EMPLOYMENT APPLICATION

PART 1 - PRE-INTERVIEW

Form #S1000

New York State (NYS) is an equal opportunity/affirmative action employer. NYS Law prohibits discrimination because of age, race, creed, color, national origin, sexual orientation, military status, sex, disability, predisposing genetic characteristics, marital status, domestic violence victim status, carrier status, gender identity or prior conviction records, or prior arrests, youthful offender adjudications, or sealed records unless based upon a bona fide occupational qualification or other exception.

If you are a person with a disability and wish to request that a reasonable accomodation be provided for you to participate in a job interview, please contact: NYS Department of Agriculture and Markets Human Resources Office at (518) 457-3216.

JOB INTEREST AND EMPLOYMENT AVAILABILITY

Position desired: *

Geographic work location(s) desired: *

If offered a position, when would you be available for work? * +

IDENTIFYING INFORMATION

First Name *

Last Name *

SSN (last 4 digits only) *

Current Mailing/ Street Address: *

NYS EMPLID (if assigned)

City *

State *

Zip Code *

County of Residence *

Area Code/ Home Phone *

Email Address *

Area Code/ Business Phone

Permanent Street Address (if different from above)

Area Code/ Cell Phone

List any other names by which you would have been known (including nicknames)

APPLICANT INFORMATION

1. All candidates must be eligible for employment in the United States and maintain this eligibility throughout their employment with NYS. Employment is contingent upon the provision of proof of the right to accept employment in the United States.

a. Are you legally authorized to work in the United States? *

Yes

b. Will you now, or in the future, require sponsorship for employment visa status (e.g. for an H- 1B Visa)? *

Yes

c. If under age 18, can you provide a work permit? *

Yes

N/A