Dear New Employee

Welcome to BMCC. Attached are a variety of documents concerning your appointment to the college that you need to be aware of or must complete. Please read these materials carefully and provide all of the requested information as quickly as possible.

The offer of this employment is conditional upon satisfactory completion of all

verifications, including but not limited to confirmation employment and background checks.

We hope you will enjoy your experience at the college. Best wishes for a productive and successful career at BMCC.

Sincerely,

Gloria M. Chao Director of Human Resources

/New Employee

Employee Check off List  

EMPLOYEE NAME:  CUNYFirst ID #: 

 Department:  EMPLOYEE TITLE: College Assistant 

 

Following for Office Use ONLY:  

INITIAL & DATE   

START DATE 

I‐9 Complete 

End Date/Length of appointment  Pay Rate 

 P.A.F. Received  Packet Completed: 

PACKET Received 

CF Enter date 

 CUNYFirst  P.O.# 

Schedule of Classes 

Money Order

 Finger Printing 

KRONOS (Classified Staff) 

Time Keeper 

 Benefits 

 FINAL STAGE: 

 

 IMAGE NOW 

   COMMENTS: 

G:\GC\Forms\College Assistant – Tutor Packet Checklist

College Assistant/Tutor Packet Checklist

The following should be used as a guide to insure you are providing Human Resources with all necessary paperwork and

information upon acceptance of offered position.

Please take time to familiarize yourself with the following:

Appointment Processing and Fees

Time and Leave System (Kronos)

College Assistant Handbook

Students Bill of Rights

Annual Security report

When you accept an offer of employment with the Borough of Manhattan Community College, you must present

ORIGINAL documents as outlined below.

Proof of Identity and Employment Eligibility

Under federal law you must complete an Employment Verification (I-9) form in the presence of an HR officer. Be sure to bring appropriate proof of identity/eligibility to HR before your first day of work.

Social Security Card-for Payroll Purposes

Tutors MUST provide an official transcript with highest degree earned. Until the official transcript is received there

may be a delay in the processing of your paperwork and the appropriate pay rate. No retroactive payments will be made.

Acceptance Letter

Personnel Information Form

CUNY Employment Application-Part 1 &

Employment Application-Part 2

Addendum to Application for Employment

Amended Constitutional Oath

Conviction Notice/ Registration Form (2 Pages)

Emergency Contact Form

New Hire Account Request Form

Report of External Employment for Classified

Staff

Signed Employee Handbook Acknowledgement

and Receipt page (located on BMCC HR website)

Policies/Procedures agreement page

Payroll:

Timesheet checklist for new College Assistants

Employee’s withholding allowance certificate (W-4 and IT-2104)

Direct Deposit of Net Pay Enrollment (If applicable)

Tax Certification for foreign Nationals (if applicable)

Benefits:

Explanation of Benefits (includes NYCERS 457 Plan)

Documentation for Benefits Available for College Assistants

Wage Works-Commuter Benefits Program Form

The timing of your initial pay check will be based on the process and our receipt of the above documents. If you have any

questions about your appointment or payroll process, please call us at 212-220-8300.

_____________________________ _________________________

Print Name Date

_____________________________ Signature

Please review the following important Policies and Procedures by opening the links provided.

CUNY Sexual Misconduct Policy

Notice of Non-Discrimination

CUNY Policies and Procedures on Non-Discrimination

Reasonable Accommodation Policy

CUNY Lactation Room Policy

Annual Security Report

College Assistant Handbook

CUNY Policy on Drug and Alcohol

Acceptable use of computer resources

Children on Campus

Time Off for Breast and Prostate Cancer Screenings and Donating Blood

Time Off for Religious Observance

Additional Policies and Procedures are available on the BMCC/HR and Office of Diversity websites for your

examination.

The college is committed to ensuring a discriminatory free environment, where all persons are treated fairly and

with respect regardless of his/her protected status. The Office of Compliance & Diversity is dedicated to

promoting an open and inclusive environment, addressing complaints as they arise, creating programs which

promote diversity and awareness and ensuring that the college complies with all applicable policies and laws.

Odelia Levy, Esq. is the college's Chief Diversity Officer. She also serves as the Coordinator for Title 504. You

may reach Ms. Levy at olevy@bmcc.cuny.edu or (212) 220-1236.

Theresa B. Wade, Esq. is the college's Deputy Director of Diversity & Title IX Compliance and can be reached

at twade@bmcc.cuny.edu or (212) 220-1273.

To file a complaint of unlawful discrimination or harassment, including sexual harassment, please contact Ms.

Levy or Ms. Wade.

By signing below, I acknowledge that I have received, and familiarized myself with the above policies and

reviewed the additional policies available on the BMCC website before commencing employment and

agree to abide by their requirements.

____________________________________________________

Signature Date

_______________________________

Print Name

To: Supervisors, Office Heads, and Applicants to the Position of College Assistants or

Tutors

From: Human Resources

Date: September 27, 2019

Subject: Appointment Processing and Fees

For all applicants to the position of College Assistants or Tutors, the following requirements must be

completed prior to the first day of employment.

Fingerprinting Fee of $88.50 will be required from all applicants who are part-time BMCC

students and full or part time students studying at another CUNY University (please see the

Procedures for Candidates Fingerprinting Using L-1 Identity Solutions Letter).

Full time BMCC students will not have to pay this fingerprinting fee. However, you will

need to provide proof of student status Each Semester in order to waive the fingerprinting

fee. (ex. Tuition Bill or a letter from the Registrar’s Office)

All applicants who are appointed for 239 hours or more must pay a CUNY Application

Processing Fee. The processing fee, is payable by cash or a money order made out to

BMCC. You must bring the processing fee and the HR form to the Bursars Office (S330).

After paying the processing fee, you must return the receipt signed by the Bursars Officer to

HR to place in your Personnel file. Your HR Representative will advise you on the amount

due.

All applicants MUST be verified for Compliance with the Immigration Reform and Control

Act (IRCA) within three days of your appointment for both identity and the required

employability certification. See the Reverse side of this Memorandum of IRCA

documentation.

Applicants MUST provide an original social security card.

All Tutors must submit official proof of highest degree earned.

The Human Resources Office has been authorized to withhold salary checks and/or remove

from the payroll all College Assistants/Tutors who fail to complete these appointment-

processing requirements.

Thank you.

To: Bursar’s Office

From: Human Resources

Subject: CUNY Application Processing Fee-payable by Cash or Money Order

Date:

Name: Last 4 of SS#

Title:

Fee:

The Bursar’s Receipt must be brought to HR to provide proof of payment.

Rev 6-28-17

Office of Human Resources Management HR Advisory Services 205 East 42nd Street, 10th floor New York, N.Y. 10017 646-664-3311 Fax 646-664-3836 Classified.CentEx@cuny.edu

Procedures for Candidates Fingerprinting Morphotrust USA Enrollment Services (formerly L1 Enrollment Services)

As part of the background check, the next step in the hiring process is for you to provide The University with fingerprints. To do so, please follow the instructions here:

1. You are required to pre-register prior to going to fingerprint location by:

a) Calling 1-877-472-6915 to speak with a Customer Service Representative (CSR) so they can capture demographic data. All credit card payments ($88.50) must be made  onsite at the time of the fingerprinting session. 

or b) Visit MorphoTrust USA website at www.identogo.com and submit your

demographic data. All credit card payments must be made onsite at the time of the fingerprinting session. ($88.50) 

 2. At the time of registration, you will need to provide the following information:

CUNY Service Code #: 156J7Y

Name of College you are applying to: BMCC College ID Code you are applying to: 466

3. At the fingerprint location, you are required to take this notice and two forms of identification.

Please note: a photo ID is required before any applicant can be fingerprinted (acceptable forms of photo ID are either state or federally issued, i.e. Drivers License, State ID, Passport, Alien Registration Card, Unexpired Foreign Passport, School or College ID, Unexpired Employment Authorization with photo, or Photo ID Card issued by Federal, State, or Local Gov’t). Along with a Social Security Card, Voter Registration Card, US Military Card or Draft Record, Military Dependants ID, Coast Guard Merchant Mariner ID, Native America Tribal Document, Canadian Drivers License, Permanent Resident Card, US Passport (expired or unexpired), Alien Registration Receipt Card, Unexpired Foreign Passport, Photo ID Card issues by Federal, State or Local Gov’t, Original or Certified Copy of Birth Certificate, Certificate of Birth Abroad (issued by US), or a US Citizen ID Card.

4. Once you have been fingerprinted, the fingerprint technician will transmit the fingerprint

records electronically to the Division of Criminal Justice Services. The fingerprint technician also issues a receipt for the fingerprinting service to you. The Division of Criminal Justice Services processes the background check for the state of New York. When the background check is completed, the results are returned directly to The City University of New York.

5. Payment for fingerprinting services is required at the time of the fingerprinting session. MorphoTrust USA accepts personal check, money order, business check, credit card, e-check, and escrow account transactions.

Final Note: Fees for fingerprint services vary depending on the type of background check required. The fees assessed by MorphoTrust USA include the fingerprint rolling charges and any fingerprint processing charges levied by the Department of State. MorphoTrust USA collects the fee for each applicant and makes the appropriate payments to the Division of Criminal Justice Services on behalf of the applicants.

Appointments are required at all locations - please proceed to the appointment

registration page and set up an appointment time for your fingerprinting or call toll-free 877-472-6915

Location listing is accurate as of Friday, February 07, 2014 locations are subject to change without notice.

NEW YORK METRO Bronx - E 149Th St Bronx, NY. (349 E 149th St, Ste 605) [Map

(opens new browser)] Mon, Tue, Thu & Fri 9:00 - 5:00; Wed 9:00 - 6:00; E/O Sat 10:00 - 2:00

Bronx - E 149th St - 2nd System Bronx, NY. (349 E 149th St, Ste 605) [Map (opens new browser)]

Mon - Thu 9:00 - 2:00 & 2:30 - 4:00

Bronx - Third Ave - 2nd System Bronx , NY. (2804a Third Ave) [Map (opens new browser)]

Mon, Tue, Thu & Fri 9:00 - 5:00; Wed 9:00 - 7:00; Sat 9:00 - 2:00

Bronx - Third Ave - Between 147th & 148th St

Bronx, NY. (2804a Third Ave) [Map (opens new browser)]

Mon, Tue, Thu & Fri 9:00 - 5:00; Wed 9:00 - 7:00; Sat 9:00 - 2:00

Brooklyn Brooklyn, NY. (2174 Fulton St) [Map (opens new browser)]

Mon - Thu 9:00 - 5:00; Fri 9:00 - 7:00; E/O Sat 9:00 - 3:00

Brooklyn - Flatbush Brooklyn, NY. (1772 Flatbush Ave - Between Ave's J & K) [Map (opens new browser)]

Mon - Fri 9:00 - 12:00 & 12:30 - 9:00; Sat 10:00 - 12:00 & 12:30 - 6:00

Brooklyn - Flatbush - 2nd System Brooklyn, NY. (1772 Flatbush Ave Between Ave's J & K) [Map (opens new browser)]

Mon - Fri 10:00 - 3:30 & 4:00 - 7:00

Glendale Glendale, NY. (79-63 Myrtle Ave) [Map (opens new browser)]

Mon, Tue, Thu & Fri: 9:00 - 12:00 & 1:00 - 5:00; Wed 9:00 - 12:00 & 1:00 - 7:00; Sat 10:00 - 2:00

New York - Broadway New York, NY. (1412 Broadway, 17th Fl) [Map (opens new browser)]

Mon - Fri 9:25 - 1:00 & 2:00 - 4:45

New York - W 35th St New York, NY. (247 W 35th St, Ste 201) [Map (opens new browser)]

Mon - Fri 9:00 - 1:30 & 2:30 - 5:20; Sat 10:00 - 4:00

New York - W 35th St - 2nd System New York, NY. (247 W 35th St, Ste 201) [Map (opens new browser)]

Mon - Fri 9:00 - 1:30 & 2:30 - 5:20; Sat 10-4

New York - W 35th St - 3rd System New York, NY. (247 W 35th St, Ste 201) [Map (opens new browser)]

Mon - Fri 9:00 - 1:30 & 2:30 - 5:20; Sat 10:00 - 4:00

New York - W 35th St - Commercial Apps Only

New York, NY. (247 W 35th St, Ste 201) [Map (opens new browser)]

Tue, Wed & Thu 9:00 - 2:00

New York - William St - 2nd System New York, NY. (130 William St, Ste 900) [Map (opens new browser)]

Mon & Thu 9:00 - 6:00; Tue & Fri 9:00 - 5:00; Wed 9:00 - 7:00; 3rd Sat 9:00 - 1:00

New York - William St - Across from Dept of State

New York, NY. (130 William St, Ste 900) [Map (opens new browser)]

Mon & Thu 9:00 - 6:00; Tue & Fri 9:00 - 5:00; Wed 9:00 - 7:00; 3rd Sat 9:00 - 1:00

New York - William St - Commercial Apps Only

New York, NY. (130 William St, Ste 900, Ninth Flr) [Map (opens new browser)]

Mon - Fri 9:00 - 5:00

Queens - Jamaica Jamaica, NY. (9024 161st St) [Map (opens new browser)]

Mon - Fri 7:00 - 8:00; Sat 8:30 - 3:00

Queens - Jamaica - 2nd System Jamaica, NY. (9024 161st St) [Map (opens new browser)]

Mon - Fri 7:00 - 8:00; Sat 8:30 - 3:00

Staten Island Staten Island, NY. (159 New Dorp Plz, Ste 201) [Map (opens new browser)]

Mon & Wed 11:00 - 5:00; Tue & Thu 9:00 - 3:00; Fri 9:00 - 3:00; E/O Sat 10:00 - 3:00

Yonkers Yonkers , NY. (5 Seminary Ave, Ste 4) [Map (opens new browser)]

Mon, Tue, Wed & Fri 10:00 - 2:30 & 3:30 - 5:00; Thu 10:00 - 2:30 & 3:30 - 7:00; Sat 10:00 - 2:00

To: All Members of the Classified Staff From: Human Resources Subject: Kronos Time and Leave System This memorandum is written to reacquaint you with the College’s policy: 1. Classified staff is required to record their time upon arrival and departure by inputting their

ID and finger images into the Kronos Touch ID System. Clocks are located throughout the

College Campuses. You should record your time of arrival and departure at the building of

your assigned work location. Before leaving the time clock, you should verify that the clock

recorded your punch. The “Accepted Punch” message is you indication that your time is

recorded.

2. In the instances where punches are not recorded, your supervisor/office head must provide a

written statement verifying attendance and the specific hours worked to Human Resources.

3. In order to enhance the service, we ask that you immediately inform us and your supervisor

when you are experiencing problems with the Kronos Touch ID Device.

Should you need additional information please call ext. 8300

Signature Date

SwipePolicy3

LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

LIST A

2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)

1. U.S. Passport or U.S. Passport Card

3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa

4. Employment Authorization Document that contains a photograph (Form I-766)

5. For a nonimmigrant alien authorized to work for a specific employer because of his or her status:

Documents that Establish Both Identity and

Employment Authorization

6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI

b. Form I-94 or Form I-94A that has the following:(1) The same name as the passport;

and(2) An endorsement of the alien's

nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.

a. Foreign passport; and

For persons under age 18 who are unable to present a document

listed above:

1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

9. Driver's license issued by a Canadian government authority

3. School ID card with a photograph

6. Military dependent's ID card

7. U.S. Coast Guard Merchant Mariner Card

8. Native American tribal document

10. School record or report card

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

4. Voter's registration card

5. U.S. Military card or draft record

Documents that Establish Identity

LIST B

OR AND

LIST C

7. Employment authorization document issued by the Department of Homeland Security

1. A Social Security Account Number card, unless the card includes one of the following restrictions:

2. Certification of report of birth issued by the Department of State (Forms DS-1350, FS-545, FS-240)

3. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

4. Native American tribal document

6. Identification Card for Use of Resident Citizen in the United States (Form I-179)

Documents that Establish Employment Authorization

5. U.S. Citizen ID Card (Form I-197)

(2) VALID FOR WORK ONLY WITH INS AUTHORIZATION

(3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION

(1) NOT VALID FOR EMPLOYMENT

Page 3 of 3Form I-9 07/17/17 N

Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

USCIS Form I-9

OMB No. 1615-0047 Expires 08/31/2019

Employment Eligibility Verification Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-9 11/14/2016 N Page 1 of 3

►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,

during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)

Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any)

Address (Street Number and Name) Apt. Number City or Town State ZIP Code

Date of Birth (mm/dd/yyyy) U.S. Social Security Number

- -

Employee's E-mail Address Employee's Telephone Number

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident

4. An alien authorized to work until (See instructions)

(expiration date, if applicable, mm/dd/yyyy):

(Alien Registration Number/USCIS Number):

Some aliens may write "N/A" in the expiration date field.

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number:

2. Form I-94 Admission Number:

3. Foreign Passport Number:

Country of Issuance:

OR

OR

QR Code - Section 1 Do Not Write In This Space

Signature of Employee Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one): I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1.(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Signature of Preparer or Translator Today's Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name)

Address (Street Number and Name) City or Town State ZIP Code

Employer Completes Next Page

Form I-9 11/14/2016 N Page 2 of 3

USCIS Form I-9

OMB No. 1615-0047 Expires 08/31/2019

Employment Eligibility Verification Department of Homeland Security

U.S. Citizenship and Immigration Services

Section 2. Employer or Authorized Representative Review and Verification (Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")

Last Name (Family Name) M.I.First Name (Given Name)Employee Info from Section 1

Citizenship/Immigration Status

List AIdentity and Employment Authorization Identity Employment Authorization

OR List B AND List C

Additional Information QR Code - Sections 2 & 3 Do Not Write In This Space

Document Title

Issuing Authority

Document Number

Expiration Date (if any)(mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any)(mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any)(mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any)(mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any)(mm/dd/yyyy)

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.

The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions)

Signature of Employer or Authorized Representative Today's Date(mm/dd/yyyy) Title of Employer or Authorized Representative

Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employer's Business or Organization Name

Employer's Business or Organization Address (Street Number and Name) City or Town State ZIP Code

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)

A. New Name (if applicable)

Last Name (Family Name) First Name (Given Name) Middle InitialB. Date of Rehire (if applicable)

Date (mm/dd/yyyy)

Document Title Document Number Expiration Date (if any) (mm/dd/yyyy)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative

Borough of Manhattan Community College

Office of Human Resources

Personnel Information Form

Name (print) Social Security Number Title Department Date of Appointment

☐ Female ☐ Male ☐ Other _____________________ Date of Birth___________________

Ethnicity:

☐ African American ☐ Alaskan Native ☐ American Indian ☐ Asian

☐ Black ☐ Hispanic ☐ Italian American

☐ Pacific Islander ☐ Puerto Rican ☐ White ☐ Other

U.S. Citizen: ☐ Yes ☐ No If you are not a U.S. Citizen,

Of what country are you a citizen? What type of VISA are you holding: Expiration Date:

Are you a Veteran? ☐ Yes ☐ No If you are a veteran, please specify:

☐ Active Reserve ☐ Disabled ☐ Disabled Vietnam Era

☐ Inactive Reserve ☐ Retired ☐ Vietnam Era Home Address: (print)

Telephone Number: E-Mail Address Emergency Contact: Relationship: Address: Telephone Number: Alternate Phone Number:

Education: Degree Major Date Earned Institution___________

To be completed by the Office of Human Resources

I-9 Date: ______________ Work Authorization Expiration Date: _______________ Staff Initial_________ Date: ________

HR-2000

 

  

Borough of Manhattan Community College 199 Chambers Street The City University of New York New York, NY 10007·1097 www.bmcc.cuny.edu te.l 212·220-8300

fax 212·220.2364  

  

Primary:

Name of Emergency Contact:

Relationship:

Address:

Home Phone Number:

Business Number:

Cell Phone Number:

Secondary:

Name of Emergency Contact

Relationship:

Address:

Home Phone Number:

Business Number:

Cell Phone Number:

   

Name (Print) Department  

  \

Signature Date   

 HR 5-2011

BOROUGH OF MANHATTAN COMMUNITY COLLEGE  

THE CITY UNIVERSITY OF NEW YORK 

 

TO:   The Director of Human Resources 

 

 

I accept this College Assistant position with the understanding that the hours I 

can work will be limited to 1040 per fiscal year (July 1st ‐ June 30th). 

 

 

        Name 

 

 

        Signature 

 

 

        Date   

 

TO:   The College Assistant Applicant 

     

A College Assistant working more than 5 hours but less than 6 hours per day 

must take a lunch break of ½ hour. 

 

A College Assistant working more than 6 hours a day must take a lunch break of 

at least 1 hour. 

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. To further CUNY's commitment to compensate its employees fairly and equally for the work they do, CUNY will not inquire about applicant'scurrent or prior compensation history.

THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION - PART ONE

Important Notice to Applicants

Name

Position

CUNY EMPLOYMENT APPLICATION - PART ONE November 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 November 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

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 leavingTelephone

Date employed to

Date employed from

Name/Title of Immediate Supervisor

Briefly describe duties

Telephone

CUNY Contract Title, if applicableAddress

Job TitleEmployer Name

CUNY EMPLOYMENT APPLICATION - PART ONE November 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 leavingTelephone

Date employed to

Date employed from

Name/Title of Immediate Supervisor

Briefly describe duties

Telephone

CUNY Contract Title, if applicableAddress

Job TitleEmployer Name

Average hours worked per week part-time Part-time Full-time

Reason for leavingTelephone

Date employed to

Date employed from

Name/Title of Immediate Supervisor

Briefly describe duties

Telephone

CUNY Contract Title, if applicableAddress

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 November 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 #

AddressAddressAddress

Company Company Company

TitleTitle

3. Name2. 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 November 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.

DateSignature

College

CUNY EMPLOYMENT APPLICATION - PART ONE November 2017

Page 7 of 7

 

 

 

AMENDED CONSTITIUTIONAL OATH UPON APPOINTMENT 

(In compliance with Section 62 of the New York State Civil Service Law) 

 

 

 

 

 

“I hereby pledge and declare that I will support the Constitution of the United States 

and the Constitution of the State of New York and that I will faithfully discharge the 

duties of the Position of                                                                          according to the best 

of my ability” 

 

 

 

Name: 

Signature: 

Address: 

 

 

Date: 

 

 

New Hire Account Request Form

Your OFFICIAL NAME must be used on this form. Please PRINT or TYPE all information.

Personal Information

Full Name:

Last First M.I.

DOB: Last 4 SSN:

Job Information

Job Title: Department:

Department’s Ext.: Employee ID:

New/ Old Ext. Line: Room # :

Hired By BMCC....………….. [ ] Research Found…………. [ ]

Position/Function Full Time………….. [ ] Part Time…………. [ ]

Faculty…………….. [ ] Staff……………….. [ ] Student-Staff………… [ ]

New Account (s) Computer…………………… [ ] Email…………….... [ ] Phone/Voicemail………… [ ] Copy/Print………… [ ]

Room Acs/Keys

Comments:

Approval

Please provide ONE signature of approval before returning This Form to the Help Desk, Room S-141

Vice-president:

Last First Date Signature

Director/Manager:

Last First Date Signature

Chairperson:

Last First Date Signature

Any missing or unclear information will result in a delay in the process.

OFFICE USE ONLY

Date Received: AD/Email Copy/Print Access/Keys

Received By:

Date Completed: Telephony Web Directory Others

Completed By:

        Report of External Employment for Classified Staff 

1  

 

Employee/Candidate: Please complete sections A‐D regarding your CUNY employment and external 

employment, both full‐time and part‐time.  Carefully read the attestation in section E and sign the bottom.  

Once it has been completed and signed, please submit this to the Human Resources Department of the CUNY 

College at which you are primarily employed or to which you have applied. 

All Information on this form is subject to verification.  Please be advised that you are required to resubmit this 

form with updates if there are any changes to your external employment. 

A.  Employee Information 

Employee Name: 

  Date Completed 

 

 B. CUNY Primary Position 

Title: 

College:  Department:

Regular Work Schedule Number of Hours per 

Week Date of Appointment 

   

 CUNY Secondary Position 

Title: 

College:  Department:

Regular Work Schedule Number of Hours per 

Week Date of Appointment 

   

 

2

C. External Employment

Employer:

Address:

Telephone & Fax Numbers:

Job Title:

Department:

Supervisor Name & Title:

Regular Work Schedule Number of Hours per Week Date of Appointment

D. No External Employment

___ I have no external employment. I understand that if I plan to obtain external employment, I must contact the HR Department of my school and submit an updated “Report of External Employment of Classified Staff” form BEFORE I begin the external employment.

E. Employee Attestation

By my signature below, I declare and affirm that the information submitted above is true and complete. I acknowledge that my full-time position at CUNY is my primary employment. I understand that may misrepresentation or material omission of facts in this form shall be a sufficient basis for ending further consideration of my application, or, in the event I have already been hired, shall constitute sufficient cause for disciplinary action, which may result in a penalty up to and including termination of employment. Signature Date

3

Sections E & F & G are for Office Use Only

F. Supervisor/Department Head Approval

____ Approve: I have reviewed this employee’s CUNY employment and his/her competed External Employment form and have determined that there is no conflict of interest between the two positions and that the situation is in compliance with CUNY’s policy regarding external employment.

____ Do Not Approve: I have reviewed this employee’s CUNY employment and his/her competed External Employment form and have determined that this situation is NOT in compliance with CUNY’s policy regarding external employment for the following reason(s):

___ there is a conflict of interest between the two positions

___ there is an overlap in scheduled work hours

___ there is not adequate time allocated for travel between the positions. Comments:

Signature Date Print Name Title G. Human Resources Director Approval: ____ Approve: I have reviewed this employee’s CUNY employment and his/her competed External

Employment form and have determined that there is no conflict of interest between the two positions and that the situation is in compliance with CUNY’s policy regarding external employment.

____ Do Not Approve: I have reviewed this employee’s CUNY employment and his/her competed External Employment form and have determined that this situation is NOT in compliance with CUNY’s policy regarding external employment for the following reason(s):

___ there is a conflict of interest between the two positions

___ there is an overlap in scheduled work hours

___ there is not adequate time allocated for travel between the positions.

Comments: Signature Date Print Name Title

4

H. Presidential Approval for External Full-Time Positions:

____ Approve: I have reviewed this employee’s CUNY employment and his/her competed External Employment form and have determined that there is no conflict of interest between the two positions and that the situation is in compliance with CUNY’s policy regarding external employment.

____ Do Not Approve: I have reviewed this employee’s CUNY employment and his/her competed External Employment form and have determined that this situation is NOT in compliance with CUNY’s policy regarding external employment for the following reason(s):

___ there is a conflict of interest between the two positions

___ there is an overlap in scheduled work hours

___ there is not adequate time allocated for travel between the positions. Comments: Signature Date Print Name Please return to the HR Director Retain original document in employee file

CHECKLIST FOR NEW COLLEGE ASSISTANTS -A few important timesheet related notes

Pay is based on total weekly hours scheduled to work provided you work these hours and submit time sheet for

every week you work. Any missing information on the timesheets must be initialed by your supervisor to get paid for that particular day. You cannot exceed the total number of hours you are scheduled to work.

o Timesheets will not be processed if they are missing names, dates, or signatures.

If your supervisor deems it necessary for you to work a different schedule for one particular week, an e-mail must be sent up to HR by your supervisor, to your time keeper, indicating the change in schedule at least one week before the change takes place. Additionally, it must be noted on the bottom half of the time sheet and signed/initialed by your supervisor.

You do not get paid for holidays. However, you can charge a holiday to annual leave provided you have time

available.

You do not get paid for annual leave or sick leave until you accumulate 500 hours of work (per fiscal year).

Once you reach 500 hours you can begin to use annual leave and sick leave hours. Fill out a leave request form and, if possible, write on the time sheet itself which date(s) you want annual or sick leave time to be used.

o Annual leave hours are accrued at the rate of 1 hour for every 15 hours worked.

o Sick leave hours are accrued at the rate of 1 hour for every 20 hours worked. (A doctor’s note should be brought in at all times, but it must be brought in when absent from work for 3 or more consecutive days and using sick time before or after a holiday (or else you cannot use sick time for that day, even if you have time available.)

A lunch break is deducted whether used or not. Time for a break is earned as follows.

o A college assistant working more than five but less than 6 hours (5-6) earn a half hour lunch break.

o A college assistant working 6 hours or more earns an hour lunch break.

Lateness is deducted based on the lateness policy. (see Explanation of Benefits for a breakout of the lateness penalties)

Discuss any questions about your timesheet and/or hours worked first with your supervisor. Many problems can

be alleviated simply by looking at your timesheet and discussing it with your supervisor. Any further questions regarding your hours worked for a given week can be referred to your timekeeper as follows:

One final note: please keep all your pay stubs as we do not have copies of these stubs. Bring your pay stubs with you if you have any questions. If you have direct deposit, your pay will be deposited into your account of Friday. If you do not have direct deposit, you may pick up your check at the Bursar’s office (3rd floor windows) after 3 pm on the Thursday.

Benefits Available for College Assistants

And Hourly Employees

HEALTH BENEFITS

College Assistants/tutors are eligible for benefits once they have completed 90 days

of employment and have continuously worked 20 or more hours a week during

that time period. As long as the forms are completed and handed in within 90 days,

the effective date of coverage is on the 91st day of employment. Otherwise it will be

effective the next payroll cycle, after the forms has been submitted.

Employees hired ON OR AFTER JULY 1, 2019 will only be eligible to enroll in the

EmblemHealth HIP HMO Preferred Plan, and must remain in the HIP HMO

Preferred Plan for the first year (365 days) of employment. City paid health plan

coverage continues only for the period that you meet the criteria mentioned above. If

for any reason you no longer meet the eligibility requirements for City paid coverage,

you may elect to continue your health plan coverage through COBRA at full cost

plus administrative fees. Please notify Human Resources if you fall under this

category. For additional information visit the nyc.gov, or the Benefits Office, room

S717E.

UNION BENEFITS

If you wish to join DC37 and become a union member, you must submit an application to the union.

An online application is available on the DC37 website. You will need to know your Local number.

Local 2054 of District Council 37, is the Union that represents College Assistants, offers a fringe

benefits package and tuition reimbursement program. To access the DC37 membership application

click here.

If you work 17 ½ hours or more a week and have completed and sent in a DC 37 Health & Security

enrollment card, you will be eligible to receive union welfare benefits. For further details contact the

Union at 125 Barclay Street, New York, NY 10007, (212) 815- 1234. Or Local 237 members for

Campus Security Assistants (Hourly) 212-924-2000.

Jury Duty

Employees summoned to Jury Duty in New York State/New York State Courts are eligible to be paid

the current juror fee for the first three days if they are scheduled to work and earn more than the

fee. If employees are not scheduled to work they will not be paid.

New Health lnsUJrance Marketplace Coverage Options and Your Health Coverage

Form Approved

OMB No. 1210-0149 (expires 11-30-2013)

PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health

Insurance Marketplace. To assist you as you evaluate opt ions for you and your family, this no tic e provides some basic

inf ormation about the new Marketplac e and employment-based health coverage offer ed by your employer.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you f ind health insurance that meets your needs and f its your budget. The

Marketplace offer s " one-stop shopping" to find and compare private health insurance optio ns. You may also be eligible

tor a new kind of tax credit that lowers your monthly premium right away. Open enrollment f or health insurance

coverage through the Marketplace begins in October 2013 for coverage star ting as early as January 1 , 201 4.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium , but only if your employer does not ofter coverage , or

offers cover age that doesn' t meet certain standards. The savings on your premium that you're eligible f or depends on

your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards , you will not be eligible

for a tax credit through the Market place and may wi sh to enroll in your employer 's health plan. However , you may be

eligible f or a tax credit that lowers your monthly premium, or a reduction in cer tain cost-sharing i f your empioyer does

no t offer coverage to you at all or does not otter coverage that meets cer tain standards. If the cost of a plan from your

employer that would cover you (and no t any other member s of your family) is more than 9.5% of your household

income tor the year, or if the coverage your employer provides does not meet the " minimum value" standar d set by the

Affordable Care Act, you may be eligible tor a tax credit .'

Note: If you purchase a health plan thr o ugh the Marketplace instead of accepting heal th coverage offered by your

employer , then you may lose the employer contribution (if any) to the employer-offered coverage . Also, this em ployer

contribution -as well as your ernployee contribution to empioyer-o ff ere d coverage- is often excluded from income f or

Federal and State income tax purposes. Your payments tor coverage through the Marketplace are made on an afler -

tax basis.

How Can I Get More Information?

For more information about your coverage off ered by your ern pioyer, please check your sum rn ary plan description or contact vour Colleae Health Benefits or Human Resources Office. Get the SPD at www.nvc.aov/olr and select "Health Benefits Proaram"

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the

Marketplace and its cost. Please visit HealthCare.gov for more information, including an online appli cation for health

insurance coverage and contac t information for a Health Insurance Marketplace in your area.

1 An employer - sponsored hea lt h p lan meets the ' m 1n im u m value standa r d " if the plan 's share of the to ta l a llowed b e n el1t c os t & co v e re d by the pla n IS no less than 60 pe rcent of such costs .

PART B: Information About Health Coverage Offered by Your Employer This

sectton contarns rnformat1on about any health coverage oifered by your employer If you dec1de to comolete an apphcat1on for coverage 1n the Marketplace. you Will be asked to orov1de th1s 1niormahon. Th1s Information IS numbered

to correspond to the Marketolace aoplicatton

3. Employer Name:

City University of New York 4. Employer Identification Number (EIN)

13-6400434 5. Employer Address

205 E 42 Street 6. Employer phone Number

212-306-7369 7. City

New York 8. State , 9. Zip Code

NY 10017 10. Who can we contact about employee health coverage at this job?

Employee's Agency Health Benefits or Human Resources Office 11. Phone number (if different from above) 1 12. Email Address

212-306-7369 healthpiancoverage@oIr.nyc.gov

Here t S some basic 1nforma1ton about health coverage offered by th1s employer

A s your employer, we offer a health plan to.

0 All employee >

IZJ Some employees. Ehg1ble employees are·

employees who work.on a regular schedule.at least 20 hours per week. and Wflose appointment IS expected to last more than 6 months.

Wrth respect to dependents.

12] We do offer coverage. Ehg1bel deoendents are:

legat spouse, certified <tomestic partner.Children under age 26 as fOllOWs:naturalChildren. adopted chll<lren.chll<lren under a medicalsupport court ocder,Children for whom employee is thelegal guardian.children Wflo are the employee's tax dependent health plan certified disabled children. seethe SPO for more info at www.nyc.gov/olr.

0 We do not offer coverage.

0 If checked. 1h1s coverage meets the mrn1mum value standard, and the cost of th1s coverage to you IS rntended to be ailordable, based on employee wages.

Even rf your emoloyer 1n!ends your coverage to be affordable. you may : ttll be eligrble for a orem1um d1scount through the Marketplace. The Marketplace wrll use your household 1ncome. along Wlth other iactors. to deiermrne v-.rhether you may be ehg1ble for a orem1um discount. If , for example. your wages vary from week to week (perhaps you ere an hourly employee or you work on a commts:s1on basis). 1f you are newly

employed mtd-year, or if you have other mcome losses. you may sttll qualify for a premrum d1scount.

If you decide to shoo for coverage 1n the Marketpal ce. HealthCato.gov w1ll gUtde you through the process Here's the employer mformation you'll enter when you v1sr t HealthCere.gov to ftnd out r f you can get a tax cred1t to lower your monthly prem1ums.

IMPORTANT

HEALTH PLAN COVERAGE FOR EMPLOYEES HIRED ON OR AFTER JULY 1, 2019

 

City of New York employees, and employees of Participating Employers, hired on or after July 1, 2019 

and become eligible to enroll for health coverage, will only be able to enroll into the Emblem Health HIP 

HMO Preferred Plan and must remain in the HIP HMO Preferred Plan for the first year (365 days) of 

employment.  

Within the 335th day and 365th day of employment, the employee will have the option of either 

remaining in the HIP HMO Preferred Plan or selecting a different health plan. If a new health plan is 

selected, the new plan will be effective on the 366th day. Paperwork must be completed and submitted 

to the employees Benefits Officer within those 30 days leading to the 365th day of employment.  

A newly hired employee who needs to request an exemption from the required enrollment in the HIP 

HMO Preferred Plan can do so by submitting a HIP HMO Opt‐Out Request Form to Emblem Health. An 

employee, or eligible dependent, must meet certain criteria and the request must be approved by 

Emblem Health before the exemption is granted by your employer. The HIP HMO Opt‐Out Request Form 

and HIP service area are available on the Emblem Health website.  

In addition, after the 365th day of employment an employee can participate in an Annual Fall Transfer 

Period to select a different plan. 

This information can also be found on the New York City Office of Labor Relations – Health Benefits 

website. A description of the plans are available under “Summary of Plans”.  

 

 

 

 

 

PENSION New York City Employees’ Retirement System (NYCERS) is a defined plan. Benefits are based on age, average salary and years of employment. Employee’s contribution is based on salary.

Annual Wages Earned During Plan Year Contribution RateUp to $45,000 3%$45,001 to $55,000 3.5%$55, 001 to $75,000 4.5%$75,001 to $100,000 5.75%Greater than $100,000 6%

The vesting period is 10 years of Credited Service. Tier 6 Basic Plan members must contribute until they separate from City service or until retirement. Full retirement age is 63, to collect an unreduced Service Retirement Benefit. The City contributes a lump sum annual to the pension funds.

TAX DEFERRED ANNUITY

This plan allows participants to defer a percentage of salary before taxes through a salary reduction from your paycheck.

TIAA offers a Tax Deferred Annuity Program, please contact: Mr. Narcisse Dargenson at 212-916-5155; OR the New York City Deferred Compensation Plan. For information call 212-306-7760.

NEW YORK STATE DEFERRED COMPENSATION PROGRAM – 457 PLAN

You may join this plan in addition to participating in the tax deferred annuity. For enrollment information please contact: Brandon Herlihy, account executive at 1-800-422-8463 ext. 8544547.

TRANSIT BENEFIT

The transit benefit program allows employees to save on transportation expenses through pre-tax payroll deductions. For information and enrollment go to http://www.cuny.edu/transitbenefit

DIRECT DEPOSIT

If you wish to have your check direct deposited into your bank account, please complete application and provide documentation e.g., checking account a void check or savings a copy of first page of statement from bank.

CUNY WORK/LIFE PROGRAM

This employee assistance program is a voluntary, free and confidential benefit for employees and their family members. Services are available 24 hours a day, 7 days a week. For additional information, please call 1-855-492-3633 or visit the CUNY Work/Life Program website at www.deeroaks.com. To log in use Company Code: BMCC Password: BMCC

Updated October 2016

Submit completed form to: Your College TransitBenefit Coordinator www.cuny.edu/transitbenefit www.commuterbenefitsnyc.com

SUSPEND TRANSIT PLAN DEDUCTION

Submit at least 2 weeks before you want to suspend your deduction. Remember, administrative deductions will continue when applicable. If you are also enrolled in the Commuter Benefits Parking Plan, the parking plan will be suspended for the same period. Please note this will only suspend your payroll deduction. To also suspend your transit pass orders you must do so directly with Edenred Commuter Benefit Solutions at www.commuterbenefitsnyc.com or (833) 584-8109.

PAY DATE TO SUSPEND DEDUCTION PAY DATE TO RESUME DEDUCTION

EMPLOYEE ACTION

NEW(Enroll)

CHANGE PERSONAL INFORMATION(Change Mailing address, Email or Telephone)

CHANGE DEDUCTION(Change Transit Plan and/or AmountDeducted from Pay each Month)

SUSPEND DEDUCTION(Temporarily Stop Transit Plan Deduction from Pay)

CANCELLATION(Terminate Your Transit Plan Payroll Deduction)

EMPLOYEE IDENTIFICATION (All fields in this section are required and must be filled out completely. Please Print.)

Social Security / ERN DOB MM_____ /DD_____/YYYY_________

Name (First/Middle/Last)

Address Line 1

Address Line 2**

City/ State/Zip

Email Address Telephone

EMPLOYEE CERTIFICATION

I hereby authorize The City University of New York to deposit my payroll deduction as indicated above into my ECBS Commuter Benefits Transit Account.

I also grant authorization for the reversal of a credit to my account in the event the credit was made in error. I understand that, under the “National Automated Clearing House Association” operating guide-lines and rules, The City University of New York can only reverse the amount of the incorrect direct deposit.

I understand, according to the Internal Revenue Code, that the average monthly amount of my transportation deductions should not exceed my average monthly cost of public transportation to and from work. If my average monthly cost of public transportation to and from work should change, I will change my deduction plan to accommodate my new circumstance. Furthermore, no reimbursement will be provided for pre-tax transportation fringe deductions. Upon cancellation, voluntary or otherwise, any funds remaining in my Transit Account will be available for use for a period of 90 days from the effective date of cancellation. Residual funds remaining in the account beyond the 90 day period will be forfeited. I understand there is a monthly fee to cover administrative costs of the program. Said fee will be deducted from my post-tax pay each month. The administrative charge is non-refundable. The administrative fees and charges are as follows:

TRANSIT PLAN Access-A-RideCommuter Card-Unrestricted

FEE2.051.25

CHARGE METHODDeducted from post-tax payDeducted from post-tax pay

Transit Pass 2.05 Deducted from post-tax pay

*For the Commuter Card-Unrestricted, Transit Pass and Access-A-Ride plans you may elect any amount up to $800.

*Located on your pay statement or check stub. ** Apt.#, Fl.# or Box# if applicable.

TRANSIT PLAN AUTHORIZATION

ACCESS-A-RIDE($2.05 Monthly Admin Fee

through Payroll Deductions)

COMMUTER CARD - Unrestricted($1.25 Monthly Admin Fee

through Payroll Deductions)

TRANSIT PASS($2.05 Monthly Admin Fee

through Payroll Deductions)

EmployeeInitials

Monthly Deduction Amount*

EmployeeInitials

Monthly Deduction Amount*

EmployeeInitials

Monthly Deduction Amount*

$ $ $

(Please select One of the following plans by writing your initials in the column next to the Transit Plan of your choice. Please enter the total amount, including dollars and cents, you want deducted from your pay each month.)

I grant authorization for The City University of New York to provide my enrollment information, including mailing address, phone number and e-mail address to Edenred Commuter Benefit Solutions for uses exclusively related to the administration of the program. I understand that this authorization will remain in effect until I submit a new request for a change or cancellation.I understand that my Commuter Benefits transit account balance and information will be maintained by ECBS and are accessible online at www.commuterbenefitsnyc.com or by calling ECBS Customer Service at (833) 584-8109.

Employee Signature ________________________________________________ DATE

(04/2019)

AGENCY PAYROLL SECTION

Payroll # Personal information updated in NYCAPS (check all that apply):

I certify that the above data was entered into PI:

Prepared By (Please Print) Signature Date

MailingAddress

Email Address

Phone Number

PI ENTRY DATE

MONTH DAY YEAR

MONTH DAY YEAR

MONTH DAY YEAR MONTH DAY YEAR

/ / / /

TRANSITBENEFIT PLANS

www.commuterbenefitsnyc.com

TTHEHE CI CITTYY OF OF NE NEWW Y YORORKK C COMOMMMUUTTERER BENEF BENEFIITTSS PR PROOGGRRAAMM

Form W-42020

Employee’s Withholding Certificate

Department of the Treasury Internal Revenue Service

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.

Give Form W-4 to your employer.

Your withholding is subject to review by the IRS.

OMB No. 1545-0074

Step 1:

Enter

Personal

Information

(a) First name and middle initial Last name

Address

City or town, state, and ZIP code

(b) Social security number

Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.

(c) Single or Married filing separately

Married filing jointly (or Qualifying widow(er))

Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the online estimator, and privacy.

Step 2:

Multiple Jobs

or Spouse

Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spousealso works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or

(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or

(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . . . .

TIP: To be accurate, submit a 2020 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

Step 3:

Claim

Dependents

If your income will be $200,000 or less ($400,000 or less if married filing jointly):

Multiply the number of qualifying children under age 17 by $2,000 $

Multiply the number of other dependents by $500 . . . . $

Add the amounts above and enter the total here . . . . . . . . . . . . . 3 $

Step 4

(optional):

Other

Adjustments

(a)

Other income (not from jobs). If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income . . . . . . . . . . . . 4(a) $

(b)

Deductions. If you expect to claim deductions other than the standard deductionand want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here . . . . . . . . . . . . . . . . . . . . . 4(b) $

(c) Extra withholding. Enter any additional tax you want withheld each pay period . 4(c) $

Step 5:

Sign

Here

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Employee’s signature (This form is not valid unless you sign it.) Date

Employers

Only

Employer’s name and address First date of employment

Employer identification number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10220Q Form W-4 (2020)

First name and middle initial Last name Your Social Security number

Permanent home address (number and street or rural route) Apartment number

City,village,orpostoffice State ZIPcode

Are you a resident of New York City? ........... Yes NoAre you a resident of Yonkers? ..................... Yes NoComplete the worksheet on page 4 before making any entries.1 Total number of allowances you are claiming for New York State and Yonkers, if applicable (from line 20) ........... 12 Total number of allowances for New York City (from line 35) .................................................................................. 2

Use lines 3, 4, and 5 below to have additional withholding per pay period under special agreement with your employer.

3 New York State amount ........................................................................................................................................ 34 New York City amount ........................................................................................................................................... 45 Yonkers amount .................................................................................................................................................... 5

Department of Taxation and Finance

Employee’s Withholding Allowance CertificateNew York State • New York City • Yonkers

Single or Head of household Married

Married, but withhold at higher single rate

Note:Ifmarriedbutlegallyseparated,markanX in the Single or Head of household box.

IcertifythatIamentitledtothenumberofwithholdingallowancesclaimedonthiscertificate.Employee’s signature Date

Employer’s name and address (Employer: complete this section only if you are sending a copy of this form to the NYS Tax Department.) Employeridentificationnumber

Penalty – A penalty of $500 may be imposed for any false statement you make that decreases the amount of money you have withheld from your wages. You may also be subject to criminal penalties.

Employee: detach this page and give it to your employer; keep a copy for your records.

Changes effective for 2020FormIT-2104hasbeenrevisedfortaxyear2020.Theworksheetonpage4andthechartsbeginningonpage5,usedtocomputewithholdingallowancesortoenteranadditionaldollaramountonline(s)3,4,or5,havebeenrevised.IfyoupreviouslyfiledaFormIT-2104andusedtheworksheetorcharts,youshouldcompleteanew2020FormIT-2104andgive it to your employer.

Who should file this form Thiscertificate,FormIT-2104,iscompletedbyanemployeeandgivento the employer to instruct the employer how much New York State (and New York City and Yonkers) tax to withhold from the employee’s pay. The more allowances claimed, the lower the amount of tax withheld.

IfthefederalFormW-4youmostrecentlysubmittedtoyouremployerwasfortaxyear2019orearlier,andyoudonotfileFormIT-2104,youremployer may use the same number of allowances you claimed on your federalFormW-4.Duetodifferencesintaxlaw,thismayresultinthewrong amount of tax withheld for New York State, New York City, and Yonkers.

Fortaxyears2020orlater,withholdingallowancesarenolongerreportedonfederalFormW-4.Therefore,ifyousubmitafederalFormW-4toyour

employerfortaxyear2020orlater,andyoudonotfileFormIT-2104,youremployer may use zero as your number of allowances. This may result in the wrong amount of tax withheld for New York State, New York City, and Yonkers.

CompleteFormIT-2104eachyearandfileitwithyouremployerifthenumberofallowancesyoumayclaimisdifferentfromfederalFormW-4orhaschanged.CommonreasonsforcompletinganewFormIT-2104eachyear include the following:

• You started a new job.• You are no longer a dependent.• Your individual circumstances may have changed (for example, you

were married or have an additional child).• You moved into or out of NYC or Yonkers.• You itemize your deductions on your personal income tax return.• You claim allowances for New York State credits.• Youowedtaxorreceivedalargerefundwhenyoufiledyourpersonal

income tax return for the past year.• Yourwageshaveincreasedandyouexpecttoearn$107,650ormore

during the tax year.

Instructions

Employer: Keep this certificate with your records.Mark an X in box A and/or box B to indicate why you are sending a copy of this form to New York State (see instructions):

A Employeeclaimedmorethan14exemptionallowancesforNYS ............ A

B Employee is a new hire or a rehire ... B First date employee performed services for pay (mm-dd-yyyy) (see instr.):

Aredependenthealthinsurancebenefitsavailableforthisemployee? ............. Yes No

IfYes,enterthedatetheemployeequalifies(mm-dd-yyyy):

IT-2104

New Employee Tax Compliance Notification Sheet

The U.S. government tax authority, the Internal Revenue Service ("IRS"), has implemented strict regulations on taxation

and reporting of payments made to non-U.S. citizens. The City University of New York ("CUNY") may be required to

withhold U.S. income tax and report to the IRS in connection with CUNY's payments to employees (e.g. Student Employees,

Faculty, Staff) who are not U.S. citizens or permanent residents and who receive payment for services.

The SPRINTAX TDS Online Tax Compliance System individual record must be completed by all individuals who are not

citizens or permanent residents of the United States. If you are a new employee, you will receive an email from

noreply@sprintax.com with a password and instructions on how to access SPRINTAX TDS Online Tax Compliance

system. Please contact the Nonresident Alien Tax Specialist if you do not receive the password. If your Individual Record

in SPRINTAX TDS has already been completed, additional or updated information may be required. Please complete the

information in SPRINTAX TDS promptly upon receipt of your access information. If you have an existing SPRINTAX TDS

record, please review and update the current record to reflect all relationships with CUNY.

After completion of the information in SPRINTAX TDS, schedule a meeting with the Nonresident Alien Tax Specialist and

bring with you all completed forms / original documents.

Please note: the entire process must be completed within 7 business days of the filing of this notification sheet. If you

do not complete the entire process within 7 business days, the maximum U.S. federal income tax rate and all other

applicable taxes, including FICA, will be withheld from all payments. CUNY will not refund any tax withheld if the

required tax information has not been provided.

The Nonresident Alien Tax Specialist is located at:

I have been notified of my requirement to complete certain information in SPRINTAX TDS. I understand that a password

and instructions for access to SPRINTAX TDS will be sent to me via email. I have included my email address and phone

number below:

Original to CUNY administrator

Copy to Employee

COLLEGE

NAME OF THE NONRESIDENT ALIEN TAX SPECIALIST

ADDRESS

CITY, STATE, ZIP CODE

PHONE EMAIL

Employee Name (print)

Email Address (CUNY email recommended)

Phone number

CUNYfirst ID

Date

Signature

CUNY admin Name (print)

Date

Signature