NYS & CSEA Partnership for Education and Training SKILLS FOR SUCCESS 
Course Application Form

 

APPLICANT INFORMATION
Directions for Completing the Skills for Success Course Application Form

Circle one        Mr.     Ms. Name of Agency or Organization

Name

Social Security # (last four digits only) Facility
Current Job Title

Home Address (all correspondence will be sent to your home address)

Grade Street/PO Box

Negotiating Unit _______    See #3 of directions

FOR New York State Government Employees (circle one):

02 = Administrative Services Unit (ASU)
03 = Operational Services Unit (OSU)
04 = Institutional Services Unit (ISU)
05 = Professional, Scientific & Technical (PS&T)*
06 = Management /Confidential (M/C)*
47 = Division of Military and Naval Affairs (DMNA)
Other________________

*Were you previously in the Administrative Services Unit
and are you currently in a traineeship or on probation as a result of an appointment to a Transition Title?     Yes___          No ___

FOR Local Government/Private Sector Employees (circle one):
      LG=Local Government
      PS=Private Sector

 City                     State                      Zip Code
Daytime Phone # (     )
Daytime Fax # (     )
Email Address

Reasonable Accommodation
If you have a disability that requires a reasonable accommodation in order to participate in any of the Skills for Success courses, please check here __________ .

A Partnership staff member will contact you at the phone number or email address you provide above for further information.


COURSE INFORMATION

Course Titles(s) (NOTE: Please list in order of preference)
Course Date(s)
Course Location (City)
1.    
2.    
3.    
4.    

SUPERVISOR'S APPROVAL
This employee has my approval to attend the course(s) listed. By signing this application, I agree to grant this employee release time, without charge to leave credits, to attend the entire course(s).

Supervisor's Name (Print or Type)

Supervisor's Signature

Supervisor's Phone #

Supervisor's Email Address
Please return this application by mail or fax. See #9 of directions Date

The NYS & CSEA Partnership for Education and Training does not discriminate on the basis of race, color, national origin, gender, religion, age, disability, or sexual orientation in employment, admission, or access to its programs or activities. Reasonable accommodation will be provided on request.                                                                         Rev. September 2009