CITY OF ROME APPLICATION FOR CIVIL SERVICE EXAMINATION AND GENERAL EMPLOYMENT
MAIL AND PERSONAL DELIVERY ADDRESS:
CITY OF ROME
DEPARTMENT OF ADMINISTRATIVE SERVICES AND CIVIL SERVICE COMMISSION 198 NORTH WASHINGTON STREET
ROME, NEW YORK 13440
PHONE: 315/ 339-7609 FAX: 315/ 339-7674 WEBSITE: www.romenewyork.com
JACQUELINE M. IZZO MAYOR
EXAM OR POSITION TITLE: ____________________________________________________________________ EXAM #: ____________________________________ PLEASE PRINT CLEARLY IN INK
_____________________________________________________________________________________________ _____________ – _________ – _________________ LAST NAME FIRST NAME MIDDLE NAME SOCIAL SECURITY NUMBER
If age is required on the examination announcement, please enter your date of birth: _________ / _________ / ___________
1. Are you a citizen of the United States ? Yes / No 2. Are you a Volunteer Firefighter ? Yes / No
PERMANENT LEGAL ADDRESS: ______________________________________________________________________________________ Number Street Apt.#: ______________________________________________________________________________________ City / Town State Zip Code _______________________________________________ _____________________________________ School District: County:
NOTE: ALL CIVIL SERVICE EXAM APPLICANTS AND ELIGIBLE LIST CANDIDATES MUST PROVIDE WRITTEN NOTICE TO THIS OFFICE OF ANY CHANGE OF ADDRESS IN ORDER TO REMAIN ELIGIBLE FOR POSITION APPOINTMENT.
MAILING ADDRESS: (IF DIFFERENT FROM LEGAL ADDRESS)
________________________________________________________________________________ Street or PO Box Apt.#:
________________________________________________________________________________ City / Town State Zip Code
HOME PHONE: CELL PHONE:
(________)_____________________________ (________)______________________________ E-MAIL ADDRESS: ________________________________________________________________________________
THIS SPACE RESERVED FOR CIVIL SERVICE DEPARTMENT USE ONLY:
AMOUNT PAID: $ __________________ WVR Requested / Date Received: __________________________ / Received By: _______________ Check ( # ____________________ ) MO ( # ________________________________________________ ) / Reviewed By: _______________ _____________________________________________________________
Approved / NDVC / DVC / CF / Disapproved Notes: _____________________________________________________________
Please answer the following questions:
1. Have you ever been discharged from or have you ever been asked to resign from any employment for reasons other than for lack of work or funds ?
Yes / No
2. Have you ever resigned 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 less than honorable conditions ? Yes / No
4. Are you presently under any criminal charges ? Yes / No
5. Have you ever been convicted of any crime (felony or misdemeanor) ? Yes / No
If you answered “YES” to any of the questions 1-5 above, you must provide specifics on a separate (8.5” x 11”) sheet of paper and securely attach it to this application. While none of the above circ*mstances will necessarily bar you from employment with the City of Rome, each case is considered and evaluated on individual merits in relation to the duties and responsibilities of the position(s) for which you are applying.
IF YOU ARE NOT APPLYING FOR A CIVIL SERVICE EXAM, INDICATE THE POSITION(S) YOU ARE APPLYING FOR IN THE SPACE PROVED BELOW
Please check the following areas or identify the skills for which you have verifiable employment experience:
Management General Office Construction Trade ( Electrical, Masonry, Welding) Commercial Motor Vehicle (CDL) Operation
Building Maintenance General Office (Clerical/Secretarial) Accounting Payroll Other skills or experience (Please identify below)
_______________________________________________________________________________________________________________________________________
EDUCATION
IMPORTANT: PLEASE REFER TO THE EXAMINATION ANNOUNCEMENT FOR SPECIFIC ACADEMIC REQUIREMENTS FOR THE EXAM YOU ARE APPLYING FOR. IF REQUIRED, ATTACH A NON-OFFICIAL
ACADEMIC TRANSCRIPT IDENTIFYING EDUCATIONAL DEGREE RECEIVED, TOTAL CREDIT HOURS EARNED, COURSE MAJORS, AND COMPLETION DATE. ANY APPLICATION THAT IS SUBMITTED WITHOUT A REQUIRED ACADEMIC TRANSCRIPT WILL NOT BE APPROVED.
HIGH SCHOOL EDUCATION:
Have you received a High School Diploma ? Yes / No
Name and Location of High School: __________________________________________________________________ / Year of graduation: _____________________
If you answered “NO” to the above, do you have a General Equivalency Diploma (G.E.D.) ? Yes / No
Date Issued: ______________________ Name of Issuing Authority: __________________________________________________ / #:__________________________
LICENSES AND CERTIFICATIONS: Please list any specific trade licenses, New York State Driver’s License or other professional certifications.
NYS DMV or Out-of-State Driver’s License (State: ________) / Class of License: _________ /Endorsem*nts:____________ Expiration: ________________________
Trade or Profession: ____________________________/ License/Certificate #: __________________________________ State: _____________________________
Trade or Profession: ____________________________/ License/Certificate #: __________________________________ State: _____________________________
Other: (please specify): ___________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
SPECIAL EXAM ARRANGEMENTS: Check this box if you are an applicant with a disability requiring special arrangements or special accommodations that will need to be made for you in order to participate in this examination on the exam day or if you will not be able to be tested on the date of exam due to a religious observance or military enlistment. A written explanation of the reason(s) you are requesting special exam arrangements and supporting documentation (if available) must be attached and submitted with this application.
VETERANS’ CREDITS (FOR EXAM APPLICANTS ONLY)
For additional information on applying for Veterans’ Credits, please see # 11 on page 5 (Application Instructions)
Please check the appropriate box below and answer questions A-E below if you wish to claim additional credit as a disabled / non-disabled wartime veteran or if you are a current active member of the U.S. armed forces:
Veteran Disabled Veteran Currently On Active Duty
A. Have you ever served in the Armed Forces of the United States ? Yes No ( If “NO”, Continue to next Section. )
(“The Armed Forces of the United States” means, the Army, Navy, Marine Corps, Air Force, and Coast Guard, including all components thereof and the National Guard when in the service of the United States pursuant to call as provided by law on a full-time active duty basis other than active duty for training purposes)
B. If “Yes”, did you receive a discharge which was honorable or were you released under honorable circ*mstances ? Yes No
C. Did you serve in the Armed Forces of the United States during any of the following periods ? Yes No
December 7, 1941 – December 31, 1945 June 27, 1950 – January 31, 1955 February 28, 1961 – May 7, 1975 Lebanon: June 1, 1983 – December 1, 1987 Grenada: October 23, 1983 – November 21, 1983 Panama: December 20, 1989 – January 31, 1990 Persian Gulf: August 8, 1990 – Present
NOTE: Credits for Lebanon, Grenada, and Panama will be limited to those who received the following Expeditionary Medals: Armed Forces, Navy or Marine Corps [ U.S. Public Health Service: July 29,1945 to December 31,1946 or June 27, 1950 to July 3, 1952 ]
D. Are you currently a resident of New York State ? Yes No
E. Since January 1, 1951, have you received a permanent appointment in New York State or from any civil service agency using veterans’ credits ?
Yes No
NOTE: If you are applying for Veterans’ Credits, a completed Application for Veterans’ Credits with veteran status documentation (Form: DD-214 “MEMBER 4”) should be attached to this application or mailed to the City of Rome Civil Service Office no later than two (2) weeks prior to the establishment of eligible list.
COLLEGE, UNIVERSITY, PROFESSIONAL, TECHNICAL, TRADE OR SPECIALLY ACQUIRED COURSES: Name of School/College and Address Graduated: Yes / No Number of Credits List Major or Courses Studied
College, University, Professional, Technical, or Trade School information.
Degree Date Received
Name of School/College and Address Graduated: Yes / No Number of Credits List Information on Courses Studied
Other Schools or Special Courses Acquired.
Degree
Date Received
PLEASE NOTE: APPLICANTS ARE RESPONSIBLE FOR SUBMITTING AN ACCURATE ACCOUNT AND CLEAR DESCRIPTION OF EMPLOYMENT HISTORY. ANY
OMISSIONS AND VAGUENESS WILL NOT BE INTREPRETED IN YOUR FAVOR. MILITARY SERVICE MEMBERS SHOULD USE THIS SECTION TO BE DESCRIPTIVE OF YOUR MILITARY DUTY AND SERVICE. IF ADDITIONAL SPACE IS NEEDED, PLEASE SECURELY ATTACH A SEPARATE (8.5” x 11”) SHEET OF PAPER.
CITY OF ROME, ROME CITY SCHOOL DISTRICT, AND ROME HOUSING AUTHORITY PROMOTIONAL APPLICANTS NEED ONLY PROVIDE EMPLOYMENT TITLES HELD AND DATES OF SERVICE AS SPECIFIED IN THE PROMOTIONAL EXAM ANNOUNCEMENT.
CITY OF ROME FIREFIGHTERS APPLYING FOR PROMOTIONAL EXAMS ARE REQUIRED TO INCLUDE THEIR EMT CERTIFICATION AND EXPIRATION DATE.
EMPLOYMENT HISTORY AND WORK EXPERIENCE
FROM: TO: NAME OF COMPANY OR ORGANIZATION ADDRESS / CITY / STATE / ZIP
SALARY: TYPE OF BUSINESS YOUR TITLE NAME / TITLE OF SUPERVISOR
HOURS PER WEEK:
FULL-TIME / PART-TIME
DESCRIBE WORK DUTIES AND RESPONSIBILITIES PERFORMED
REASON FOR LEAVING:
FROM: TO: NAME OF COMPANY OR ORGANIZATION ADDRESS / CITY / STATE / ZIP
SALARY: TYPE OF BUSINESS YOUR TITLE NAME / TITLE OF SUPERVISOR
HOURS PER WEEK: FULL-TIME / PART-TIME
DESCRIBE WORK DUTIES AND RESPONSIBILITIES PERFORMED
REASON FOR LEAVING:
FROM: TO: NAME OF COMPANY OR ORGANIZATION ADDRESS / CITY / STATE / ZIP
SALARY: TYPE OF BUSINESS YOUR TITLE NAME / TITLE OF SUPERVISOR
HOURS PER WEEK:
FULL-TIME / PART-TIME
DESCRIBE WORK DUTIES AND RESPONSIBILITIES PERFORMED
REASON FOR LEAVING:
APPLICATION AFFIRMATION: By checking this box, I declare that I have fully reviewed and understand the “MINIMUM QUALIFICATIONS”, the application instructions outlined in this application,
and/or the civil service examination announcement for the examination and/or position which I am applying and that the statements made in this application (including statements made in my accompanying papers) have been examined by me and to the best of my knowledge and belief are true and correct. Any false statements made may result in termination of employment. I further understand, that as a condition of my employment with the City of Rome, and in accordance with the City of Rome’s Drug and Alcohol Policies that I may be required to submit to a urinalysis test as a condition of employment. Applicants may also be required to undergo a City of Rome polygraph examination and/or New York State Department of Criminal Justice Services and FBI criminal history and background investigation, which will include a fingerprint check, to determine my suitability for appointment. Failure to meet the standards for the background investigation may result in my disqualification for employment.
X ___________________________________________________________________________________________________
Signature / Date
APPLICATION INSTRUCTIONS AND GENERAL INFORMATION
CITY OF ROME
DEPARTMENT OF ADMINISTRATIVE SERVICES AND CIVIL SERVICE COMMISSION 198 NORTH WASHINGTON STREET
ROME, NEW YORK 13440 PHONE: 315/ 339-7609 FAX: 315/ 339-7674 WEBSITE: www.romenewyork.com
1. APPLICATIONS: If you are applying for a civil service exam, this application is considered as part of your examination. Unless otherwise indicated, all applicants are required to complete an “Application for Civil Service Examination and General Employment” form. Exam applicants must answer all questions on the application form and make sure that the application is complete in all respects.
EXAM APPLICANTS ARE SOLELY RESPONSIBLE TO ENSURE THAT ALL EMPLOYMENT RELATED INFORMATION INCLUDING ACADEMIC TRANSCRIPTS (IF REQUIRED); DRIVER’S LICENSES; OR SIMILAR DOCUMENTATION SUFFICIENT TO VERIFY EXPERIENCE AND QUALIFICATIONS AS REQUIRED IN THE EXAMINATION ANNOUNCEMENT ARE SUBMITTED WITH THIS APPLICATION.
THE CITY OF ROME CIVIL SERVICE OFFICE ASSUMES NO RESPONSIBILITY TO CONTACT APPLICANTS IN AN EFFORT TO OBTAIN ANY MISSING OR INCOMPLETE INFORMATION.
THE CITY OF ROME CIVIL SERVICE COMMISSION RESERVES THE RIGHT TO DISAPPROVE AND REJECT ANY APPLICATION THAT IS INCOMPLETE OR MISSING ANY INFORMATION THAT IS OTHERWISE REQUIRED TO SUFFICIENTLY ESTABLISH EXPERIENCE AND QUALIFICATIONS. The City of Rome Civil Service Office does not acknowledge receipt of applications and does not accept responsibility for non-delivered mail or postal delays. Applications delivered in person to the Rome Civil Service Office at Rome City Hall will be accepted between normal business hours of 8:30a.m. and 4:30p.m. Monday through Friday. Approved candidates will receive an Exam Admission Notice two (2) weeks prior to the day of examination. Non-qualifying candidates will be separately notified by mail after the application closing date. 2. ADDRESS CHANGES: Candidates must notify the City of Rome Civil Service office of any change of address. Failure to notify this office of a change of address may result in disqualification for examination or appointment. No attempt will be made to locate candidates who have moved.
3. ADMISSION NOTICES: Approved candidates will receive an Exam Admission Notice two (2) weeks prior to the day of examination. No one will be admitted to the examination without the official admittance form.
4. ALTERNATE TEST DATES: Alternate test dates for written examinations only may be arranged upon review of the circ*mstances according to the Alternate Test Date Policy. For additional information, please contact the City of Rome Civil Service office.
5. COLLEGE DEGREE / CREDITS: If your degree and/or college credit was awarded by an educational institution outside of the United States and its territories, you must provide independent verification of equivalency. Information relating to recognized companies that provide this service is available on the New York State Department of Civil Service website at: www.cs.ny.gov/jobseeker/degrees.cfm .
6. CROSS-FILING: Candidates that have applied for and plan to take an examination that will given by New York State, another county, or another local civil service agency on the same day as this test, must make arrangements to take all of the examinations at one site. Cross-filing Notification forms are available at this office and on the City’s website: www.romenewyork.com .
Cross-filing Notification forms must clearly indicate the agency(ies) where you have cross-filed, where you intend to take your exam(s), and must be submitted to this office no later than two (2) weeks prior to the examination date. New York State Civil Service exam applicants are required to take all exams at the New York State designated examination site.
7. SPECIAL EXAM ARRANGEMENTS AND ACCOMMODATIONS: If you are an applicant with a disability requiring special arrangements or special accommodations be made for you to participate in this examination on the exam day or if you will not be able to be tested on the date of exam due to a religious observance or military enlistment, a written explanation of the reason(s) you are requesting special exam arrangements and any supporting documentation (if available) must be attached and submitted with this application.
8. ELIGIBLE LISTS: Appointments from an Eligible List must be made from the top three (3) candidates willing to accept appointment. The duration of an eligible list may be fixed for a minimum period of one (1) year up to a maximum period of four (4) years. Changing conditions may make it advisable to certify to future vacancies at higher or lower salaries than those indicated on this announcement.
9. EMERGENCIES: If an emergency prevents you from appearing for the examination, please notify this office no later than the first business day following the exam date. Verifiable documentation of the emergency will be required.
10. WEATHER RELATED EMERGENCIES: In cases involving adverse weather conditions that may delay or lead to the cancellation of an examination, please tune to: WKTV NewsChannel 2 /Utica (Channel 2 on Spectrum Cable, DirecTV-Utica, and Dish Network-Utica) and WKAL 1450 A.M. /Rome between the hours of 6:00 AM and 8:00 AM on the date of the examination.
11. VETERANS’ CREDIT: 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 like to have these extra credits added to your exam score, you should answer the questions contained in this application. You can waive the extra credits later if you wish.
Veterans’ or disabled veterans eligible for additional credit may submit an “Application for Veterans’ Credits” with their exam application or at any time after the examination, but, no later than two (2) weeks prior to the establishment of the resulting eligible list. Veterans’ credits are applied to passing exam scores and may only be used once. No credit will be granted after the establishment of the eligible list. Additional information concerning eligibility is available on the Veterans’ Credit application form. Applications for Veterans’ Credits are available from this office and on the City’s website: www.romenewyork.com .
12. SENIORITY CREDIT: An additional four tenths (.4) of a point will be added to a passing exam score for each year of continuous employment service in the competitive class for the City of Rome positions in which promotion is sought up to a maximum of twenty (20) years or a total of 8.0 points. Employment must be continuous from the permanent date of appointment in a City of Rome competitive class position.
13. SPECIAL CREDIT: In conformance with section 85-a of the Civil Service Law, children of firefighters and police officers killed in the line of duty shall be entitled to receive an additional ten (10) points in a competitive examination for original appointment in the same municipality in which his or her parent has served. If you are qualified to participate in this examination and are a child of a firefighter or police officer killed in the line of duty in this municipality, please inform this office of this matter when you submit your application for examination. A candidate claiming such credit has a minimum of two months from the application deadline to provide the necessary documentation to verify additional credit eligibility. However, no credit will be added after the eligible list has been established.
14. WAIVER OF APPLICATION FEE: In accordance with Civil Service Law Section 50.5(b), fees may be waived for candidates who certify to the state civil service department, a municipal or regional commission that they are unemployed and primarily responsible for the support of a household, or are receiving public assistance. Application Fee Waiver Request forms are available from this office and on the City’s website: www.romenewyork.com and must be received at the time your application is submitted or no later than the last filing date.
15. RESIDENCY: Residency is not required to participate in City of Rome Civil Service exams or to apply for general employment. Preference in appointment may be given to successful candidates that legally reside in the City of Rome at time of appointment.
16. Federal and State Law prohibit discrimination because of age, race, color, religious affiliation, national origin, gender, sexual orientation, disability, and marital status. The City of Rome is an Equal Opportunity Employer. (CITY OF ROME CIVIL SERVICE COMMISSION (01-2018)
