying, complete the following questions.

Do you have professional license(s), certificate(s), or registration(s)?

q YES

q NO

If YES, please list below:

PROFESSION OR TRADE

GRANTING AGENCY

DOCUMENT NUMBER

DATE ISSUED

DATE EXPIRES

PROVISIONAL OR TEMPORARY LICENSE(S)

 

 

DATE ISSUED

DATE EXPIRES

LICENSE(S) FOR WHICH YOU ARE ELIGIBLE:

 

 

 

 

 

 

 

 

 

 

 

Have you ever been found guilty of unprofessional conduct, professional misconduct, or negligence in any profession?

Are charges now pending against you for unprofessional conduct, or negligence in any profession?

Have you ever surrended any license in lieu of disciplinary procedures?

q YES

(Explain under

q NO

 

“MISCELLANEOUS” BELOW)

 

q YES

(Explain under

q NO

 

“MISCELLANEOUS” BELOW)

 

q YES

(Explain under

q NO

 

“MISCELLANEOUS” BELOW)

 

MISCELLANEOUS

List any professional honors received, works published, or other professional accomplishments.

I certify that the statements made in this application supplement are true and correct to the best

of my knowledge and belief, and authorize investigation of all information given.

SIGNATURE

FOR OFFICE USE ONLY

ProcessingReferences

Interview Date

Interviewed by

Test

Score

Physical Date

Starting Date

Assignment

Item Number

Title

 

How to Edit 80 Adm Form Online for Free

Should you intend to fill out pdf who moved my cheese, you won't have to download any programs - simply use our PDF tool. To keep our editor on the cutting edge of convenience, we strive to put into practice user-driven features and improvements on a regular basis. We are routinely glad to receive feedback - help us with revampimg PDF editing. With just a few easy steps, you'll be able to begin your PDF editing:

Step 1: Press the "Get Form" button at the top of this webpage to get into our tool.

Step 2: With the help of this online PDF editing tool, you're able to accomplish more than just fill out blank form fields. Express yourself and make your docs look faultless with customized text added, or optimize the file's original content to excellence - all comes along with the capability to add any images and sign it off.

In order to complete this form, ensure you provide the information you need in each and every blank field:

1. The pdf who moved my cheese requires specific details to be typed in. Ensure that the next fields are completed:

The right way to prepare omh application stage 1

2. Soon after filling in the last part, head on to the next part and enter the essential particulars in all these fields - From MoYr, Name of Employer, To MoYr, Employers Address, Salary, Name of Supervisor, Reason for Leaving, From MoYr, Name of Employer, To MoYr, Employers Address, Salary, Name of Supervisor, Reason for Leaving, and Title.

Stage # 2 of submitting omh application

3. This 3rd segment is typically pretty simple, E EDUCATION, Circle highest grade completed, College , Do you have a High School, q YES If YES specify issuing body, q NO, SCHOOL, NAME, CITY AND STATE, DIPLOMA OR, DEGREE RECEIVED, MAJOR, High School, College Technical or Business, and Graduate School or Additional - every one of these fields is required to be filled in here.

Step # 3 in submitting omh application

4. Now complete this next portion! In this case you have all these Have you ever been employed by, Have you ever been employed by, Have you previously applied to, Were you ever discharged from, funds disability or medical, Have you ever resigned from any, or termination, Are you an exempt volunteer fire, q YES, q YES, q YES, q NO If YES from to , q NO If YES from to , q NO, and q YES form blanks to fill out.

omh application writing process detailed (portion 4)

5. This final section to submit this PDF form is pivotal. Be certain to fill out the displayed blanks, for instance H PERSONAL REFERENCES Not relatives, Name, Name, Address, Address, BY MY SIGNATURE I AGREE TO TAKE A, To treat patients with kindness, I certify that all questions, SIGNATURE, and DATE, before using the form. Failing to do it could result in a flawed and possibly unacceptable form!

omh application writing process shown (portion 5)

It is easy to make a mistake when completing the Address, therefore ensure that you reread it prior to deciding to send it in.

Step 3: Make certain your information is right and then click "Done" to progress further. Make a free trial subscription at FormsPal and obtain immediate access to pdf who moved my cheese - which you can then work with as you would like in your personal account. FormsPal ensures your information confidentiality via a protected method that never records or distributes any kind of personal data involved. Feel safe knowing your files are kept confidential any time you work with our services!