Playland Career Application Form – Fill Out and Use This PDF

Application for Summer Employment 2013

EARLY RETURN OF THIS APPLICATION IS SUGGESTED.

The minimum age for employment is 16.

Complete both sides of this application and return to:Playland Park

Playland Parkway

Rye, New York 10580

Attn: Human Resources Department

Personal Information

Last

First

Middle

Social Security #

Name:

/

/

No.

Street

City

State

Zip

Tel. # (

)

Address:

Cell # (

)

Are you 18 years of age or older?  Yes  No

Are you a Westchester County

E-mail address:

If not, age?

Minimum age for hire: 16

resident?

 Yes

 No

_______________________________

Education

Name & Location

Attendance Dates

Course or Major

Date Degree Received/Expected

High School

College or

Business School

Graduate or

Professional School

Certificates or Special Training:

Employment History

(Last 5 Years)

Name & Location

From

To

Type of Work

Salary

Reason for Leaving

of Employer

Mo./Yr.

Mo./Yr.

or Position

Have you worked for Westchester County Government before?  Yes

 No

Which Department: ______________

Reason for leaving:

In addition to English, are you fluent in any other language?

 Yes  No If yes, specify: ______________________

Do you have any computer skills?

Keyboarding Skills?

Can you operate any other equipment?

 Yes  No

 Yes

 No

______WPM?

 Yes

 No

If yes, please specify:

If yes, specify:

Place a “1” next to your 1st choice  a “2” next to your 2nd choice  a “3” next to your 3rd choice

1.

Cashier

______

6. Restroom Attendant

______

11. EMT

______

2.

Ride Operator

______

7. Beach/Pool Attendant

______

12. Management

______

3.

Kiddyland Operator

______

8.

Maintenance

______

13. Office Clerk

______

4.

Sweeper/Garbo Attendant

______

9.

Guest Services

______

14. Other (please indicate)

______

5.

Ride Attendant

______

10.

Lifeguard

______

_______________________________

Dates available to work: from

_______________ to ______________

Do you have a Driver’s License?

Mo./Day

Mo./Day

 Yes  No TYPE: ____________

Availability

Which months are you available to work weekends?

April  Yes  No

May  Yes  No

June  Yes  No

July  Yes  No

August  Yes  No

I am available to begin working every day beginning on

April

May

June

July

August ____

Can you work?

Saturdays  Yes

Sundays

 Yes

Holidays

 Yes

Weekdays  Yes

Evenings

 Yes

 No

 No

 No

 No

 No

List hours and days you are available to work:

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

From (time)

To (time)

Where did you hear about this program/job?

Comments:

1. WERE YOU EVER DISMISSED OR DISCHARGED FROM ANY EMPLOYMENT FOR REASONS OTHER THAN

LACK OF WORK OR FUNDS?

YES ___

NO ___

2. DID YOU EVER RESIGN FROM ANY EMPLOYMENT RATHER THAN FACE DISMISSAL?

YES ___

NO ___

3. DID YOU EVER RECEIVE A DISCHARGE FROM THE ARMED FORCES OF THE UNITED STATES

WHICH WAS OTHER THAN HONORABLE, OR WHICH WAS ISSUED FOR OTHER THAN HONORABLE

CIRCUMSTANCES?

YES ___

NO ___

4. HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENSE (FELONY OR MISDEMEANOR)?

(GIVE DETAILS)

YES ___

NO ___

5. HAVE YOU EVER FORFEITED A BAIL BOND POSTED TO ANSWER ANY CRIMINAL CHARGE?

(GIVE DETAILS)

YES ___

NO ___

6. ARE YOU NOW UNDER CHARGES FOR ANY CRIMINAL OFFENSE (FELONY OR MISDEMEANOR)?

(GIVE DETAILS)

YES ___

NO ___

IF YOU ANSWERED “YES” TO ANY QUESTIONS ABOVE, YOU MUST GIVE SPECIFICS. ATTACH ADDITIONAL 8 ½ X 11 SHEET.

ALL STATEMENTS ARE SUBJECT TO VERIFICATION AND CRIMINAL RECORDS CHECK.

THIS AFFIRMATION MUST BE COMPLETED: I affirm that all statements made on this application (including any attached papers) are true under the penalties of perjury. (Applicants are advised that all statements made by them in connection with their application(s) for employment are subject to investigation and verification.) This application may be used for review by the prospective appointing authority as part of a background investigation.

PURSUANT TO 210.45 OF THE NEW YORK STATE PENAL LAW, IT IS A CRIME PUNISHABLE AS A CLASS “A” MISDEMEANOR TO KNOWINGLY MAKE A FALSE STATEMENT HEREIN.

By accepting employment with the County of Westchester, I hereby agree to submit to any and all forms of drug testing (such as urinalysis, breath and/or blood testing) as a condition of Seasonal Employment with Westchester County in accordance with Westchester County’s Comprehensive Drug-Free Workplace Policy & Procedures.

DATE: ____________

APPLICANT’S SIGNATURE:

IF UNDER AGE 18, SIGNATURE OF PARENT OR GUARDIAN IS REQUIRED

“I have read my child’s/ward’s completed application form and hereby give my permission for him/her to be hired by Westchester County for the purpose of Seasonal Employment and I further give my permission for him/her to receive emergency medical treatment if necessary. If at any time I revoke this permission, I will do so in writing to the Westchester County Department of Human Resources, and upon receipt by the Dept. of Human Resources of said revocation my child’s/ward’s employment shall be terminated”.

By my signature below, I hereby give my permission forto submit to any

and all forms of drug testing (such as urinalysis, breath, and/or blood testing) as a condition of Seasonal Employment with Westchester County in accordance with Westchester County’s Comprehensive Drug-Free Workplace Policy & Procedures.

DATE: ____________

SIGNATURE of PARENT or GUARDIAN:

ROBERT P. ASTORINO, County Executive

The County of Westchester is an Equal Opportunity Employer.

Playland Park

Employment Verification Request

Dear Applicant:

Please complete the following information. If you have no employment history, please complete the “Additional References” information.

Name of Individual:

SSN:

-

-

Previous Employers:

1.

Name

Phone Number

From

To

Reason for Leaving

Mo./Yr.

Mo./Yr.

2.

Name

Phone Number

From

To

Reason for Leaving

Mo./Yr.

Mo./Yr.

Previous School(s):

3.

Name

Phone Number

From

To

Reason for Leaving

Mo./Yr.

Mo./Yr.

Additional References:

If you do not have any previous employment, please list three personal references. These references can either be from places of worship, youth groups, teachers and/or guidance counselors.

1.

Name

Phone Number

Relationship to applicant

2.

Name

Phone Number

Relationship to applicant

2.

Name

Phone Number

Relationship to applicant

I,		, hereby authorize my current or former employer, school, college and/or
	(print name)

personal reference to provide Playland with information and documentation concerning my application for employment. Such information/documentation may include, but is not limited to, the information stated above.

Applicant Signature:

Date:

(HR-2007)

TO BE COMPLETED BY APPLICANT’S FORMER EMPLOYERS

This form may be copied as needed.

Playland

Human Resources Department Playland Parkway

Rye, NY 10580

914-813-7010 (Phone)

914-813-7055 (Fax)

Name of Individual:

SSN:

-

-

Dear Employer:

Please answer the following questions regarding employment of the individual named above with your company. Kindly fill out the information and fax to the number listed above. If you require additional information, please do not hesitate to contact us. Your help is greatly appreciated.

	Above				Below
	Average				Average					Average
Ability
Attendance
Punctuality
Productivity
Dates of employment	From:						To:
Would you re-hire?	Yes						No				, If no why?

Reason Employment Ended:

Additional information:

Representative Name:			Title:
Representative Signature:			Date:

(HR-2007)