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THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION (CUNY Kingsborough Community College)

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Our Commitment to Diversity
Diversity and inclusion are core values of The City University of New York (CUNY or The University). We believe adherence to these values
creates an environment that best allows our students, faculty and staff to learn, work and succeed. As a University, we strive to respect
differences, but more importantly, we seek to leverage the talents of all members of the University community in order to foster academic and
administrative excellence. These values make CUNY a great place to learn and work!
Notice of Non-Discrimination
It is the policy of the University-applicable to all colleges and units-to recruit, employ, retain, promote, and provide benefits to employees and
to admit and provide services for students without discriminating on the basis of actual or perceived race, color, creed, national origin, ethnicity,
ancestry, religion, age, sex, sexual orientation, gender, gender identity, marital status, partnership status, disability, genetic information,
alienage, citizenship, military or veteran status, pregnancy, status as a victim of domestic violence/stalking/sex offenses, unemployment status,
caregiver or familial status, prior record of arrest or conviction, or any other legally prohibited basis in accordance with federal, state and city
laws. This policy is set forth in CUNY's Policy on Equal Opportunity and Non-Discrimination.
CUNY's Policy on Sexual Misconduct prohibits all forms of sexual misconduct, including sexual harassment, gender harassment and sexual
violence.
It is also the University's policy to provide reasonable accommodations and academic adjustments, when appropriate, to individuals with
disabilities, individuals observing religious practices, individuals who have pregnancy or child birth-related medical conditions and victims of
domestic violence/stalking/sex offenses.
Inquiries or complaints relating to CUNY's Policy on Equal Opportunity and Non-Discrimination should be addressed to the College’s Chief
Diversity Officer. Inquiries or complaints relating to CUNY's Policy on Sexual Misconduct, or about sex discrimination, should be addressed to
the College’s Title IX Coordinator or to the Office for Civil Rights of the United States Department of Education.
Disability Accommodation Available for Applicants
If you require an accommodation for a disability in order to participate in the selection process, please contact the College's Office of Human
Resources.
Clery Act
CUNY complies with the Clery Act. Copies of each college's Annual Security Report, which includes security policies and crime statistics, are
available in the Office of Public Safety and on the web site for each campus.
Military Service
If you are claiming preference for military service, you will be required to submit an original DD 214 along with verification of your disciplinary
record.
Professional References
Current and former employers may be contacted for verification of any and all information stated in this application or obtained during any
phase of the selection process. In order for CUNY to obtain this information, please complete the Authorization to Release Reference
Information form agreeing to hold any and all of your reference sources harmless and free of any liability for releasing information CUNY deems
relevant to determining whether to employ you.
Applicants who do not want their current employer to be contacted prior to receiving an offer of employment are required to make such a
request and provide reasons therefor.
Consistent with State of New York Executive Order No. 161 and to further CUNY's commitment to compensate its employees fairly and equally
for the work they do, CUNY will not inquire about an applicant's current or prior compensation history until a conditional offer of employment
has been extended.
THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION - PART ONE
Important Notice to Applicants
Name
Position
CUNY EMPLOYMENT APPLICATION - PART ONE February 2017
Page 1 of 7
Dept.
College
THE CITY UNIVERSITY OF NEW YORK
APPLICATION FOR EMPLOYMENT- PART ONE
Position Title
If part-time, hours available
Contract Title
Last Name
P.M.
A.M.
Personal Information
First Name Middle Initial
If known by another name, please provide
Address
City State
Zip Code
Apt. #
Daytime Phone #
Evening Phone #
email
Do you have any relatives employed in the department for which you are applying?
If yes, please explain
Are you legally authorized to work in the United States?
Applicant Attestation:
By my signature below, I declare and affirm that I have read and fully understand that:
- Any misrepresentation or material omission of facts in this application or in any other materials I submit in support of my candidacy
(including but not limited to the letter of application and resume/CV), or in any oral statements I may make during the selection process shall
be sufficient cause to end further consideration of my application prior to being hired, or shall be sufficient cause for disciplinary action up to
and including termination, in the event I am hired;
- The University will verify academic and professional credentials and may contact present and past employers to check professional
references, as provided, either prior to or after receiving an offer of employment;
- An offer of employment is contingent on successful completion of the entire employment selection process. Offers and terms of
employment will only be made in writing.
- No manager or representative of CUNY has the authority to make an offer of employment or to represent a condition of employment which is
in violation of the bylaws, policies, or collective bargaining agreements governing employment at CUNY; and any representations that are
contrary to these policies, even when made in writing, are unenforceable.
Date
Job ID#
Full-time Part-time
No relatives
Yes, I have (a) relative (s)
Yes No
Application for Employment - Part One (Employment and Educational History of the Applicant)
Signature
College
CUNY EMPLOYMENT APPLICATION - PART ONE February 2017
Page 2 of 7
Will you now or in the future require sponsorship for employment visa status (e.g., H-IB visa status)?
Please be advised that sponsorship for employment authorization is a campus-based decision and is generally reserved for academic
appointments.
No Yes
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signature
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A. Education (Please indicate highest equivalent grade of education completed):
List schools attended, beginning with most recent (university, college, business school, vocational or trade school, high school, etc.)
School Name
Location
Major Study
Credits
completed
Degree
received
B. Employment History:
Begin with present or most recent job and work back for the last 15 years, listing all full or part-time employment. Be sure to include any current CUNY employment held.
Attach additional pages, if necessary.
Degree
received
Credits
completed
Major Study
Location
School Name
Doctorate
Masters
Baccalaureate Associate
High School/GED
Trade/Vocational School
Reason for leaving
Date employed
to
Date employed
from
Average hours worked
per week part-time
Part-time
Full-time
Telephone
Name/Title of
Immediate
Supervisor
Telephone
Briefly describe
duties
Address
Job TitleEmployer Name
Degree
received
Credits
completed
Major Study
Location
School Name
Degree
received
Credits
completed
Major Study
Location
School Name
IF REQUIRED FOR POSITION: Provide driver's license number,
professional/trade license/certification numbers. Attach page, if necessary
Professional Degree
CUNY Contract Title, if applicable
Average hours worked
per week part-time
Part-time
Full-time
Reason for leaving
Telephone
Date employed
to
Date employed
from
Name/Title of
Immediate
Supervisor
Briefly describe
duties
Telephone
CUNY Contract Title, if applicable
Address
Job TitleEmployer Name
CUNY EMPLOYMENT APPLICATION - PART ONE February 2017
Page 3 of 7
C. Important skills, competencies, or experience not identified above:
Identify other important skills, competencies, expertise, or related experiences (such as volunteer work, competence in foreign language, etc.) that you feel should be
considered in evaluating your suitability for this position. Attach additional pages, if necessary.
Average hours worked
per week part-time
Part-time
Full-time
Reason for leaving
Telephone
Date employed
to
Date employed
from
Name/Title of
Immediate
Supervisor
Briefly describe
duties
Telephone
CUNY Contract Title, if applicable
Address
Job TitleEmployer Name
Average hours worked
per week part-time
Part-time
Full-time
Reason for leaving
Telephone
Date employed
to
Date employed
from
Name/Title of
Immediate
Supervisor
Briefly describe
duties
Telephone
CUNY Contract Title, if applicable
Address
Job TitleEmployer Name
Have you ever left a position for any disciplinary reason?
Yes No
If yes, explain briefly:
Attach additional pages, if necessary
CUNY EMPLOYMENT APPLICATION - PART ONE February 2017
Page 4 of 7
G. How did you learn about this position? Check all that apply:
Other General Category
(Please explain)
Search Firm
Social Media (LinkedIn, Facebook, Academia.edu, Other)
Professional or academic group, contact, or referral
Job Fair, Conference, or Convention
Government Job Bank or Resource Agency (Veterans' Vocational Rehabilitation, Other)
External Job Board
Printed Advertisement
Search Engine (Bing, Google)
Union office
Someone I know who works at CUNY
CUNY Website (cuny.edu or cuny.jobs)
College Website
College Human Resources Office
COLLEGE USE ONLY
Reviewed by Chair of Search Committee / Hiring Manager:
Name
Date
Title
e-mail
e-mail e-mail
Daytime Phone #
Daytime Phone #Daytime Phone #
Address
Address
Address
Company
Company Company
Title
Title
3. Name
2. Name1. Name
Please list a minimum of three persons who are not related to you and who have definite knowledge of your qualifications and fitness for the position for which
you are applying. The Authorization to Release Reference Information Form (Page 7) must be completed.
D. Professional References:
Signature
CUNY EMPLOYMENT APPLICATION - PART ONE February 2017
Page 5 of 7
THIS PAGE INTENTIONALLY LEFT BLANK
I have applied for a position with The City University of New York (CUNY) and would like CUNY to be fully informed of my qualifications for the
position. I hereby authorize any current or former employer, professional reference, and education/training provider, to disclose in good faith
any information they may have regarding and pertaining to my qualifications and fitness for employment.
I agree to hold such employers, references, educational/training institutions and any other persons giving references harmless from liability or
damages for providing the requested information.
A photocopy or fax of this authorization shall be as valid as the original.
Authorization to Release Reference Information
Position sought
Name of Candidate
Consistent with legal mandates, CUNY defines protected classes for the purposes of affirmative action in employment as follows:
Asian, Black or African American, Hispanic or Latino (including Puerto Rican), American Indian or Alaska Native, Native Hawaiian or Other
Pacific Islander, Individuals with Disabilities, Veterans, and Women. The Chancellor of CUNY expanded these classes to include Italian
Americans on December 9, 1976.
CUNY is an EEO/AA/Vet/Disability Employer.
Date
Signature
College
CUNY EMPLOYMENT APPLICATION - PART ONE February 2017
Page 7 of 7
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