8/12/2019 2014 NYSF Employment Application

http://slidepdf.com/reader/full/2014-nysf-employment-application 1/2

 

AMP – 103 (2014)  NYS Department of Agriculture and MarketsDivision of Human Resources Management10B Airline Drive, Albany, New York 12235

518-457-3216

DIVISION OF THE STATE FAIR

APPLICATION FOR EMPLOYMENT

ALL QUESTIONS MUST BE ANSWERED. THIS APPLICATION WILL BE KEPT ACTIVE FOR ONE YEAR.

Name:

Mr.

Ms.

Position(s) applied for:

Summer : Labor Clerical General Mechanic

 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Fair time : Labor Cashier/Usher Restroom Staff

Parking Other ____________________

Can you work all 12 days of the State Fair?  YES  NO

Shift Availability AM PM Any 

Address:

City/State/Zip:

E-mail: Social Security Number:

Provide last four digits only __ __ __ __

Telephone Number(s):

Cell____________________ Daytime________________________

Evening__________________________________________________

Have you worked for this agency before?  YES  NO

If yes, what department __________________________Year(s) ________

Position_____________________________________________________

Driver’s License: YES NO

State _______ Class______ DL # ________________________ 

Do you currently work for any NYS agency?  YES NO

If yes, where? ________________________________________________Note: A Dual Employment form must be approved by your primary agency

and on file with the State Comptroller before you may begin work.

Are you legally eligible for work in the United States?

YES NO

Are you 18 years of age or older?

YES NO If no, current age _______

Except for minor traffic violations, have you ever been convicted of a crime? YES NO

If yes, please attach a copy of the Certificate of Disposition for each conviction. A “yes” answer does not necessarily preclude your employment by t

Department. However, Failure to accurately report prior convictions will bar your employment or if discovered after your employment will result in dismissFailure to attach a copy of the Disposition(s) will delay the consideration of your application.

Are you currently awaiting trial on any criminal charges?   YES NO

If yes, please explain______________________________________________

Have you ever been discharged or asked to resign from any position to avoid dismissal? YES NO

If yes, please explain______________________________________________

Family and Personal Relationships Disclosure:

Do you have any personal or family relationships with a current employee of the State Fair? YES NO

If yes, name(s) and relationship__________________________________________________________________________________

 ____________________________________________________________________________________________________________

Personal and family relationships include: persons living in the same household, parents, spouse, siblings, child ren, aunts, uncles, nieces, nephews, in-laws

grandparents.

Conflict of Interest Disclosure:

Do you have any personal, family or business relationships with any contractor, vendor, sponsor of or anyone doing business with the Sta

Fair?  YES NO

If yes, name(s) and relationship__________________________________________________________________________________

 ___________________________________________________________________________________________________________

Business relationships include: ownership, employment, activity, or financial interest with business, vendors, license holders or others that do business

have contracts with the State Fair. 

This area is for Department use only 

Department: Comments: Date: Reviewer:

8/12/2019 2014 NYSF Employment Application

http://slidepdf.com/reader/full/2014-nysf-employment-application 2/2