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THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION (City University of New York)

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Rev. 7/15/20 CUNY Employment Application Part Two 1
THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION – PART TWO
POST CONDITIONAL OFFER OF EMPLOYMENT
This form should be completed only after a conditional job offer has been made.
Last Name: ___________________________________ First Name: _________________________________
Co
llege: _____________________________________ Department: ________________________________
Po
sition: ____________________________________ Check here if you are a CUNY Doctoral Student
Post Conditional Offer Verifications and Checks
Employment Eligibility and Identity Documents Verification
Newly hired employees must complete Section 1 of the Dept. of Homeland Security/U.S. Citizenship & Immigration
Services I-9 Form no later than the first day of employment. CUNY is required to verify evidence of identity and
employment authorization within 3 business days of the employee's first day of employment.
Verification of Credentials
Academic and professional credentials, as submitted in CUNY Employment Application Part 1, will be verified by
the college.
Criminal Background Check
As a candidate with a conditional offer of employment, you must provide criminal background information. For
some positions, a criminal history report may also be required. CUNY will consider your criminal history in
accordance with Article 23-A of the New York State Correction Law.
A conviction record will not necessarily disqualify you from the position for which you are applying. However, failure
to provide truthful responses will, when discovered, automatically result in the withdrawal of the conditional offer of
employment or your termination, if employed.
Before any adverse action is taken based on a previous criminal conviction, CUNY will:
• Provide a written Article 23-A analysis to the candidate in a form determined by the New York City
Commission on Human Rights (NYCCHR), together with any and all supporting information and/or
documents which formed the basis and reasons for the adverse action; and
• After providing the candidate with the required documentation, allow him or her at least three business
days to respond and, during that time, hold the position open for the candidate.
Credit History Check, Medical Certification, Medical Examination, Drug Screening, and Physical Agility and
Fitness Assessment
For some positions, a credit history, medical certification, medical examination, drug test, and/or physical agility
and fitness assessment may be required as a condition of employment. CUNY processes all information per
applicable laws.
Rev. 7/15/20 CUNY Employment Application Part Two 2
Accommodation required to perform Essential Job Functions
It is the University's policy to provide reasonable accommodations, when appropriate, to individuals with
disabilities, individuals observing religious practices, employees who have pregnancy or child-birth related medical
conditions, or employees who are victims of domestic violence/stalking/sex offenses.
If you require an accommodation to perform the essential job functions for the position for which you have
received a conditional offer of employment, please contact the HR Director at the college or unit where you have
received the conditional offer of employment.
Rev. 7/15/20 CUNY Employment Application Part Two 3
THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION – PART TWO
CONFIDENTIAL BACKGROUND INFORMATION
Only candidates who have receives a conditional job offer should complete this form.
For questions and concerns, candidates may request guidance from the Office of Human Resources.
The completed form should be submitted to the Office of Human Resources only.
College: _______________________________________ Position: ___________________________________
Contract Title: __________________________________ Job ID#: ____________________________________
Full-Time Part-Time *if part-time, hours available: A.M. P.M.
Check here if you are a CUNY Doctoral Student
Personal Information
Last Name: ___________________________ First Name: ___________________________ Middle Initial: _______
If known by another name, please provide: _________________________________________________________
Address: ______________________________________________________ Apt: #: _____________________
City: _______________________________ State: ___________________ Zip Code: ____________
Email: _____________________________________ Preferred Phone #: __________________________
Please complete Page 3
Rev. 7/15/20 CUNY Employment Application Part Two 4
Confidential Criminal Background Information
1. Have you ever been convicted of a misdemeanor or felony? Even if you were convicted, answer “NO” if your
conviction:
a. Was sealed, expunged or reversed on appeal
b. Was for a violation, infraction or other petty offense such as “disorderly conduct”
c. Resulted in a youthful offender or juvenile delinquency finding
d. If you withdrew your plea after completing a court program and were not convicted of a
misdemeanor or felony.
Yes No
2. Are there any criminal charges currently pending against you?
Yes No
3. Please explain below all past convictions or currently pending criminal charges against you (as specified in
Questions 1 and 2 above). If necessary, attach additional pages
Offense Date of Conviction Name/Location of Court Disposition including incarceration
Offense Date of Conviction Name/Location of Court Disposition including incarceration
Offense Date of Conviction Name/Location of Court Disposition including incarceration
Offense Date of Conviction Name/Location of Court Disposition including incarceration
Applicant Attestation:
By my signature below, I declare and affirm that I have read and fully understand that:
Any misrepresentation of material omission of facts on this form shall be sufficient cause to end further
consideration of my candidacy for the position for which I have received a conditional offer of employment or shall
be sufficient cause for disciplinary action up to and including termination, in the event that I am hired.
Signature: ____________________________________________ Date: ________________________
College Use Only
Received by the Director of Human Resources
Name: _______________________________________________ Date: ________________________
Signature: _____________________________________________
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THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION (City University of New York)

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Completed 2 February 2022

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