APPLICATION FOR EXAM SUPPLEMENT

(You must return this supplement with your application)

            Section 50-b of the New York State Civil Service Law requires that all applicants for examination be asked the following questions:

1.      Have you any loans made or guaranteed by the New York State Higher Education Services Corporation which are currently outstanding?

  ____Yes        ____No

2.      If so, are you presently in default on any such loan?

____Yes            ____ No

Name: ________________________________________________________

Address:_______________________________________________________

City , State, Zip:_________________________________________________

Examination Number and Title:______________________________________

THIS AFFIRMATION MUST BE COMPLETED:  I  affirm under penalties of perjury that all statements made on this application supplement are true.

Signature:_______________________________________ Date:____________

Higher Education Services Corporation      email: correspondence@hesc.com

99 Washington Ave

Albany NY 12255

518-402-1239

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