Nycha Employment Application – Fill Out and Use

1.

LAST NAME

FIRST NAME

MIDDLE INITIAL

2. LAST FOUR DIGITS

SOCIAL SECURITY #

3.

HOME ADDRESS (NUMBER AND STREET)

APT #

BOROUGH or CITY

STATE

ZIP CODE

4.

HOME TELEPHONE

(

)

–

5.

TELEPHONE NUMBER WHERE A MESSAGE MAY BE LEFT

(

)

–

NAME OF CONTACT

6.

DO YOU LIVE IN A NEW YORK CITY HOUSING AUTHORITY DEVELOPMENT?

YES

NO

IF YES, NAME OF DEVELOPMENT

7.

ARE YOU RELATED TO ANYONE NOW WORKING FOR

YES

NO

8.

IF YOU ARE UNDER 18 OR OVER 70

THE HOUSING AUTHORITY?

IF YES, RELATIVE'S NAME

RELATIONSHIP

PLEASE STATE AGE

9.

ARE YOU ELIGIBLE TO WORK IN THE UNITED STATES?

10.

ARE YOU A U.S. VETERAN?

YES

NO

..................................................................................................................................

.............

.............

.............

YES

NO

IF YES, LENGTH OF SERVICE

FROM

TO

Type of Discharge

11.

HAVE YOU FILED FOR ANY EXAMINATION OR ARE

12. HAVE YOU EVER WORKED FOR

YOU ON ANY CIVIL SERVICE LIST?

YES

NO

THE NYC HOUSING AUTHORITY?

YES

NO

Year (s)

.......................................................................................................................................................................................................................

............

IF YES, EXAMINATION TITLE

............ PLACE ON LIST

IF YES, TITLE OF POSITION

............EMPLOYMENT

............ FROM

TO

DATES

OF

SKILLS

13.

LIST LICENSE (S) TYPE YOU HOLD

14. LIST OFFICE MACHINES YOU OPERATE WELL

15.

IF YOU TYPE,

16. IF YOU TAKE,

17.

LIST YOUR COMPUTER SKILLS

SPEED IN WORDS

SHORTHAND, SPEED

PER MINUTE

IN WORDS PER MINUTE

18.

WHICH COMPUTER PROGRAM (S) CAN YOU OPERATE?

19.

LIST FOREIGN LANGUAGES YOU SPEAK

NYCHA 015.005D (Rev. 6/07) & Reverse

(CONTINUED ON OTHER SIDE. . .)

.

.

.

From

.

To

Job Title

Weekly Salary

Type of Business

.

.

Dates of

.

.

.

.

$

.

.

1 Employment .

.

.

.

.

.

Firm Name

.

Firm Address (Number and Street)

.

(Borough or City, State, Zip Code)

..

..

.

.

.

.

.

.

.

.

Duties (Describe fully)

.

.

.

From

.

To

Job Title

Weekly Salary

Type of Business

Dates of

.

.

2

.

.

.

.

.

.

$

Employment .

.

.

.

.

.

Firm Name

.

Firm Address (Number and Street)

.

(Borough or City, State, Zip Code)

..

..

.

.

.

.

.

.

.

.

Duties (Describe fully)

--------------------------------------------------------------------------------------------------------------------------------------

Reason for leaving

.

.

.

Dates of

.

.

Job Title

Weekly Salary

Type of Business

.From

.To

3

.

.

Employment

.

.

.

.

.

.

.

$

.

Firm Name

.

.

.

.

.Firm Address (Number and Street)

.(Borough or City, State, Zip Code)

.

.

.

.

.

.

.

.

Duties (Describe fully)

Yes

No

a. If yes, indicate pension system and agency from which you retired.

Pension System:

Agency:

benefits?

Yes

No

24. How were you referred

Friend Civil

Service List

Other (Indicate)

to us?

News Paper

Authority Employee (Name)

.

D O N O T W R.I T E B E L O W T H I S L I N E

.

APPLICATION REVIEWED

.

INTERVIEWED BY

.

INTERVIEWED BY

.

. DATE

.DATE

. DATE

BY

.

.

.

NQ

HQ

Q

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