Becoming a police officer offers the opportunity to serve and protect your community, while receiving great benefits.
Please Complete All Required (*) Sections and Any Others Which Apply, then Submit.
Refer to your PERMANENT LEGAL ADDRESS:
Indicate how long this has been your legal residence, up to the date of this application, showing that you meet the residency requirements as announced:
Mark the appropriate box to the right of each question:
*1. Have you graduated from high school or received a High School Equivalency diploma? Yes No
* If yes, Name and Location of High School or Issuing Governmental Agency and High School Equivalency Number:
*2. Are you under charges for any crime? Yes No
*3. Have you ever been convicted of any crime (felony or misdemeanor)? Yes No
*4. Are you a citizen of the United States? Yes No
*5. If you are not a citizen of the United States, do you have the legal right to accept employment in the United States? Yes No
If you answered “YES” to Questions 2 or 3, you may give specifics under “Remarks” at the bottom of this application. If you elect not to provide specifics, or if such explanation is insufficient, you may be required to submit further information. None of the above circumstances are automatic bar to employment. 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 claiming additional Veterans Credits, you must answer questions 1-5 of this section. Be sure that you read the instructions relating to Veterans Credits.
*1. Do you wish to claim additional credit as an honorably discharged veteran? Yes No If yes, complete questions 2-5 for Veterans Credits and attach DD-214 below.
*2. Have you ever served in the Armed Forces of the United States? Yes No
*3. Did you serve in the Armed Forces of the United States during any of the following periods? Yes No
Note: Credits for Lebanon, Grenada, and Panama will be limited to those who received the following Expeditionary Medals
*4. At the time of this application, are you currently a resident of New York State? Yes No
*5. Since January 1, 1951, have you received a permanent appointment in New York State using your Veterans Credits? Yes No
*I cannot be tested on the scheduled date and required a religious accommodation. Yes No
See Instructions E listed below under Instructions and Information section.
Length of Employment
From: MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000
To: MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000
* Are you cross filing for this examination? Yes No
COMPLETE IF APPLYING FOR CIVIL SERVICE EXAMINATIONS ON THE SAME TEST DATE FOR MORE THAN ONE CITY, COUNTY OR STATE CIVIL SERVICE AGENCY.
If you have applied for examinations in more than one Local Government (City, State or County Agencies), you must make arrangements to take all the examinations at one test site.
Arrangements to take all the examinations at one test site. You must make your request for these arrangements no later than ten (10) days before the date of the examination. You must notify all agencies with which you have filed an application of the test site at which you wish to take your examination(s).
For City of Utica examinations, complete this form.
If you have applied for both State and Local Government examinations, you must make arrangements to take all your examinations at the State examination Center by calling (518) 457-7022 no later than ten (10) days before the test date.
ALL EXAMINATION NUMBERS, TITLES AND LOCATIONS FOR WHICH YOU HAVE APPLIED:
Note: When filling out your application form, check to make sure that all appropriate questions have been answered. An incomplete application may result in its disapproval.
THIS AFFIRMATION MUST BE COMPLETED I affirm that the statements made on this application (including any attached papers) are true and under penalty of perjury.
Please read the announcement for this examination carefully before filling out the application. Refund of fees will not be made to disqualified candidates.
Do not interpret a notice to appear for, or actual participation in the examination, to mean that you have been found to meet fully the announced requirements.
Depending on the time available before an examination, applicants may be admitted to the examination on the basis of statements made on the application or conditionally, without prior review of the application. Such statements may not be reviewed and/or verified until after the examination is held. At that time those candidates not meeting the requirements will be disqualified and notified of such disqualification. Those candidates who are subsequently disqualified after taking the test will NOT be notified of their score.
Notify this agency immediately if you do not receive a notice within three days of the date of the examination information you whether or not you are to be admitted to the examination.
Notify this agency immediately of any change of address. When writing, give the number and title of the examination.
Most written examinations are held on Saturday. If you are unable to take a test on the date indicated in the examination announcement due to a conflict with a religious observance or practice, check the box “Yes” in the Religious Accommodations section. We will send you an admission notice with the special arrangements for the time, date and place of your written examination(s).
If you are a person with a disability or if you are in the military and need a reasonable accommodation in order to participate in the examination, you may either describe the accommodation you need in the remarks section below or write to or call the City of Utica Civil Service Department at (315) 792-0225 no later than the last date of filing for this examination. Your request must include the examination number and title and the type of special arrangements required.
If you are making a claim for Veterans Credits with this application, be sure you read the following information very carefully: Any claim for additional credits as a disabled or non-disabled war veteran for the examination should be made with this application. If you are claiming Veterans Credits, you must check the appropriate category in the Veterans Credits section and answer all questions. Failure to do so, accurately and completely, may result in a denial of your claim.
If you are claiming credits as a disabled war veteran, you must in addition to meeting the requirements as indicated by a “YES” answer to questions 1-3 and a “NO” answer to question 4, be certified by the veteran’s administration as being disabled in the actual performance of duty in any war; that the disability is rated at ten (10) percent or more and that the disability exists at the time of application for appointment or promotion.
All claims and grants of Veterans Credits are tentative and must be verified through inspection of discharge papers and other related documents, as necessary, prior to the establishment of the eligible list. You will be advised as to which documents must be produced by you for this verification. All statements you make in support of your claim for additional credits are subject to investigation and substantiation by this agency. In the event of subsequent disclosure of any material misstatement or fraud in this claim, your appointment may be rescinded and you
NOTE:
Effective 1/1/98 any candidate who is currently serving in the Armed Forces of the United States on a full-time active duty basis, other than active duty for training, may file for Veterans Credits on an examination prior to the list being established.
Additional Veterans Credits will be granted to qualifying candidates (proof of Active Duty must be provided) on a conditional basis. A candidate receiving conditional Veterans Credits must be restricted from certification using the credits unit the appropriate documentary proof indicating that the service was in time of war and that the individual received an honorable discharge or was released under honorable circumstances has been presented. It is the candidate’s responsibility to provide such proof to Civil Service in order to have the restriction removed and be certified at a score including the Veterans Credits. Until such documentation is submitted, a candidate may only be certified with the examination score, not including the Veterans Credits.
In conformance with Section 85-a (effective 9/17/02) of Civil Service Law, children of firefighters and police officers killed in the line of duty shall be entitled to receive an additional ten 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 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 may be added after the eligible list has been established.
Any member of the armed forced who properly filed, within the announced filing period, an application for a competitive examination but was unable to participate in the examination due to active military service, will be provided with a special make-up examination under the terms and conditions deemed appropriate by the State Department of Civil Service and/or local Civil Service agency (Check with Civil Service personnel for more information.)
Individuals serving on active duty in the armed forced during the filing period for a Civil Service examination, or individuals who have been discharged with other than a dishonorable discharge after the filing period has commenced will be permitted to file an application for examination no later than ten business days before the scheduled examination date, or the last date to file, whichever is later. A special make-up examination will be provided under the terms and conditions deemed appropriate by the State Department of Civil Service and/or local Civil Service agency. (Check with Civil Service personnel for more information.)
No Veterans Credits may be granted after the establishment of the eligible list.
THE NEW YORK STATE HUMAN RIGHTS LAW PROHIBITS DISCRIMINATION IN EMPLOYMENT BECAUSE OF AGE, RACE, CREED, COLOR, NATIONAL ORIGIN, SEX, SEXUAL ORIENTATION, DISABILITY, MARITAL STATUS, OR CRIMINAL RECORD. ACCORDINGLY, NOTHING IN THIS APPLICATION FORM SHOULD BE VIEWED AS EXPRESSING DIRECTLY OR INDIRECTLY ANY LIMITATION, SPECIFICATION, OR DISCRIMINATION AS TO AGE, RACE, CREED, COLOR, NATIONAL ORIGIN, SEX, SEXUAL ORIENTATION, DISABILITY, MARITAL STATUS, OR CRIMINAL RECORD IN CONNECTION WITH EMPLOYMENT.
