Form NYS-APP-3 #20-349 (NYS-APP-3 #20-523) "Application for NYS Examinations Open to the Public" - New York

What Is Form NYS-APP-3 #20-349 (NYS-APP-3 #20-523)?

This is a legal form that was released by the New York State Department of Civil Service - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2021;
  • The latest edition provided by the New York State Department of Civil Service;
  • Easy to use and ready to print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form NYS-APP-3 #20-349 (NYS-APP-3 #20-523) by clicking the link below or browse more documents and templates provided by the New York State Department of Civil Service.

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Download Form NYS-APP-3 #20-349 (NYS-APP-3 #20-523) "Application for NYS Examinations Open to the Public" - New York

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EXTRA CREDITS FOR WAR TIME VETERANS
NYS-APP-3 #20-349/20-523 (1/2021 L)
www.cs.ny.gov
COMPLETE THIS SECTION ONLY IF YOU: Wish to claim War Time Veteran Credits, AND have not used DISABLED veteran credits for a
permanent appointment to a position in New York State or Local Government.
APPLICATION FOR NYS EXAMINATIONS
Answering questions in this section means that you are requesting extra credits as either a non-disabled veteran or a disabled veteran. All veterans are
encouraged to answer questions in this section of the application to ensure that appropriate points are added to passing examination scores. Veterans
OPEN TO THE PUBLIC
who answer “YES” to questions 1, 2, AND 3 may receive tentative credits as a non-disabled veteran; candidates who also answer “YES” to question 4
may receive tentative disabled veteran credits. If you previously used non-disabled veteran credits to obtain a permanent appointment to a position in
Human Resources
Send
New York State or Local Government, and subsequent to appointment, were certified as a disabled veteran, you may be eligible to receive additional
Stony Brook University Hospital
Completed
disabled veteran credits by answering “YES” to BOTH questions 5a AND 5b in this section. NOTE: All veterans claiming extra credit will be
required to produce eligibility documentation which will be verified at time of interview. Candidates found ineligible for such credit will have the
Stony Brook, New York 11794-9300
Application to:
points subtracted from their examination score(s). If it is determined that veteran credits do not increase one’s reachability for appointment from an
eligible list, the use of veteran credits for such appointment will be waived, and veteran credits can be claimed for future civil service examinations
until such time as they are used to receive a permanent appointment as provided by the New York State Constitution.
Do you expect to receive or have you already received a discharge which was honorable or release under honorable circumstances from
Exam No.
Titles
the Armed Forces of the United States; or have you applied to or been approved by the New York State Division of Veterans’ Services as
1. Yes
No
20-349
Emergency Medical Technician
a veteran pursuant to the Restoration of Honor Act? 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.
Emergency Medical Technician
20-523
Are you now serving, or have you served, on an active duty basis other than active duty for training purposes during one or more of the
(Paramedic)
2. Yes
No
following Time of War periods?
In the Armed Forces:
or earned the Armed Forces, Navy, or Marine or in the U.S. Public Health Service:
• Aug. 2, 1990 until the
Corps expeditionary medal for service in:
• June 26, 1950 to July 3, 1952
Last Name
First Name
MI
Persian Gulf hostilities end
• (Panama) Dec. 20, 1989 to Jan. 31, 1990
• July 29, 1945 to Sept. 2, 1945
• Feb. 28, 1961 to May 7, 1975
• (Lebanon) June 1, 1983 to Dec. 1, 1987
• June 27, 1950 to Jan. 31, 1955
• (Grenada) Oct. 23, 1983 to Nov. 21, 1983
• Dec. 7, 1941 to Dec. 31, 1946
Mailing Address: No., Street, Apt., or P.O. Box
3. Yes
No
Are you a United States citizen or an alien lawfully admitted for permanent residence?
4. Yes
No
Do you have a service connected disability rated at 10% or more by the U.S. Department of Veterans Affairs? This disability must have
been incurred during a Time of War period listed above.
City or Post Office
State Zip Code
5a. Yes
No
Have you USED NON-DISABLED veteran credits for a permanent appointment to a position in New York State or Local Government?
If you answered “Yes” to “5a” above, you must answer “5b”:
5b. Yes No
After you were permanently appointed using non-disabled veteran credits, were you subsequently certified as having a service connected
Email Address
disability rated at 10% or more by the U.S. Department of Veterans Affairs?
New York State Residency Requirement for Extra Credits as a War Time Veteran or Disabled Veteran: You will be required to provide proof of current
New York State residency at time of appointment.
Social Security Number
ELIGIBILITY FOR EMPLOYMENT
You must be legally eligible to work in the United States at time of appointment and throughout your employment with New York State. If
appointed, you must produce documents that establish your identity and eligibility to work in the United States, as required by the Federal
Home Phone
Day Phone
Immigration Reform and Control Act of 1986, and the Immigration and Nationality Act.
I affirm under penalties of perjury that all statements made on this application (including any attached papers) are true. I
understand that all statements made by me in connection with this application are subject to investigation and verification
PERSONAL PRIVACY PROTECTION LAW NOTIFICATION
and that a material misstatement or fraud may disqualify me from appointment and/or lead to revocation of my appointment.
The information which you are providing on this application is
X
being requested pursuant to Section 50.3 of the New York State Civil
Service Law for the principal purpose of determining the eligibility
of applicants to participate in the examination(s) for which they
Signature of Applicant
Date
Please print any other last name by which
you are or have been known.
have applied. This information will be used in accordance with
Section 96(1) of the Personal Privacy Protection Law, particularly
subdivisions (b), (e), and (f). Failure to provide this information
It is the policy of the State of New York to provide for and promote equal opportunity employment, compensation, and other terms and conditions
may result in disapproval of the application. This information will
of employment without unlawful discrimination on the basis of age, race, color, religion, disability, national origin, gender, sexual orientation,
be maintained by the Personnel Office, SUNY University Hospital
veteran or military service member status, marital status, domestic violence victim status, genetic predisposition or carrier status, arrest and/or
at Stony Brook, Stony Brook, New York 11794-9300. For further
criminal conviction record, or any other category protected by law, unless based upon a bona fide occupational qualification or other exception.
information, relating only to the Personal Privacy Protection
It is the policy of New York State Department of Civil Service to provide qualified persons with disabilities equal opportunity to participate in and
Law, call (518) 457-9375. For examination information on this
receive the benefits, services, programs and activities of the Department, and to provide such persons reasonable accommodations and reasonable
examination, call (631) 444-4742.
modifications as are necessary to provide such equal opportunity, including accommodations in the examination process. Further, it is the policy
of the Department to provide reasonable accommodations for religious observance.
EXTRA CREDITS FOR WAR TIME VETERANS
NYS-APP-3 #20-349/20-523 (1/2021 L)
www.cs.ny.gov
COMPLETE THIS SECTION ONLY IF YOU: Wish to claim War Time Veteran Credits, AND have not used DISABLED veteran credits for a
permanent appointment to a position in New York State or Local Government.
APPLICATION FOR NYS EXAMINATIONS
Answering questions in this section means that you are requesting extra credits as either a non-disabled veteran or a disabled veteran. All veterans are
encouraged to answer questions in this section of the application to ensure that appropriate points are added to passing examination scores. Veterans
OPEN TO THE PUBLIC
who answer “YES” to questions 1, 2, AND 3 may receive tentative credits as a non-disabled veteran; candidates who also answer “YES” to question 4
may receive tentative disabled veteran credits. If you previously used non-disabled veteran credits to obtain a permanent appointment to a position in
Human Resources
Send
New York State or Local Government, and subsequent to appointment, were certified as a disabled veteran, you may be eligible to receive additional
Stony Brook University Hospital
Completed
disabled veteran credits by answering “YES” to BOTH questions 5a AND 5b in this section. NOTE: All veterans claiming extra credit will be
required to produce eligibility documentation which will be verified at time of interview. Candidates found ineligible for such credit will have the
Stony Brook, New York 11794-9300
Application to:
points subtracted from their examination score(s). If it is determined that veteran credits do not increase one’s reachability for appointment from an
eligible list, the use of veteran credits for such appointment will be waived, and veteran credits can be claimed for future civil service examinations
until such time as they are used to receive a permanent appointment as provided by the New York State Constitution.
Do you expect to receive or have you already received a discharge which was honorable or release under honorable circumstances from
Exam No.
Titles
the Armed Forces of the United States; or have you applied to or been approved by the New York State Division of Veterans’ Services as
1. Yes
No
20-349
Emergency Medical Technician
a veteran pursuant to the Restoration of Honor Act? 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.
Emergency Medical Technician
20-523
Are you now serving, or have you served, on an active duty basis other than active duty for training purposes during one or more of the
(Paramedic)
2. Yes
No
following Time of War periods?
In the Armed Forces:
or earned the Armed Forces, Navy, or Marine or in the U.S. Public Health Service:
• Aug. 2, 1990 until the
Corps expeditionary medal for service in:
• June 26, 1950 to July 3, 1952
Last Name
First Name
MI
Persian Gulf hostilities end
• (Panama) Dec. 20, 1989 to Jan. 31, 1990
• July 29, 1945 to Sept. 2, 1945
• Feb. 28, 1961 to May 7, 1975
• (Lebanon) June 1, 1983 to Dec. 1, 1987
• June 27, 1950 to Jan. 31, 1955
• (Grenada) Oct. 23, 1983 to Nov. 21, 1983
• Dec. 7, 1941 to Dec. 31, 1946
Mailing Address: No., Street, Apt., or P.O. Box
3. Yes
No
Are you a United States citizen or an alien lawfully admitted for permanent residence?
4. Yes
No
Do you have a service connected disability rated at 10% or more by the U.S. Department of Veterans Affairs? This disability must have
been incurred during a Time of War period listed above.
City or Post Office
State Zip Code
5a. Yes
No
Have you USED NON-DISABLED veteran credits for a permanent appointment to a position in New York State or Local Government?
If you answered “Yes” to “5a” above, you must answer “5b”:
5b. Yes No
After you were permanently appointed using non-disabled veteran credits, were you subsequently certified as having a service connected
Email Address
disability rated at 10% or more by the U.S. Department of Veterans Affairs?
New York State Residency Requirement for Extra Credits as a War Time Veteran or Disabled Veteran: You will be required to provide proof of current
New York State residency at time of appointment.
Social Security Number
ELIGIBILITY FOR EMPLOYMENT
You must be legally eligible to work in the United States at time of appointment and throughout your employment with New York State. If
appointed, you must produce documents that establish your identity and eligibility to work in the United States, as required by the Federal
Home Phone
Day Phone
Immigration Reform and Control Act of 1986, and the Immigration and Nationality Act.
I affirm under penalties of perjury that all statements made on this application (including any attached papers) are true. I
understand that all statements made by me in connection with this application are subject to investigation and verification
PERSONAL PRIVACY PROTECTION LAW NOTIFICATION
and that a material misstatement or fraud may disqualify me from appointment and/or lead to revocation of my appointment.
The information which you are providing on this application is
X
being requested pursuant to Section 50.3 of the New York State Civil
Service Law for the principal purpose of determining the eligibility
of applicants to participate in the examination(s) for which they
Signature of Applicant
Date
Please print any other last name by which
you are or have been known.
have applied. This information will be used in accordance with
Section 96(1) of the Personal Privacy Protection Law, particularly
subdivisions (b), (e), and (f). Failure to provide this information
It is the policy of the State of New York to provide for and promote equal opportunity employment, compensation, and other terms and conditions
may result in disapproval of the application. This information will
of employment without unlawful discrimination on the basis of age, race, color, religion, disability, national origin, gender, sexual orientation,
be maintained by the Personnel Office, SUNY University Hospital
veteran or military service member status, marital status, domestic violence victim status, genetic predisposition or carrier status, arrest and/or
at Stony Brook, Stony Brook, New York 11794-9300. For further
criminal conviction record, or any other category protected by law, unless based upon a bona fide occupational qualification or other exception.
information, relating only to the Personal Privacy Protection
It is the policy of New York State Department of Civil Service to provide qualified persons with disabilities equal opportunity to participate in and
Law, call (518) 457-9375. For examination information on this
receive the benefits, services, programs and activities of the Department, and to provide such persons reasonable accommodations and reasonable
examination, call (631) 444-4742.
modifications as are necessary to provide such equal opportunity, including accommodations in the examination process. Further, it is the policy
of the Department to provide reasonable accommodations for religious observance.
SUPP #20-349/20-523 (1/2021 L)
SUPPLEMENT QUESTIONNAIRE
PAGE 1
SOCIAL SECURITY NUMBER
CONTINUOUS RECRUITMENT EXAMINATION NO. 20-349/20-523
EMERGENCY MEDICAL TECHNICIAN and EMERGENCY MEDICAL
TECHNICIAN (PARAMEDIC)
This is a training and experience examination. Your rating will be based on a review of your responses to this questionnaire. All
information provided is subject to verification.
INSTRUCTIONS
1.
Please print clearly in ink.
2.
Answer all questions on this questionnaire and application form NYS-APP-3 #20-349/20-523 (attached) completely and
accurately. Incomplete information may result in a lower score or disqualification. Retain a copy of the completed form for
your records.
3.
Your degree and/or college credits must have been awarded from a regionally accredited college or university or one recognized
by the New York State Education Department as following acceptable educational practices. If your degree and/or college credit
was awarded by an educational institution outside the United States and its territories, you must provide independent verification
of equivalency and a course-by-course evaluation. You can write to the NYS Department of Civil Service, Examination
Information, Albany, New York 12239 for a list of acceptable companies who provide this service or this information can be
found on the Internet at: http://www.cs.ny.gov/jobseeker/degrees.cfm. You must pay the required evaluation fee.
4.
Mail this application form NYS-APP-3 #20-349/20-523 and SUPP #20-349/20-523 to:
Human Resources
Stony Brook University Hospital
Stony Brook, New York 11794-9300
Retest Policy – You may reapply for this exam after one year.
5.
6.
Appropriate part-time and volunteer experience, which can be verified, will be accepted on a prorated basis.
ADDITIONAL EXAMINATION CREDITS PURSUANT TO CIVIL SERVICE LAW SECTION 85-a
If you are a child or sibling of a firefighter, police officer, emergency medical technician, or paramedic who was killed in the line of duty
in the service of New York State, you may be entitled for additional examination credits pursuant to Civil Service Law Section 85-a. For
further information, please contact the Department of Civil Service at (518) 473-9566.
I.
ACADEMIC RECORD
Indicate any degrees received or expected to be received.
A.
Semester
Quarter
Type of
Major Subject
College, University, Professional or
Did You
Degree
Credits
Hours
Degree
or Type of
Technical Schools
Graduate
Expected
Received
Received
Received
Course
Name
Yes
MO.
YR.
No
Address (City, State)
Name
Yes
MO.
YR.
No
Address (City, State)
Note: Provide photocopies of undergraduate and graduate transcripts from all colleges attended. These need not be official transcripts,
although we reserve the right to require official transcripts at time of interview. As candidates will be evaluated on relevant coursework,
failure to provide transcripts will result in a lower score.
Certification:
Complete the following:
Certification Number:
Type of Certification:
Current Certification:
MO.
YR.
MO.
YR.
Date First Issued:
FROM
TO
Check any of the following EMT training that you have successfully completed and attach verification.
BLS/BCLS
BTLS/PHLS
ACLS
PALS
NRP/NALS
Are you currently listed with the National Registry of Emergency Medical Technicians?
Yes
No
If yes, attach verification.
SUPP #20-349/20-523 (1/2021 L)
SUPPLEMENT QUESTIONNAIRE
PAGE 2
SOCIAL SECURITY NUMBER
CONTINUOUS RECRUITMENT EXAMINATION NO. 20-349/20-523
EMERGENCY MEDICAL TECHNICIAN and EMERGENCY MEDICAL
TECHNICIAN (PARAMEDIC)
II. DESCRIBE YOUR EXPERIENCE:
Beginning with your most recent, list all employment, military service, or volunteer experience that relates to the duties described for this position. We cannot interpret
omissions or vagueness in your favor. You are responsible for an accurate and clear description of your experience. DO NOT SEND YOUR RESUME. Under
DUTIES describe the nature of the work which you personally performed including the estimated percentage of time spent on each type of activity.
USE COPIES OF THIS PAGE IF MORE SPACE IS NEEDED
LENGTH OF EMPLOYMENT
FIRM NAME
ADDRESS
CITY AND STATE
MO.
YR.
MO.
YR.
TO
FROM
YOUR EXACT TITLE
DUTIES:
NAME OF YOUR SUPERVISOR
TELEPHONE NUMBER
LENGTH OF EMPLOYMENT
FIRM NAME
ADDRESS
CITY AND STATE
MO.
YR.
MO.
YR.
FROM
TO
YOUR EXACT TITLE
DUTIES:
NAME OF YOUR SUPERVISOR
TELEPHONE NUMBER
ADDITIONAL QUESTIONS
If you answer YES to any of these questions, please provide an explanation in the REMARKS section provided below:
1. Yes
No
Were you ever discharged from any employment except for lack of work, funds, disability or medical condition?
2. Yes
No
Did you ever resign from any employment rather than face a dismissal?
REMARKS:
USE ADDITIONAL SHEETS IF NECESSARY TO COMPLETE INFORMATION
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