Preview
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023
City of New York 6 9 u 3 O
Comprehensive'Personnel Document (CPD-B)
Read Section I of the CPD (B) Applicant Guldelines Before You Complete This Application.
" If you are a current city employee or a prior
city employee separated (rom NYC less than one year ago and
. there is a fully completed Personal
History Questionnaire (PHQ) or Comprehensive Personnel Document
(CPO) in your Personnel Folder (TPF), this form may not be required. Instead complete
an Update
Personnet Document (UPD.)
" Type or print clearly In BI..ACK frIK in the boxes provided.
" All questions must be answered
" completely and accurately.
If you·have additional comments or yo0r answer requires
additional space, request
sheets and/or use the comments page (Section supplementary data
" XI.) .
A false statement or Intentional omission of any material fact
even following may cause you to be disqualified,
' your appointment, and may lead to prosecution.
" .
Each page m,._u.jitbe initialed and you must count the number
of pages you ha e cornpieted
(including
supplementary data sheets) and provide that information on page 20.
I. BASIC !NFORMATION
Position, tradolicense or certificate you are appi ing for
Social
Birth M M D D Y Y
List below any other name s) you
may have been known by. (This includes maiden nam )
Last . First
Name < .
Name MI
Last .
First
Name
Name M[
List below arr other Social Number you have used and effective
Security date.
Social M
Effective M D D Y Y
Security
Number Date
_ __ . .
Current
For assistance, see CPD (B) ApplicantiSaidelines, page 13
Applicant's Initials Use Only:
Agency
OP-2488-CPD (B) (1/25/94)
TPF Sectlan 4
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023
. ll, Miscellaneous Questions
For each of the following questions, answer YES (Y) or NO (N) in the box to the dght For q esti ns 5,10 11 and 12, you must
read Section LA/B, pages 1-7 in the CRP (B) Applicant Guidelines. . Y/N
1. Are you legally authoriz.ed to work In the l.Inited States?
2. if this title requkes American citizenship, are you a US citizen?
If American citizenshipis not required, pdnt N/A (Not applicatite) in the following space
3. Are you a current City employee or have you had a break in service from City employment of less than one year?
4. Fiave you ever been employed by a New York City (NYC) agency? If YES, state last NYC agency ernployed by
and date separated from employment
. .
.
Agency M M D D Y Y
5. In addition to assuming a position for which this application Is being completed, are you continuing
emp(oyment with another City agency or other govemmental agency or jurisdiction? (lf YES, complete
Form DP-1021A. jf both employers are NYC mayoral agencies, DCAS approval is required.)
6. Are you a retiree from any retirement system administered by NYS or any of Its political sulxfivisions (I e., state
county, or m'unicipality?) If YES, indicate below the pension system and agency from which you are retired.
(Noto:Under NYS Retirementand SocialSeanity Law, your pensionmay be affectedif approvalhas not beenreceivedfromDCAS.)
Pension Agency
System Retired From
7. Are you being sppointed to a position in a new agency and requesting a leave of absence from your pennanent
civil service list title? (Note: If you are changing agencies and have previously been granted such a leave of
'
absence,·you must now request a new leave from your original agency.)
8. Did you claim and use veteran's (V) or disabled veteran's (D) preference credits for this position? If YES, (ndicate
*V' or "D"
9. Have you ever used your veteran's preference credits before for a civil service dppointment or promotion with IN
. State or any of Its political subdivisions? (f YES, indicate agency below
| Agency
10. Are you a resident of New York City?
11. Are you a nonresident of New York City required to move Into New York City?
For questions 12 to 17, If you answer YES,you mug provide complete.details sp'ectfying date, agency, reason,
Disposition, etc. on Comments Page18.
12 Are you a non.resident of New York City who Is not required to move Into New York City?
13, Have you ever applied for ernployment with NYC and/or been Investigated for employment by the NYC
Department of Personnel, or. the Depertment of Citywide Administrative Services, the NYC Pollm Department
or any other City agency? .
.
14. Were you ever barred or disqualified from a City, Country, State or Federal job?
15. Were you ever discipIlned (i.e., suspended, demoted, repiimanded, fined, fired, terminated, discharged) in any
position by either a public or private employer? .
16..Did you ever resign from a job while disciplinary acUon ps pending against you?
17. Have you ever resigned from a job10 avoid termination grdisciplinary action?
.
For assistance, see CPD (B) Applicant Guidelines, page13-15
Applicanes Initials Agency Use Only:
DP-2488-CPD (B) (1/25/94) 2 TPF Sec6on 4
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023
. 269638
Ill. CONVICTION RECORD
a e u ac
List all your convictions and pending .charges below, Use the Comments page to list additional convictlans. You
must list EVERY conviction. (Do NOT include traffic violations in this
sectíon.) If you cannot recall all of your
convictions, theo you MUST Indicate this below.
Note: Offenses include.felonies, misdemeanors and'vlolatlans. A plea of guilty is a conviction even If you were
never imprisoned. only paid a fine, were conditionally or discharged or received a Ceftificate of
unconditionally
Relief from Disabilities. Except for Firefighter, Police Officer or Peace Officer (including Special Patrolman)
applicants, you DO NOT have to disclose any material sealed, expunged, or set aside under Federal or State law.
or juvenlie delinquent or youthful offender adjudications. You are not considered a youthful offender just because
your age at the time of the offense. Only a court can determine youthful offender status. (if you are unsure whether
you were considered a youthful offender, list the
offense(s) below and provide details on Page 18.)
A conviction record or pending criminal charges will not
necessarily disqualify you from the position for which you
are applying. If you·list convictions or pending charges. you
may state facts in favor of your employment on the
Comments Page 18. These facts will be considered when the investigator reviews your case.
A) Have you ever been convicted of en offense anywhere? (Yes/No)
B) Are any crirninal charges pending against you? (Yes/No)
LIST A_LL CONVICTi0NS AND/OR PENDING CHARGES BELOW: . .
.
ARREST DATE· OFFENSE NAME AND LOCATION OF COURT SENTENCE AND DATE OF
·
MM/DD/YY) SENTENCE
0 &/Pfe) AtÈd Lart'e NCt o ro . (f ourt
Six NdA Atw mL 8 ]93|o5
f
}O |$O'b R4/ } tracCw% pis :d coe AM0 &A Swr kry 12/24/o3
4 m o 3
"
VT L of), GA It rd mu york
(
bi0n°
IN4/2oolf
"
9 03 2.cc e a ty.A,f employment was not List % of time for each
continuous, state total year/months acttrally worked. . duty (must total 100pe)
mmà°
P rer;es DÛ HaÎer s Ld u»ct
s)Abras,r.)
GmWt (elc Steer (Djjy , Plasm. 7Ò
100%
Forassistance,seeCPD(B) ApplicantGuidelines, Page 16-18.
For Agency Uso Only
Agericy . verificadon
Applicant'sinitials Type initials catevertried
Processing
I
Verbal (x)
DP-2,488-CPD (B) (1/25/B4) 6 TPF Section 4
. . .
.
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023
69v38-
EMPLOYMENT.COCTINUED
=e LN e I . M7Ba
B) Dates Employed
r wo N
Day/Night Company Still in Business? (Y/N) La
Indicateper Annum (A). Day(D), Hour (H)Here ‘
Job Title L Ot ..
CMI Solvice Title (if with
NYC
Em o er Name
Street-Address
Cit ·orTown . StatusINUn NYC
State 21 Code Pennanent(C)
..Coun_hyif not US
ForeFqaPostal Code ·
. .. -- . . .- . ··_..(-... j'-, y.. " .·.:·' rvampt (v)
:.· Labor(L)
, .. : ... · .,.; . P:©c.:.· . .-t - · v.-- .. Undassl6ed(U)
q.tq
Supervisor (Namef lle/Phone -
Number) orchte
(
I 532 f>xf5
Reason for leaving O
Duties (include numbernitle of employees supervised If employment was not
directly/indirectly.) Ust % of time for each
continuous, state total yearknonths actually worked.
duty (must total 100%)
beno |i),od O S ;dtw& K S for at &"vere)r
'
úhu áQ
of t^.)oq“
.Ua·ovç Q fferAs y
wek
100%
For assistance, see CPD(B) Applicant Guidelines, Page 16-18.
. For Aqancy Use Only
Agency verification
Applicanes Initials Type tattrats Data Vertfied
Processing
_E!!tge_tn.1xL_
. * Verbal (x)
DP-2488-CPD (B) (1/25I94)
7 TPF Section 4
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023
EMPLOYMENT CONTINUED
C) Dates Employed 3 8
Day/Night Company SUllIn Business? (Y/N) Las
Job Titio
Civil ServiS Title (if with
NYC .
"
Em er Name AJ
Street Address
CI or Town Slatus If withNYC
Zi Code Permanent(C)
State *- -
ProvisionalU) _,___
Coun if not US .
Noncomp
Foreign Postal Code
. . 2
. ', - ". . ". ., . Labor (L)
· · . . . - . :, . . .. . ., .. ,- . .. . Undassified (U)
Supervisor (Name/Title/Phone Number)
Reason forleaving A 5 ('Ot-( .
Duties (indude number/title of employees supervised directly ndirectly.) If employment was not Ust % of time for each
continuous, state total year/months actually walked. duty (must total 100%)
CL o9 t°S :v¼ e 0Â 2-S
Are(wel u baUed I f¿lte) Mud Aqs/se om Enf
mumeJd exrse
we me u.ws ,·.u s asa
rn
wret >r saus a g ff
ene aws 2G &
(
. .
.
. 1M%
For assistance, see CPD(B) Applicant Guidelines, Page 16-18,
For Agency Uso Only
vertncanon
Agency
we , Initials Date verined
Applicants Initials Processint
wrutan x
Verbal (x)
. DP-2488-CPD (B) (1þ5/94) TPF Section4
g
a
.
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023
EMPLOYMENT
269 38
CON INUED
Na a
D) Dates Employed . q269638
From M M D D Y Y To M M D D Y Hours Worked I [ Badge
0 5 fk D 3 0 I \ 5 0 parw"" I I No.
.
Day/NIght Cornpany Stilf in Business? (Y/N) Las
Indicateper Annum (A). Day (D), Hour (H) Hennt
CMI Service Title (if with
NYC
Em fo er Name T
Street Address
Ci or Town stalus If wth NYC
State Zi Code Permanent(C)
Count if not US - Provisional(J). _.__
Foreign Postal Code Noncompelluve(N) __
.· . . . _ . . . ", . . * . .. . . .; .-. - - - .. . . Exampt (X)
"- . .f.'·,-·. ·f . ... " Labor(L)
-. . . . .. ,.
., . , . " ..* . . . .-. .. ,, , . .. . -. . .· , __
, . Unciassified(U)
Supervisor (Name/Titte/Phone Number) D N OMRC.
Reason for leaving CO o S·e o w o
Duties (include number/title of employees supervised
directlylindirectly.) .If employment was riot List % of time for each
continuous, state total year/months actually wod(ed. duty (must total 100%)
S th tÔ HE q?ine s Q ceaSS dhe Tr i DA0
2e3) ieuite ¼ Cot f ÉC) HafRue behe /th 20&
100%
For assistance, see CPD(B) Applicant Guidelines, Page 16-18.
For Agency Use Only
Agency verlacation
Applicant'qInitials Type initials Dats Verined
written x
- Verbal (x)
.
OP-2488-CPD (B) (1/25/94) TPF Section 4
9
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023
. . &
EMPLOYMENT-CONTINUED
ft Tel-1Tl-lTIT
E) Dates Em icyed
( o O f CL
From To at M D D Hours Worked Badge
Day/Night Company Stdl in Business? (Y/N)
Indicateper Annum(A), Day(D), Hour (H) Heret
Job Tica .
Civil Service Title (if with
'
Em lover Name U
Street Address ___
. C or Town O c statusirwith NY
State Zi Code Permanent(C)
Provisionai(J)
Coun if not US
Foreign Postal Code
No m e)he (N) _
. -. . . . , c. :,J. . . Labor(L)
.. -
: ; . - . .... . ...J;..."i. .. . . . ..,:. . , ..c .. . . a . .· " UndasslEed(U)
. Supervisor (Name/Title/Phone Number)
- . Reason for leaving O
Oulies (include number/title of employees supervised directly/indirectly.) If employrnent was nal List % of time for each
continuous, state total year/months actually worked. duty (must total 100%)
· DJ o
rk¬.d S“oCE Foort for Uhri a
.
.
100%
For assistance, see CPD(B) AppNcantGuidelines, Page 16 18.
For Agency Use Only
verificanon
Agency
TYPe Inidals. DateVerHied
Applicants initials
wriuon x
. verbai (x)
.
. .
DP-2488-CPD (B) (1/25/94) " " TPF SecUon4
10
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023
EMP.LOYMENT CONTINUED
Last First Soc.
Name Initial Sec.
F) Dates Employed .
From M M D D X To M O D Y Hours Worked Badge
" per week No.
f)
Day/Night Company Still In Business? (Y/N) Las
Indicateper Annum(A), Day (D). Hour (H) Heret
Job Title γr b 5 DJ .
(
Civil Service Title (if with
NYC
'
Em to er Name C C.
Street Address O
C or Town . StatusItwithNYC
State
-
- 21 Code Permanent(C)
Provisional(J)
_
__
Coun dnot US
Fore(qnPostal Code
*' . .
/ . . . . , ., . . . Labor (L)
- . . -. . . . . s. .. - .- .c .-. ... p.. . :, ..: 2..· ., ;. . . , .. . .. Undassified (in
. Supervisor (NameRide/Phone Number) 30
Reason for leaving Q rf f{( O #f
Duties (include number/title of employees supervised directly/indirectly.) If employrnent was not Llst % of time for each
continuous, state total year/months actually worked. duty (rnust total 100%)
rn-em) ad :~uesh del 0ad &wP0dr 22 2
Pbternd I PNer/, a~S 95
fIly .n3
•fsfbNR Lle -for Subah (wct reWMM
100%
For assistance, see CPD(B) Applicant Guidelines, Page 16.18.
For Aqancy Uso Only
. . " verification
Agency
Type initials DataVertfied
. Applicantsinitials
Written x
Verbal (x) . .
DP-2488-CPD (B) (17).5/94) I [ TPF Section 4
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023
2 S 38
EMPLOYMENT CONYINUED
a a nÊt se .
G) Datos E loyed
CL
Y D D Y Y Hours Worked Badge
Frám | O | D Y TO M
No.
] 5 O . i (-2 6 par-eak
I 0
. Day/Night Company Still th Business? (Y/N) Last
Salary5
Indicale perAnnum(A), Day (D), Hour (H) Here t
CMI Service Title (if with
Street Address
. Statusif wlb NYC "
. State ZI Code Pannanent(C) __._
o Ud (N)
Foreign Pos(afCode
.' .. . Labor(L)
. '.
Undassi6ed(0)
Supervisor (Name/Tide/Phone Number)
Reason for leaving
Duties (include number/tiue of errfployees supervised direcUy/indirectly.) If ernployment was not List % of Ume for each
continuous,
Preview
FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023 City of New York 6 9 u 3 O Comprehensive'Personnel Document (CPD-B) Read Section I of the CPD (B) Applicant Guldelines Before You Complete This Application. " If you are a current city employee or a prior city employee separated (rom NYC less than one year ago and . there is a fully completed Personal History Questionnaire (PHQ) or Comprehensive Personnel Document (CPO) in your Personnel Folder (TPF), this form may not be required. Instead complete an Update Personnet Document (UPD.) " Type or print clearly In BI..ACK frIK in the boxes provided. " All questions must be answered " completely and accurately. If you·have additional comments or yo0r answer requires additional space, request sheets and/or use the comments page (Section supplementary data " XI.) . A false statement or Intentional omission of any material fact even following may cause you to be disqualified, ' your appointment, and may lead to prosecution. " . Each page m,._u.jitbe initialed and you must count the number of pages you ha e cornpieted (including supplementary data sheets) and provide that information on page 20. I. BASIC !NFORMATION Position, tradolicense or certificate you are appi ing for Social Birth M M D D Y Y List below any other name s) you may have been known by. (This includes maiden nam ) Last . First Name < . Name MI Last . First Name Name M[ List below arr other Social Number you have used and effective Security date. Social M Effective M D D Y Y Security Number Date _ __ . . Current For assistance, see CPD (B) ApplicantiSaidelines, page 13 Applicant's Initials Use Only: Agency OP-2488-CPD (B) (1/25/94) TPF Sectlan 4 FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023 . ll, Miscellaneous Questions For each of the following questions, answer YES (Y) or NO (N) in the box to the dght For q esti ns 5,10 11 and 12, you must read Section LA/B, pages 1-7 in the CRP (B) Applicant Guidelines. . Y/N 1. Are you legally authoriz.ed to work In the l.Inited States? 2. if this title requkes American citizenship, are you a US citizen? If American citizenshipis not required, pdnt N/A (Not applicatite) in the following space 3. Are you a current City employee or have you had a break in service from City employment of less than one year? 4. Fiave you ever been employed by a New York City (NYC) agency? If YES, state last NYC agency ernployed by and date separated from employment . . . Agency M M D D Y Y 5. In addition to assuming a position for which this application Is being completed, are you continuing emp(oyment with another City agency or other govemmental agency or jurisdiction? (lf YES, complete Form DP-1021A. jf both employers are NYC mayoral agencies, DCAS approval is required.) 6. Are you a retiree from any retirement system administered by NYS or any of Its political sulxfivisions (I e., state county, or m'unicipality?) If YES, indicate below the pension system and agency from which you are retired. (Noto:Under NYS Retirementand SocialSeanity Law, your pensionmay be affectedif approvalhas not beenreceivedfromDCAS.) Pension Agency System Retired From 7. Are you being sppointed to a position in a new agency and requesting a leave of absence from your pennanent civil service list title? (Note: If you are changing agencies and have previously been granted such a leave of ' absence,·you must now request a new leave from your original agency.) 8. Did you claim and use veteran's (V) or disabled veteran's (D) preference credits for this position? If YES, (ndicate *V' or "D" 9. Have you ever used your veteran's preference credits before for a civil service dppointment or promotion with IN . State or any of Its political subdivisions? (f YES, indicate agency below | Agency 10. Are you a resident of New York City? 11. Are you a nonresident of New York City required to move Into New York City? For questions 12 to 17, If you answer YES,you mug provide complete.details sp'ectfying date, agency, reason, Disposition, etc. on Comments Page18. 12 Are you a non.resident of New York City who Is not required to move Into New York City? 13, Have you ever applied for ernployment with NYC and/or been Investigated for employment by the NYC Department of Personnel, or. the Depertment of Citywide Administrative Services, the NYC Pollm Department or any other City agency? . . 14. Were you ever barred or disqualified from a City, Country, State or Federal job? 15. Were you ever discipIlned (i.e., suspended, demoted, repiimanded, fined, fired, terminated, discharged) in any position by either a public or private employer? . 16..Did you ever resign from a job while disciplinary acUon ps pending against you? 17. Have you ever resigned from a job10 avoid termination grdisciplinary action? . For assistance, see CPD (B) Applicant Guidelines, page13-15 Applicanes Initials Agency Use Only: DP-2488-CPD (B) (1/25/94) 2 TPF Sec6on 4 FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023 . 269638 Ill. CONVICTION RECORD a e u ac List all your convictions and pending .charges below, Use the Comments page to list additional convictlans. You must list EVERY conviction. (Do NOT include traffic violations in this sectíon.) If you cannot recall all of your convictions, theo you MUST Indicate this below. Note: Offenses include.felonies, misdemeanors and'vlolatlans. A plea of guilty is a conviction even If you were never imprisoned. only paid a fine, were conditionally or discharged or received a Ceftificate of unconditionally Relief from Disabilities. Except for Firefighter, Police Officer or Peace Officer (including Special Patrolman) applicants, you DO NOT have to disclose any material sealed, expunged, or set aside under Federal or State law. or juvenlie delinquent or youthful offender adjudications. You are not considered a youthful offender just because your age at the time of the offense. Only a court can determine youthful offender status. (if you are unsure whether you were considered a youthful offender, list the offense(s) below and provide details on Page 18.) A conviction record or pending criminal charges will not necessarily disqualify you from the position for which you are applying. If you·list convictions or pending charges. you may state facts in favor of your employment on the Comments Page 18. These facts will be considered when the investigator reviews your case. A) Have you ever been convicted of en offense anywhere? (Yes/No) B) Are any crirninal charges pending against you? (Yes/No) LIST A_LL CONVICTi0NS AND/OR PENDING CHARGES BELOW: . . . ARREST DATE· OFFENSE NAME AND LOCATION OF COURT SENTENCE AND DATE OF · MM/DD/YY) SENTENCE 0 &/Pfe) AtÈd Lart'e NCt o ro . (f ourt Six NdA Atw mL 8 ]93|o5 f }O |$O'b R4/ } tracCw% pis :d coe AM0 &A Swr kry 12/24/o3 4 m o 3 " VT L of), GA It rd mu york ( bi0n° IN4/2oolf " 9 03 2.cc e a ty.A,f employment was not List % of time for each continuous, state total year/months acttrally worked. . duty (must total 100pe) mmà° P rer;es DÛ HaÎer s Ld u»ct s)Abras,r.) GmWt (elc Steer (Djjy , Plasm. 7Ò 100% Forassistance,seeCPD(B) ApplicantGuidelines, Page 16-18. For Agency Uso Only Agericy . verificadon Applicant'sinitials Type initials catevertried Processing I Verbal (x) DP-2,488-CPD (B) (1/25/B4) 6 TPF Section 4 . . . . FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023 69v38- EMPLOYMENT.COCTINUED =e LN e I . M7Ba B) Dates Employed r wo N Day/Night Company Still in Business? (Y/N) La Indicateper Annum (A). Day(D), Hour (H)Here ‘ Job Title L Ot .. CMI Solvice Title (if with NYC Em o er Name Street-Address Cit ·orTown . StatusINUn NYC State 21 Code Pennanent(C) ..Coun_hyif not US ForeFqaPostal Code · . .. -- . . .- . ··_..(-... j'-, y.. " .·.:·' rvampt (v) :.· Labor(L) , .. : ... · .,.; . P:©c.:.· . .-t - · v.-- .. Undassl6ed(U) q.tq Supervisor (Namef lle/Phone - Number) orchte ( I 532 f>xf5 Reason for leaving O Duties (include numbernitle of employees supervised If employment was not directly/indirectly.) Ust % of time for each continuous, state total yearknonths actually worked. duty (must total 100%) beno |i),od O S ;dtw& K S for at &"vere)r ' úhu áQ of t^.)oq“ .Ua·ovç Q fferAs y wek 100% For assistance, see CPD(B) Applicant Guidelines, Page 16-18. . For Aqancy Use Only Agency verification Applicanes Initials Type tattrats Data Vertfied Processing _E!!tge_tn.1xL_ . * Verbal (x) DP-2488-CPD (B) (1/25I94) 7 TPF Section 4 FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023 EMPLOYMENT CONTINUED C) Dates Employed 3 8 Day/Night Company SUllIn Business? (Y/N) Las Job Titio Civil ServiS Title (if with NYC . " Em er Name AJ Street Address CI or Town Slatus If withNYC Zi Code Permanent(C) State *- - ProvisionalU) _,___ Coun if not US . Noncomp Foreign Postal Code . . 2 . ', - ". . ". ., . Labor (L) · · . . . - . :, . . .. . ., .. ,- . .. . Undassified (U) Supervisor (Name/Title/Phone Number) Reason forleaving A 5 ('Ot-( . Duties (indude number/title of employees supervised directly ndirectly.) If employment was not Ust % of time for each continuous, state total year/months actually walked. duty (must total 100%) CL o9 t°S :v¼ e 0 2-S Are(wel u baUed I f¿lte) Mud Aqs/se om Enf mumeJd exrse we me u.ws ,·.u s asa rn wret >r saus a g ff ene aws 2G & ( . . . . 1M% For assistance, see CPD(B) Applicant Guidelines, Page 16-18, For Agency Uso Only vertncanon Agency we , Initials Date verined Applicants Initials Processint wrutan x Verbal (x) . DP-2488-CPD (B) (1þ5/94) TPF Section4 g a . FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023 EMPLOYMENT 269 38 CON INUED Na a D) Dates Employed . q269638 From M M D D Y Y To M M D D Y Hours Worked I [ Badge 0 5 fk D 3 0 I \ 5 0 parw"" I I No. . Day/NIght Cornpany Stilf in Business? (Y/N) Las Indicateper Annum (A). Day (D), Hour (H) Hennt CMI Service Title (if with NYC Em fo er Name T Street Address Ci or Town stalus If wth NYC State Zi Code Permanent(C) Count if not US - Provisional(J). _.__ Foreign Postal Code Noncompelluve(N) __ .· . . . _ . . . ", . . * . .. . . .; .-. - - - .. . . Exampt (X) "- . .f.'·,-·. ·f . ... " Labor(L) -. . . . .. ,. ., . , . " ..* . . . .-. .. ,, , . .. . -. . .· , __ , . Unciassified(U) Supervisor (Name/Titte/Phone Number) D N OMRC. Reason for leaving CO o S·e o w o Duties (include number/title of employees supervised directlylindirectly.) .If employment was riot List % of time for each continuous, state total year/months actually wod(ed. duty (must total 100%) S th tÔ HE q?ine s Q ceaSS dhe Tr i DA0 2e3) ieuite ¼ Cot f ÉC) HafRue behe /th 20& 100% For assistance, see CPD(B) Applicant Guidelines, Page 16-18. For Agency Use Only Agency verlacation Applicant'qInitials Type initials Dats Verined written x - Verbal (x) . OP-2488-CPD (B) (1/25/94) TPF Section 4 9 FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023 . . & EMPLOYMENT-CONTINUED ft Tel-1Tl-lTIT E) Dates Em icyed ( o O f CL From To at M D D Hours Worked Badge Day/Night Company Stdl in Business? (Y/N) Indicateper Annum(A), Day(D), Hour (H) Heret Job Tica . Civil Service Title (if with ' Em lover Name U Street Address ___ . C or Town O c statusirwith NY State Zi Code Permanent(C) Provisionai(J) Coun if not US Foreign Postal Code No m e)he (N) _ . -. . . . , c. :,J. . . Labor(L) .. - : ; . - . .... . ...J;..."i. .. . . . ..,:. . , ..c .. . . a . .· " UndasslEed(U) . Supervisor (Name/Title/Phone Number) - . Reason for leaving O Oulies (include number/title of employees supervised directly/indirectly.) If employrnent was nal List % of time for each continuous, state total year/months actually worked. duty (must total 100%) · DJ o rk¬.d S“oCE Foort for Uhri a . . 100% For assistance, see CPD(B) AppNcantGuidelines, Page 16 18. For Agency Use Only verificanon Agency TYPe Inidals. DateVerHied Applicants initials wriuon x . verbai (x) . . . DP-2488-CPD (B) (1/25/94) " " TPF SecUon4 10 FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023 EMP.LOYMENT CONTINUED Last First Soc. Name Initial Sec. F) Dates Employed . From M M D D X To M O D Y Hours Worked Badge " per week No. f) Day/Night Company Still In Business? (Y/N) Las Indicateper Annum(A), Day (D). Hour (H) Heret Job Title γr b 5 DJ . ( Civil Service Title (if with NYC ' Em to er Name C C. Street Address O C or Town . StatusItwithNYC State - - 21 Code Permanent(C) Provisional(J) _ __ Coun dnot US Fore(qnPostal Code *' . . / . . . . , ., . . . Labor (L) - . . -. . . . . s. .. - .- .c .-. ... p.. . :, ..: 2..· ., ;. . . , .. . .. Undassified (in . Supervisor (NameRide/Phone Number) 30 Reason for leaving Q rf f{( O #f Duties (include number/title of employees supervised directly/indirectly.) If employrnent was not Llst % of time for each continuous, state total year/months actually worked. duty (rnust total 100%) rn-em) ad :~uesh del 0ad &wP0dr 22 2 Pbternd I PNer/, a~S 95 fIly .n3 •fsfbNR Lle -for Subah (wct reWMM 100% For assistance, see CPD(B) Applicant Guidelines, Page 16.18. For Aqancy Uso Only . . " verification Agency Type initials DataVertfied . Applicantsinitials Written x Verbal (x) . . DP-2488-CPD (B) (17).5/94) I [ TPF Section 4 FILED: NEW YORK COUNTY CLERK 12/30/2023 12:05 AM INDEX NO. 150020/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/30/2023 2 S 38 EMPLOYMENT CONYINUED a a nÊt se . G) Datos E loyed CL Y D D Y Y Hours Worked Badge Frám | O | D Y TO M No. ] 5 O . i (-2 6 par-eak I 0 . Day/Night Company Still th Business? (Y/N) Last Salary5 Indicale perAnnum(A), Day (D), Hour (H) Here t CMI Service Title (if with Street Address . Statusif wlb NYC " . State ZI Code Pannanent(C) __._ o Ud (N) Foreign Pos(afCode .' .. . Labor(L) . '. Undassi6ed(0) Supervisor (Name/Tide/Phone Number) Reason for leaving Duties (include number/tiue of errfployees supervised direcUy/indirectly.) If ernployment was not List % of Ume for each continuous,