2. Date*
   Date
4. I am declining the *

   1. Temporary
   2. Contingent-Permanent
   3. Permanent
5. position of*
7. in the appointing jurisdiction of*
   -- Select One --Cayuga CountySchool DistrictSpecial DistrictTownVillage
9. Cayuga County Department*
   -- Select One --Real Property (Assessments)Buildings & GroundsClerk of the LegislatureCounty AdministratorCounty AttorneyCounty ClerkCounty HistorianCounty TreasurerDistrict AttorneyE911Elections (Board of Elections)Emergency ManagementEmergency Medical ServicesEmployment & TrainingFireHighwayHuman Resources & Civil ServiceIndigent DefendantsInformation TechnologyJailLegislative BoardMed Exam & CoronerMental HealthMotor Vehicle BureauOffice for the AgingPlanning BoardProbationPublic HealthPublic WorksSheriffSheriff-COB-Building SecuritySheriff-CourtsSocial ServicesStop-DWIVeteransWeight & MeasuresYouth Bureau
11. School District*
    -- Select One --Cato-Meridian CSDMoravia CSDPort Byron CSDSouthern Cayuga CSDUnion Springs CSDWeedsport CSD
13. Special District*
    -- Select One --Cayuga Community CollegeCayuga County Soil & Water Conservation DistrictCayuga County Water & Sewer AuthorityCayuga-Onondaga BOCESSeymour Library
15. Town*
    -- Select One --AureliusBrutusCatoConquestFlemingGenoaIraLedyardLockeMentzMontezumaMoraviaNilesOwascoScipioSemproniusSennettSpringportSterlingSummerhillThroopVeniceVictory
17. Village *
    -- Select One --AuroraCatoCayugaFair HavenMeridianMoraviaPort ByronUnion SpringsWeedsport
19. Please Choose One*

    1. Please leave my name on the list for this title
    2. Please inactivate my name on the list for this title
21. Name*
22. Email Address*
24. Attestation - I certify that I am the candidate listed above and do not wish to be considered for the position listed above at this time.

    1. Yes
    2. No
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27. Email address

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