Nys Taxation And Finance Form 20 971 PDF Details

The New York State Department of Taxation and Finance Form 20 971, also known as the NYS-APP#3 25626&25627, represents a crucial step for individuals aspiring to become correction officer trainees within the state's correctional system. Scheduled for examination on April 13, 2013, this form serves as both an application and a precursor to potential employment, demanding meticulous attention to personal and professional details. It inquires about basic qualifications such as education, legal eligibility to work in the United States, and any history of student loans with the New York State Higher Education Services Corporation. Additionally, it delves into personal background, seeking information on past employment, military service, and any criminal history, emphasizing the importance of accuracy and truthfulness under penalty of perjury. This document not only offers a pathway to employment for those meeting its criteria but also outlines necessary accommodations for religious practices, disabilities, and provides a non-refundable processing fee protocol. Notably, the form underscores New York’s commitment to equal opportunity and the provision of reasonable accommodations, reflective of broader state and federal laws designed to ensure fair and equitable treatment of all applicants.

QuestionAnswer
Form NameNys Taxation And Finance Form 20 971
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmisstatement, 1983, NYS-APP-3, New_York

Form Preview Example

FORM NYS-APP#3 25626&25627 (1/13 L)

www.cs.ny.gov

APPLICATION FOR

CORRECTION OFFICER TRAINEE

Send

Application Processing

Completed

New York State Department of Civil Service

Application to:

Albany, NY 12239

 

 

Read Instructions on Page 2 First - Please Print Clearly

Announced Test Date:

April 13, 2013

25-626, Correction Oficer Trainee

25-627, Correction Oficer Trainee

(Spanish Language)

 

 

Last Name

 

First Name

 

 

 

MI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address: No., Street, Apt., or P.O. Box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City or Post Ofice

 

 

 

 

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone

 

Day Phone

 

 

 

 

 

 

 

(

)

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you have a High School

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or Equivalency Diploma?

 

 

 

Yes

No

If YES, Name and location of High School or Issuing

________________________________

RELIGIOUS ACCOMMODATION

I cannot be tested on the scheduled test date due to a conlict with a religious observance or practice. (See Page 2.)

REASONABLE ACCOMMODATIONS IN TESTING

I require reasonable accommodations to take this test. (See Page 2.)

ELIGIBILITY FOR EMPLOYMENT

You must be legally eligible to work in the United States at time of appointment and throughout your employment with New York State. If appointed, you must produce documents that establish your identify and eligibility to work in the United States, as required by the Federal Immigration Reform and Control Act of 1986, and the Immigration and Nationality Act.

For Civil Service Use Only

W G U

Governmental

Authority:

Forces of the United

States

.

The “Armed Forces of the United States” means the Army, Navy, Marine Corps, Air Force and Coast Guard,

STUDENT LOANS

Yes

No

Have you any loans made or guaranteed by the NYS Higher Education Services Corporation which are currently

 

 

outstanding?

Yes

No

If so, are you currently in default on any such loan?

ADDITIONAL QUESTIONS FOR OPEN-COMPETITIVE APPLICANTS ONLY:

Yes

No

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

Yes

No

Did you ever resign from any employment rather than face discharge?

Yes

No

Did you ever receive a discharge from the Armed Forces of the United States which was other than “Honorable” or

 

 

which was issued under other than honorable conditions?

Yes

No

Have you ever been convicted of any crime (felony or misdemeanor)?

Yes

No

Are you now under charges for any crime?

If you answered YES to any of these questions, provide details under REMARKS on Page 3. Your failure to answer any of these questions

or to provide details will signiicantly delay any determination concerning your qualiications and may deprive you of potential employment opportunities.

NON-REFUNDABLE PROCESSING FEE

Please read exam announcement and information on Page 2.

Check One

No Fee Is Due Because:

I have enclosed the fee.

I am a NY State employee and my fee is paid by my union

(Enclose a check or money order payable to the

for an open-competitive examination.

NYS Department of Civil Service).

(CSEA Negotiating Units 02, 03, 04 or 47)

DO NOT SEND CASH.

I am unemployed and primarily responsible for the support

(The Fee will NOT BE REFUNDED

of a household.

if your application is DISAPPROVED.)

I am receiving public assistance as described on Page 2.

 

I afirm under penalties of perjury that all statements made on this application (including any attached papers) are true. I understand that all statements made by me in connection with this application are subject to investigation and veriication and that a material misstatement or fraud may disqualify me from appointment and/or lead to revocation of my appointment.

X Signature of Applicant

Date

Please print any other last name by which you are or have been known.

DO NOT COMPLETE THIS SECTION UNLESS YOU:

1.Wish to claim War Time Veterans Credits, AND

2.Have NOT used veterans credits for appointment to a position in NY State or Local Government.

EXTRA CREDITS FOR WAR TIME VETERANS YOUR ANSWERS MUST BE ‘YES’ TO BE ELIGIBLE FOR ADDITIONAL CREDITS.

Yes

No

I expect to receive or have already received, a discharge which was honorable or release under honorable circumstances from the Armed

 

 

including all components thereof, and the National Guard when in the service of the United States pursuant to call as provided by Law, on

Yes

No

a full-time active duty basis other than active duty for training purposes.

 

I am now serving, or have served, on an active duty basis other than active duty for training purposes during one or more of

 

 

the following Time of War periods.

 

 

 

 

In the Armed Forces:

or earned the Armed Forces, Navy, or Marine

or in the U.S. Public Health Service

 

 

• Aug. 2, 1990 to the date when

Corps expeditionary medal for service in:

• June 26, 1950 to July 3, 1952;

 

 

the Persian Gulf hostilities ends:

• (Panama) Dec. 20, 1989 to Jan. 31, 1990;

• July 29, 1945 to Sept. 2, 1945.

 

 

• Feb. 28, 1961 to May 7, 1975;

• (Lebanon) June 1, 1983 to Dec. 1, 1987;

 

 

 

• June 27, 1950 to Jan. 31, 1955;

• (Grenada) Oct. 23, 1983 to Nov. 21, 1983;

 

Yes

No

• Dec. 7, 1941 to Dec. 31, 1946;

 

 

I am a United States citizen or an alien lawfully admitted for permanent residence.

 

To claim additional credits as a Disabled Veteran, you must also answer YES to this question:

 

Yes

No

I have a service connected disability rated at 10% or more by the US Department of Veterans Affairs. This disability was incurred during

 

 

a “Time of War” period listed above.

 

 

New York State Residency Requirement for Extra Credits as a War Time Veteran or Disabled Veteran: You will be required to provide proof of current

New York residency at time of appointment.

It is the policy of the State of New York to provide for and promote equal opportunity employment, compensation, and other terms and conditions of employment without discrimination on the basis of age, race, color, religion, disability, national origin, gender, sexual orientation, veteran or military service member status, marital status, domestic violence victim status, genetic predisposition or carrier status, or arrest and/or criminal conviction record unless based upon a bona ide occupational qualiication or other exception.

It is the policy of New York State Department of Civil Service to provide qualiied persons with disabilities equal opportunity to participate in and receive the beneits, services, programs and activities of the Department, and to provide such persons reasonable accommodations and reasonable modiications as are necessary to provide such equal opportunity, including accommodations in the examination process. Further, it is the policy of the Department to provide reasonable accommodations for religious observers.

FORM NYS-APP#3 25626&25627 (1/2013 L)

 

www.cs.ny.gov

 

Application for Correction Officer Trainee

Page 2

EXAMINATION APPLICATION

Use this form to apply for Examination Numbers 25-626 and 25-627, Correction Officer Trainee. Read each exam announcement carefully to be sure that you meet the Minimum Qualifications.

Mail your application and the required processing fee to Application Processing, NYS Department of Civil Service, Albany, New York 12239.

ADMISSION TO EXAMINATION

You will be admitted to the test pending a full review of your application. If you take the test but your application is disapproved later, we will notify you of the reason.

If you do not receive an admission notice from us at least three days prior to the test date, immediately call (518) 474-6470 in the Albany area, or toll free at 1-877-697-5627 (press 2, then press 1).

PLACE OF EXAMINATION

 

 

Unless the exam announcement states otherwise, written tests are

Albany

Kingston

Rochester

held in the following locations, although some may not be open for

Amsterdam

Middletown

Saranac Lake

every examination. You will be assigned to the nearest OPEN

Binghamton

New York City (Manhattan)

Syracuse

location based on the postal ZIP code for your mailing address.

Buffalo

Nyack

Utica

 

Fredonia

Port Jefferson

Watertown

Oral tests are usually held in Albany only.

Hicksville

Poughkeepsie

 

RELIGIOUS ACCOMMODATIONS

Most written tests are held on Saturdays. If you cannot take the test on the announced test date due to a conflict with a religious observance or practice, check the box under “Religious Accommodation.” We will make arrangements for you to take the test on a different date (usually the following day).

REASONABLE ACCOMMODATIONS IN TESTING

We provide reasonable accommodations for persons with disabilities to take a test. If you need a reasonable accommodation, check the box, "I require reasonable accommodations to take this test." On or before the last date for filing applications, write to the Department of Civil Service or call (518) 457- 2487 (press 2, then press 2) (in the Albany area) or 1-877-697-5627 (outside of the Albany area) and describe the accommodation you need. For TDD services, call NY Relay at 711 (requires a fee) or 1-800-662-1220.

NON-REFUNDABLE PROCESSING FEE

Refer to the front of the exam announcement for the required processing fee. Enclose a check or money order for the total amount required, made payable to the New York State Department of Civil Service. DO NOT SEND CASH. If your application is disapproved, the fee will not be refunded. Check the box, “I have enclosed the fee.”

If you are a NYS employee in a position represented by CSEA and you are applying for an OPEN-COMPETITIVE examination, you are not required to submit a processing fee under current negotiated agreements. Check the box “I am a NYS employee and my fee is paid by my union for an open- competitive examination (CSEA Negotiating Units 02, 03, 04 or 47).” Refunds will not be issued to employees covered by the agreements if they submit a fee.

No fee is due if you are unemployed and primarily responsible for the support of a household. Do not enclose any payment with your application. Check the box, “I am unemployed and primarily responsible for the support of a household.”

No fee is due if you are determined eligible for Medicaid, or receiving Supplemental Social Security payments, or Public Assistance (Temporary Assistance for Needy Families/Family Assistance or Safety Net Assistance) or are certified Job Training Partnership Act/Workforce Investment Act eligible through a state or local social service agency. Do not enclose any payment with your application. Check the box, “I am receiving public assistance.”

All claims are subject to verification. Those not supported by appropriate documentation are grounds for barring or rescinding an appointment.

EXTRA CREDITS FOR WAR TIME VETERANS

Answering these questions means that you are requesting the extra credits. Do not answer the questions if you are not a war time active duty member of the Armed Forces or a War Time Veteran or if you do not want to request the extra credits. If you are currently in the Armed Forces on full-time active duty (other than for training) or if you are a War Time Veteran or Disabled Veteran, you are eligible for extra credits added to your exam score if you pass. These extra credits can be used only once for any permanent government employment in New York State. If you want to have these extra credits added to your exam score, you must answer the questions now. You can waive the extra credits later if you wish. At the time of interview and appointment you will be required to produce the documentation, such as discharge papers, to prove that you are eligible for the extra credits.

ADDITIONAL EXAMINATION CREDITS PURSUANT TO CIVIL SERVICE LAW SECTION 85-a

If you are a child of a police officer or firefighter who was killed in the line of duty in the service of New York State, you may be entitled for additional examination credits pursuant to Civil Service Law Section 85-a. For further information, please contact the Department of Civil Service at (518) 473-9950.

PERSONAL PRIVACY PROTECTION LAW NOTIFICATION

The information which you are providing on this application is being requested pursuant to Section 50.3 of the New York State Civil Service Law for the principal purpose of determining the eligibility of applicants to participate in the examination(s) for which they have applied. This information will be used in accordance with Section 96(1) of the Personal Privacy Protection Law, particularly subdivisions (b), (e), and (f). Failure to provide this information may result in disapproval of the application. This information will be maintained by the Director, Division of Staffing Services, Department of Civil Service, Albany, New York 12239. For further information, relating only to the Personal Privacy Protection Law, call (518) 457-9375. (For examination

information, call (518) 457-2487 (press 2, then press 3); or toll free at 1-877-697-5627 (press 2, then press 3).

REMARKS:

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