References and Pre-employment Certification
for Classified Staff Application
Name ______________________________________________ Date of Application ____________________
(List name and contact info for at least three individuals who can speak to your professional work-related behaviors)
1: Current or latest supervisor: ___________________________________________________________________________________
2: Former supervisor: __________________________________________________________________________________________
Comments (include here any employer you do NOT wish us to contact and why): _________________________________________
Incomplete applications may disqualify you from consideration for employment
PLEASE CAREFULLY READ AND SIGN BELOW
Certification of Qualifications
I certify that everything I have listed in this application is a true, accurate, and complete representation of my qualifications for the
position for which I have applied. I understand that any falsification, misrepresentation, or material omission in my application
materials (including this certification) or making other false or fraudulent representations in securing employment may be grounds for
disqualification of my candidacy or may be grounds for termination if discovered after the date of hire.
Acknowledgement of Responsibility to Obtain/Maintain Eligibility to Work in the United States
I understand SUNY Cobleskill employs only individuals who are lawfully eligible to work in the United States and that employment
eligibility will be verified upon employment. If I do not currently have permanent eligibility to work in the U.S., I understand that it is
my responsibility to obtain and/or maintain eligibility to work and that loss of eligibility to work at any future date will invalidate my
employment relationship and result in concurrent separation from employment without recourse or appeal.
Certification or Disclosure Pertaining to Criminal Convictions
I understand that in selected circumstances, convictions for a misdemeanor, gross misdemeanor, or felony related to the duties and
responsibilities of a given position may influence consideration for employment. I certify that unless I have listed below a statement
about the dates, charges, and circumstances of any such convictions, I have not been convicted of a misdemeanor, gross misdemeanor,
or felony in any jurisdiction inside or outside the U.S. ________________________________________________________________
Acknowledgment of SUNY Cobleskill Application Process
Cobleskill considers only those applications submitted for a specific posted position. I understand that if I applied for a job not
currently posted, my application materials may be discarded after 30 days.
Authorization to Verify Application Materials
My signature below authorizes SUNY Cobleskill to verify all of my application materials including contacting listed references as
well as validating educational and employment records, with the understanding that facsimiles or photocopies of this authorization
shall be deemed as valid as the original. If submitted electronically, I acknowledge and agree that by typing my name on the
signature line, I am authorizing and validating the statements above to the same degree as my original signature.
Signature of Applicant: __________________________________________________________________
Printed Name of Applicant: _______________________________________________ Date: ______________________________
SUNY Cobleskill is an Affirmative Action/Equal Opportunity educational institution. It is guided by the principle that equal
opportunity means more than equal employment opportunity, and that access to facilities and services shall be available to all people
regardless of their race, color, religion, sex, national origin, age, veteran status, disability, marital status, or sexual orientation.
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