Fillable Printable UCS Form for Unified Court System
Fillable Printable UCS Form for Unified Court System
UCS Form for Unified Court System
1
SCHOOL DID YOU
GRADUATE?
YES NO
NAME AND LOCATION TOTAL CREDITS
EARNED
MAJOR
SUBJECT
DEGREE
EARNED
HIGH SCHOOL /
GED
COMMUNITY /
COLLEGE /
UNIVERSITY
GRADUATE /
PROFESSIONAL
OTHER
NEW YORK STATE
Unified Court System
Application for employment
Mail the application to the individual indicated on the
employment announcement. You are encouraged to
enclose a resume and cover letter.
HAVE YOU EVER BEEN DISCIPLINED BY, OR ARE CHARGES PRESENTLY
PENDING BEFORE, ANY AGENCY AUTHORIZED TO BRING DISCIPLINARY
PROCEEDINGS RELATED TO THE PRACTICE OF ANY PROFESSION?
YES NO
if you answer “yes” to this
question, provide details
on page 4.
TITLE OF POSITION ANNOUNCEMENT NUMBER
NAME (LAST, FIRST, MIDDLE) SOCIAL SECURITY NUMBER
MAILING ADDRESS PHONE
CITY, STATE, ZIP
E-MAIL ADDRESS
ARE YOU CURRENTLY RECEIVING A GOVERNMENT PENSION? YES NO
LIST ANY LICENSES, CERTIFICATIONS AND SPECIAL SKILLS.
educAtion
UCS-5 (Rev 1-09)
2
EMPLOYER
ADDRESS
EMPLOYMENT DATES FROM: / / TO: / /
TITLE AND DUTIES OF YOUR POSITION
EMPLOYER
ADDRESS
EMPLOYMENT DATES FROM: / / TO: / /
TITLE AND DUTIES OF YOUR POSITION
EMPLOYER
ADDRESS
EMPLOYMENT DATES FROM: / / TO: / /
TITLE AND DUTIES OF YOUR POSITION
employment history Resume Attached?
Begin with most recent employer.
YES NO
3
ARE YOU A CITIZEN OF THE UNITED STATES?
IF “NO,” DO YOU HAVE A LEGAL RIGHT TO WORK IN THE UNITED STATES?
employment eligibility
YES NO
A) EXCEPT FOR ADJUDICATIONS AS YOUTHFUL OFFENDER, WAYWARD MINOR, OR JUVENILE
DELINQUENT, HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR OR FELONY?
B) DO YOU HAVE ANY CRIMINAL CHARGES PENDING AGAINST YOU?
C) HAVE YOU EVER BEEN DISMISSED FROM ANY EMPLOYMENT?
D) HAVE YOU EVER RECEIVED A DISCHARGE FROM THE ARMED FORCES THAT WAS
OTHER THAN HONORABLE?
E) ARE YOU CURRENTLY IN VIOLATION OF A COURT ORDER IN ANY STATE
FOR CHILD OR SPOUSAL SUPPORT?
legAl history
If you answer “yes” to any of these questions, provide details on page 4.
YES NO
AffirmAtion
I affirm that the statements made on this application (including any attached pages) are true.
[False statements made in this application are punishable under Penal Law (§210.45) and may result in your disqualification.]
SIGNATURE OF APPLICANT DATE
the state of new york unified court system is an equal opportunity employer
Answer all questions by placing an X in the appropriate column.
4
AdditionAl detAils
If you answered “yes” to any question that requires additional details, explain here.
Attach additional sheets if necessary.
