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

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THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION – PART ONE
Last Name: ____________________________________ First Name: _________________________________
C
ollege: _______________________________________ Department: ________________________________
C
heck here if you are a CUNY Doctoral Student
Important Notice to Applicants
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.
C
UNY's Policy on Sexual Misconduct prohibits all forms of sexual misconduct, including sexual harassment, gender
harassment and sexual violence.
I
t 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.
I
nquiries 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 include security policies
and crime statistics, are available in the Office of Public Safety and on each campus’ website.
Rev. 7/15/20
CUNY Employment Application Part One
1
Military Service
If you are claiming Civil Service 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 reasoning.
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.
Rev. 7/15/20
CUNY Employment Application Part One
2
THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION – PART ONE
EMPLOYMENT AND EDUCATION HISTORY OF APPLICANT
Position Title: __________________________________________________________________________________
Contract Title: _________________________________________________________________________________
College: _____________________________________ 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: _____________
Preferred Phone #: __________________________________ Email: ______________________________
Do you have any relatives employed in the department for which you are applying?
Yes No
If yes, please explain: ____________________________________________________________________________
Are you legally authorized to work in the United States?
Yes No
Will you now or in the future require sponsorship for employment visa status (e.g., H-1B visa status)?
Yes No
Please be advised that sponsorship for employment authorization is a campus-based decision and is generally
reserved for academic appointments.
Rev. 7/15/20
CUNY Employment Application Part One
3
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.
Signature: _________________________________________________ Date: ________________________
Rev. 7/15/20
CUNY Employment Application Part One
4
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signature
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Education
Please indicate the highest equivalent grade of education completed:
Doctorate Professional Degree Masters Baccalaureate
Associate Trade/Vocational School High School/GED
List schools attended, beginning with most recent:
School Name(1): ________________________________ Location: ___________________________________
Major Study: ________________________________ Credits Completed: ___________________________
Degree Received? ____________________________
School Name(2): ________________________________ Location: ___________________________________
Major Study: ________________________________ Credits Completed: ___________________________
Degree Received? ____________________________
School Name(3): ________________________________ Location: ___________________________________
Major Study: ________________________________ Credits Completed: ___________________________
Degree Received? ____________________________
School Name(4): ________________________________ Location: ___________________________________
Major Study: ________________________________ Credits Completed: ___________________________
Degree Received? ____________________________
IF REQUIRED FOR POSITION: Please provide driver’s license number, professional/trade license/certification
numbers. If necessary, attach page to application.
Type: _____________________________________ License Number: _____________________________
Rev. 7/15/20
CUNY Employment Application Part One
5
Employment History
Begin with present or most recent job and work back for the last 15 years, listing all full and part time
employment. Be sure to include any current CUNY employment held. If necessary, attach additional pages.
Employer Name(1): _____________________________________________________________________________
Address: ______________________________________________________________________________________
Job Title: _________________________________ CUNY Contract Title (if applicable): ______________________
Full-Time Part-Time *if part-time, average hours per week: ________
Phone #: _____________________________ Date Employed from: ____________ Date Employed to: ___________
Duties:
Name/Title of Immediate Supervisor: _______________________________________________________________
Phone #: _______________________ Reason for Leaving: _________________________________________
Employer Name(2): _____________________________________________________________________________
Address: ______________________________________________________________________________________
Job Title: _________________________________ CUNY Contract Title (if applicable): ______________________
Full-Time Part-Time *if part-time, average hours per week: ________
Phone #: _____________________________ Date Employed from: ____________ Date Employed to: ___________
Duties:
Name/Title of Immediate Supervisor: _______________________________________________________________
Phone #: _______________________ Reason for Leaving: _________________________________________
Employer Name(3): _____________________________________________________________________________
Address: ______________________________________________________________________________________
Job Title: _________________________________ CUNY Contract Title (if applicable): ______________________
Full-Time Part-Time *if part-time, average hours per week: ________
Phone #: _____________________________ Date Employed from: ____________ Date Employed to: ___________
Rev. 7/15/20
CUNY Employment Application Part One
6
Duties:
Name/Title of Immediate Supervisor: _______________________________________________________________
Phone #: _______________________ Reason for Leaving: _________________________________________
Employer Name(4): _____________________________________________________________________________
Address: ______________________________________________________________________________________
Job Title: _________________________________ CUNY Contract Title (if applicable): ______________________
Full-Time Part-Time *if part-time, average hours per week: ________
Phone #: _____________________________ Date Employed from: ____________ Date Employed to: ___________
Duties:
Name/Title of Immediate Supervisor: _______________________________________________________________
Phone #: _______________________ Reason for Leaving: _________________________________________
Important Skills, Competencies, or Experience Not Identified Above
Identify other important skills, competencies, expertise or related experience (such as volunteer work, competence
in foreign language, etc.) that you feel should be considered in evaluating your suitability for this position. If
necessary, attach additional pages.
Rev. 7/15/20
CUNY Employment Application Part One
7
Professional References
P
lease 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 Information
Form (final page of employment application) must be completed.
Name/Title(1): _________________________________________________________________________________
C
ompany: ______________________________________ Address: ___________________________________
P
hone: ________________________________________ Email: _____________________________________
N
ame/Title(2): _________________________________________________________________________________
C
ompany: ______________________________________ Address: ___________________________________
Phone: ________________________________________ Email: _____________________________________
N
ame/Title(3): _________________________________________________________________________________
C
ompany: ______________________________________ Address: ___________________________________
Phone: ________________________________________ Email: _____________________________________
H
ow did you learn about this position? Check all that apply:
C
ollege Human Resources Office College Website CUNY Website (cuny.edu or cuny.jobs)
Some I know who works at CUNY Union Office Search Engine (Google, Bing, etc.)
P
rinted advertisement External Job Board Job Fair, Conference or Convention
G
overnment Job Bank or Resource Agency (Veteran’s Vocational Rehabilitation, Other)
P
rofessional of Academic Group, Contact or Referral Social Media:
S
earch Firm Other (please explain):
College Use Only
R
eviewed by Chair of Search Committee/Hiring Manager:
N
ame: ________________________________________________________________________________________
Signature: _____________________________________________ Date: _______________________________
Rev. 7/15/20
CUNY Employment Application Part One
8
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signature
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C
ollege: ______________________________________________________________________________________
N
ame of Candidate: _____________________________________________________________________________
Position Sought: ________________________________________________________________________________
Authorization to Release Reference Information
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.
S
ignature: __________________________________________ Date: _____________________
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.
Rev. 7/15/20
CUNY Employment Application Part One
9
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Completed 2 February 2022

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