Form CS-14 "Application for Employment" - Rhode Island

What Is Form CS-14?

This is a legal form that was released by the Rhode Island Department of Administration - a government authority operating within Rhode Island. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 17, 2013;
  • The latest edition provided by the Rhode Island Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CS-14 by clicking the link below or browse more documents and templates provided by the Rhode Island Department of Administration.

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Download Form CS-14 "Application for Employment" - Rhode Island

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DIVISION OF HUMAN RESOURCES
APPLICATION FOR EMPLOYMENT
Office of Personnel Administration
An Equal Opportunity Employer
CS-14 Rev. 12/17/13
THIS SECTION IS TO BE FILLED IN BY APPOINTING AGENCY
Class Title and Number
Identify below the license or certificate required by the class specification and held by the applicant
Type of License _____________________________________
License Number _______________ Date Issued __________
PRE-EMPLOYMENT INFORMATION – TO BE FILLED OUT BY APPLICANT
Applicants selected for an interview will be required to complete the Criminal Record Supplemental Form (CS-14B) at the
time of initial interview or anytime thereafter. A conviction is not necessarily a bar to employment. See RIGL §28-5-7(7).
1. Print Name (as you wish it to appear on payroll check and official records)
2. Telephone Number
___________________________________________
___________________________________________________________________________________
3. Print Actual Address (Street and Number, City, State and Zip Code)
4. Mailing Address (if different)
_____________________________________
___________________________________________________________________________________
EDUCATION
ELEMENTARY AND SECONDARY EDUCATION
Highest school grade completed
Type of High School Course
1 2 3 4 5 6 7 8 9 10 11 12
__________________________________________________________
Name and address of elementary or secondary school last attended
Did you graduate?
YES
NO
_________________________________________________________________________________
COLLEGE, BUSINESS SCHOOL, TRADE SCHOOL AND OTHER EDUCATION
Dates Attended
Type of Diploma
If No Degree,
Name of School
Major and/or Course of Study
or
# of Credits
Degree Earned
From
To
5. Have you ever worked for the State before?
6. Have you ever been dismissed from any position? If your answer is yes, give
details on an attached sheet.
NO
YES - Name of agency/organization:
______________________________________
YES
NO
EXPERIENCE
7. Describe below all the positions you have held in the past ten years. In addition, describe any other experience which you think may qualify you for
this job. Include all previous employment with the State of Rhode Island. Begin with your present or most recent employment.
Name of Employer
Type of Business
Lowest Weekly Salary
From (Date)
Address of Employer
Title of Position
Highest Weekly Salary
To (Date)
Duties:
DIVISION OF HUMAN RESOURCES
APPLICATION FOR EMPLOYMENT
Office of Personnel Administration
An Equal Opportunity Employer
CS-14 Rev. 12/17/13
THIS SECTION IS TO BE FILLED IN BY APPOINTING AGENCY
Class Title and Number
Identify below the license or certificate required by the class specification and held by the applicant
Type of License _____________________________________
License Number _______________ Date Issued __________
PRE-EMPLOYMENT INFORMATION – TO BE FILLED OUT BY APPLICANT
Applicants selected for an interview will be required to complete the Criminal Record Supplemental Form (CS-14B) at the
time of initial interview or anytime thereafter. A conviction is not necessarily a bar to employment. See RIGL §28-5-7(7).
1. Print Name (as you wish it to appear on payroll check and official records)
2. Telephone Number
___________________________________________
___________________________________________________________________________________
3. Print Actual Address (Street and Number, City, State and Zip Code)
4. Mailing Address (if different)
_____________________________________
___________________________________________________________________________________
EDUCATION
ELEMENTARY AND SECONDARY EDUCATION
Highest school grade completed
Type of High School Course
1 2 3 4 5 6 7 8 9 10 11 12
__________________________________________________________
Name and address of elementary or secondary school last attended
Did you graduate?
YES
NO
_________________________________________________________________________________
COLLEGE, BUSINESS SCHOOL, TRADE SCHOOL AND OTHER EDUCATION
Dates Attended
Type of Diploma
If No Degree,
Name of School
Major and/or Course of Study
or
# of Credits
Degree Earned
From
To
5. Have you ever worked for the State before?
6. Have you ever been dismissed from any position? If your answer is yes, give
details on an attached sheet.
NO
YES - Name of agency/organization:
______________________________________
YES
NO
EXPERIENCE
7. Describe below all the positions you have held in the past ten years. In addition, describe any other experience which you think may qualify you for
this job. Include all previous employment with the State of Rhode Island. Begin with your present or most recent employment.
Name of Employer
Type of Business
Lowest Weekly Salary
From (Date)
Address of Employer
Title of Position
Highest Weekly Salary
To (Date)
Duties:
Name of Employer
Type of Business
Lowest Weekly Salary
From (Date)
Address of Employer
Title of Position
Highest Weekly Salary
To (Date)
Duties:
Name of Employer
Type of Business
Lowest Weekly Salary
From (Date)
Address of Employer
Title of Position
Highest Weekly Salary
To (Date)
Duties:
Name of Employer
Type of Business
Lowest Weekly Salary
From (Date)
Address of Employer
Title of Position
Highest Weekly Salary
To (Date)
Duties:
THIS AFFIRMATION MUST BE COMPLETED
I certify that there are no willful misrepresentations and falsifications of the above statements and answers to questions. I understand that should an
investigation disclose such misrepresentations and falsifications, my application may be rejected and, should I be employed, my service may be
terminated.
_____________________
________________________________________
DATE
SIGNATURE
STOP! Do not write in the spaces below!
IF CANDIDATE IS HIRED, ALL POST-EMPLOYMENT INFORMATION BELOW MUST BE COMPLETED.
YOU MUST ALSO ATTACH THE “CRIMINAL RECORD SUPPLEMENTAL QUESTIONNAIRE (CS14-B) TO THIS APPLICATION.
Approved by Appointing Authority/Signature ______________________________________________
DATE _______________________
Title of Appointing Authority ______________________________________________
8. Date of Birth
9. Your Social Security No.
10. Age
11. Sex
Male
12. Marital Status
Married
Single
____________
_____________________
______
Female
Divorced
Widowed
Separated
13. Spouse’s Name
14. Spouse’s Date of Birth
15. Spouses Social Security No.
16. YOUR Maiden Name
(if
applicable)
___________________________
__________________________
____________
___________________________
17. Are you a Veteran?
18. Are you a war Veteran?
Yes
No
20. Do you have the proper “WORK
(Including Desert Storm activation)
AUTHORIZATION” documentation to
If yes, identify below the War/Conflict and the dates of
work in the U.S.?
Yes
No
service that apply:
Yes
No
____________________________________________
19. Are you a disabled Veteran? (RIGL-36-4-19)
War/Conflict
Service Dates
Yes
No
SIGNATURE ________________________________________________________
DATE ______________________
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