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The City University of New York (Lehman College)

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A. Action being requested: (indicate all that apply)
(See page one for definitions, required documents and other helpful information)
B. Current Nature of Position: (indicate one only)
New Filled on a Substitute basis Vacant, previously filled Reorganized functions Accretion of functions
C. Appointment Information:
Waiver Requested (Y/N)
Proposed
Payroll Title
Proposed
Functional Title
Bylaw (Type) Search
Requested
Effective Date
Candidate’s Name Supervisor’s Name/Title
To Whom Will Report
Candidate’s Prior CUNY
Payroll Title, if Any
Annual Base Salary
Prior/Proposed
$ /$
D. College Approval: E. College Certification: Committee Meeting Date / /
/ /
Vice President/Dean College HR Officer/Committee Liaison Date
The City University of New York
Non-Teaching Instructional Staff Action Form: HEO, CLT, RA
LEHMAN COLLEGE
OFSR Use Only
Date Received
UPO Action
Committee Review
VC Review
Reclassification
Merit Increase (one/two-step, in-title)
Merit Increase (exceeding two-steps Research Assc.)
Position Approval ONLY
Appointment from a Search
Reorganization Plan: Related Appointment
or Reclassification
Promotion (CLT Series only)
Substitute Appointment (to a position
requiring a search)*
Substitute Appointment
(to a position of a temporary nature)*
Functional Title Change (including Reassignment)
Other: (Specify)
Payroll Title
*Complete CUNY Substitute Appt. History
Sub. Appt Period
1.
2.
3.
4.
Chair, Director
Page 1 of 4
Instructional Staff Data Form:
The information below is to be completed by the college based on information supplied by the candidate. If more space is
required, attach another page. The candidate should attest to the college regarding the accuracy of the information on which
the college bases the information provided below.
Name Address SSN
Educational Background (most recent degree first):
Accredited Institution City/State Dates Attended
From (M/Y) To
Degree Conferred/Expected
Degree Field Date
Recent 10 years (most recent first) paid (and unpaid, if relevant) work experience (other than with CUNY):
Non-CUNY Employer
Job Title/Primary
Responsibility
Dates Employed
from (M/Y): To (M/Y)
If PT, hours
per week
If supervisor,
# supervised
Final Pay
Year/Hour
$
Yr Hr
$
Yr Hr
$
Yr Hr
$
Yr Hr
Recent 10 years (most recent first) work experience with CUNY:
CUNY College Job Title/Primary
Responsibility
Dates Employed
From (M/Y): To (M/Y)
If PT, hours
per week
If supervisor,
# supervised
Final Pay
Year/Hour
$
Yr Hr
$
Yr Hr
$
Yr Hr
Notice to Appointment Officials: any offer of employment by an official of a college is contingent on successful completion of the total employment process,
including the verification of references which the College official considers satisfactory. 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
, University or College policies, or collective bargaining
agreements governing the administration of the Non-Teaching Instructional Staff Service of the University. Any representations which are contrary to
administrative policies of the University, including those made in writing are unenforceable. Only the representations made by the President of the College or
designee—usually the College HR Officer—made in writing prior to appointment constitute official representations. The City University reserves the right
to revise without notice any personnel policy or practice at any time other than those set forth in the University Bylaws
, applicable New York State Laws,
and collectively bargained agreements.
Page 2 of 4
N/A
THE CITY UNIVERSITY OF NEW YORK
AFFIRMATIVE ACTION CERTIFICATION For NON-TEACHING INSTRUCTIONAL STAFF (HEO, CLT, RA)
The Affirmative Action Program of the City University of New York mandates that equal opportunity be afforded to all qualified
persons when positions are available. Good faith efforts must be made to encourage women, minorities, veterans and persons
with disabilities to apply for available vacant positions.
SECTION A: RECRUITMENT PLAN CERTIFICATION
A recruitment plan is to be submitted to the Office of Compliance and Diversity for approval before
the search begins.
I certify that I reviewed and approved the recruitment plan submitted by
of
Chair/Director or Responsible College Officer Department/Office
For the position of
Bylaw/Functional Title of Position
Job ID Number
Compliance and Diversity Officer Date
THE APPLICANT POOL (This
section will be completed by the Office of Compliance and Diversity)
Black Hispanic Asian/
Pacific Islander
American Indian/
Alaskan Native
Italian
American
White Unknown Total
Men
Women
Total
SECTION B: SEARCH PROCEDURES DOCUMENTATION (This section to be completed by department)
1. Federal and University regulations require documentation of recruitment efforts. List all sources (Websites, journal and
newspaper ads, professional organizations, etc.) that were used to recruit for this position:
2. Number of applications received: Male Female Total Applications
3. Provide gender and race/ethnicity data for the applicants interviewed:
Black Hispanic Asian/
Pacific Islander
American Indian/
Alaskan Native
Italian
American
White Total
Men
Women
Total
Page 3 of 4
4. Name of Candidate Selected:
From what specific sources was the candidate recruited:
5. If the position was offered to another candidate but that candidate declined, please complete this section:
Name of candidate:
Reason candidate declined the position:
6. List the names of other candidates interviewed but not offered the position:
SECTION C: Affirmative Action Certification
Before an offer is made, appropriate College officers shall certify that affirmative action procedures have been
followed. In the case of reclassification, College officers must attest that the proposal conforms with all equal
opportunity policies.
Substitute positions may be for a maximum of
WZRFRQVHFXWLYHVL[PRQWKSHULRGVonly. A Job Description to begin
the se
arch for a regular line must accompany the request for the first substitute appointment.
I certify that the Affirmative Action pro
cedures have been followed and that the above is true to the best of
my knowledge and belief.
Name and Signature of Responsible College Officer
Department/Office
Date
(Chairperson/Director/Dean)
Name and Signature of Director of Compliance and Div
ersit
y Date
REGULATIONS REQUIRE THE RETENTION OF ALL SUPPORTING DOCUMENTS, INCLUDING RESUMES OF APPLICANTS, FOR AT LEAST
THREE (3) YEARS.
Page 4 of 4
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Completed 3 May 2022

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