Executive Compensation Plan - New Hire ChecklistOffice of Human Resources

The Graduate Center

Name:__________________________________ Title:______________________________________

Date of New Hire Orientation:_______________ Home Telephone:___________________________

ORIENTATION DOCUMENTS: Please bring the completed forms with you to the orientation.

o Employment Eligibility Verification - Form I-9o W-4 (Federal Tax Withholding)o IT-2104 (State Tax Withholding)o Direct Deposito Personnel Data Surveyo Emergency Contact Information

o Release of Informationo Amended Constitutional Oath Upon Appointmento Cuny Employment Application - Part Threeo Commuter Benefits Program Enrollment Form (Edenred)

OTHER REQUIRED DOCUMENTS:

Please submit a copy of your highest degree to dkotkas@gc.cuny.edu

Attn: Instructional Staff Coordinator Office of Human Resources The Graduate Center 365 Fifth Avenue Room 8403 New York, NY 10016

POLICIES & INFORMATION: Employees are responsible for knowing all CUNY and The Graduate Center Policies. Please review each as part of your appointment.

Charge of Discrimination Form CUNY Policy on Computer Use Domestic Violence Employee Notice of Work Related Injury or Illness Form Equal Opportunity Employment Program Fire Safety and Emergency Evacuations Hiring and Retention of Individuals with Disabilities Jury Duty Multiple Position Policy New York State’s Public Integrity Law Notice of Non-Discrimination Office of Compliance & Diversity

Ombuds Office Patient Protection and Affordable Care Act Report of Injury Security Policies and Crime Reporting Procedures Sexual Misconduct Snow Emergency Closing Procedures Title IX Awareness Tobacco Free CUNY Veterans and Veterans of the Vietnam Era with a Disability Workplace Violence Policies, Procedures and Prevention Plans You Have a Right to Know

MANDATORY EMPLOYEE TRAININGS: Please complete the following mandatory CUNY training programs within 90 days of your appointment.

Employee Sexual and Interpersonal Violence Prevention and Response Course (“ESPARC”) CUINY IT Security Awareness Course New York State Joint Commission on Public Ethics (JCOPE)’s Online Ethics Orientation (OEO) Workplace Violence Prevention Training

I have received the links to the policies and employee training programs governing my appointment.

Signature:__________________________________________________ Date:___________________________

Office of Human Resources

365 Fifth Avenue New York, NY 10016-4309 212.817.7700 phone 212.817.1639 fax hr@gc.cuny.edu www.gc.cuny.edu

July 1, 2020

Memorandum

To: All New Employees

From: David Boxill Executive Director of Human Resources

Subject: Compliance with Federal Employment Eligibility Certification Procedures

This is to inform you that the U.S. Citizenship and immigration Services (USCIS) requires employers to verify the identity and employment authorization of newly hired and some rehired employees. Form 1-9 is used for this purpose.

Please be advised that the Graduate Center cannot process any personnel appointment unless completed Form 1-9, with the attached supporting documentation, is on file in the Graduate Center's Office of Human Resources (OHR). Please note that you must complete Section 1 of the attached form and bring it with the appropriate, unexpired, documentation to OHR (Room 8403) for certification.

Attached are the lists of documents from which you may select. List A contains those documents that will establish both your identity and your authorization to work. If you choose to provide documents from Lists Band C, you must provide documents form BOTH List B and C. Please note that you must present ORIGINAL UNEXPIRED DOCUMENTS no later than the first day of employment.

If you have any questions or need further clarification, please email hr@gc.cuny.edu or call (212) 817-7700.

Thank you

USCIS Form I-9

OMB No. 1615-0047 Expires 10/31/2022

Employment Eligibility Verification Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-9 10/21/2019 Page 1 of 3Form I-9 10/21/2019 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)

- -

Employee's E-mail Address Employee's Telephone Number U.S. Social Security Number

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.

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):

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 10/21/2019 Page 2 of 3Form I-9 10/21/2019 Page 2 of 3

USCIS Form I-9

OMB No. 1615-0047 Expires 10/31/2022

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 theemployee is authorized to work in the United States.

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

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

B. 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 establishescontinuing 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

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 AlienRegistration Receipt Card (Form I-551)

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

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

4. Employment Authorization Documentthat contains a photograph (FormI-766)

5. For a nonimmigrant alien authorizedto work for a specific employerbecause of his or her status:

Documents that Establish Both Identity and

Employment Authorization

6. Passport from the Federated Statesof Micronesia (FSM) or the Republicof the Marshall Islands (RMI) withForm I-94 or Form I-94A indicatingnonimmigrant admission under theCompact of Free Association Betweenthe United States and the FSM or RMI

b. Form I-94 or Form I-94A that hasthe following:

(1) The same name as the passport;and

(2) An endorsement of the alien'snonimmigrant status as long asthat period of endorsement hasnot yet expired and theproposed employment is not inconflict with any restrictions orlimitations 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 aState or outlying possession of theUnited States provided it contains aphotograph or information such asname, date of birth, gender, height, eyecolor, and address

9. Driver's license issued by a Canadiangovernment authority

3. School ID card with a photograph

6. Military dependent's ID card

7. U.S. Coast Guard Merchant MarinerCard

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 localgovernment agencies or entities,provided it contains a photograph orinformation 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 authorizationdocument issued by theDepartment of Homeland Security

1. A Social Security Account Numbercard, unless the card includes one ofthe following restrictions:

2. Certification of report of birth issuedby the Department of State (FormsDS-1350, FS-545, FS-240)

3. Original or certified copy of birthcertificate issued by a State,county, municipal authority, orterritory of the United Statesbearing an official seal

4. Native American tribal document

6. Identification Card for Use ofResident Citizen in the UnitedStates (Form I-179)

Documents that Establish Employment Authorization

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

(2) VALID FOR WORK ONLY WITHINS AUTHORIZATION

(3) VALID FOR WORK ONLY WITHDHS AUTHORIZATION

(1) NOT VALID FOR EMPLOYMENT

Page 3 of 3Form I-9 10/21/2019

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

Refer to the instructions for more information about acceptable receipts.

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

Direct Deposit Form

• Please bring a voided check or have your bankrepresentative fill out the middle portion of this formprior to the Human Resources orientation.

• If you have a joint account please have both partiesprovide signatures.

Thank You

AC 2772 (Rev. 8/07) PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS

Direct Deposit Form for NYS Employees (To be used for enrollment, changes and cancellations)

Section A: Employee Information

NAME (LAST, FIRST, MI) ________________________________________________ WORK PHONE # ( ) ____________

LAST FOUR DIGITS OF SOCIAL SECURITY # __ __ __ __ AGENCY/DEPT CODE __ __ __ __ __

For more than three accounts or if you prefer to list each Financial Institution on a separate form, use additional forms as necessary. Up to seven fixed amount or percentage deposits may be processed as well as one excess (net pay) deposit.

Section B: Account Type New or Additional *

( )

Change Joint

Account Holder *

( )

Change Amount or Percentage

( )

Cancel

( )

Name of Financial Institution

Account Number Amount, Percentage or

Excess

1. Savings Checking

2. Savings Checking

3. Savings Checking

*For new/additional accounts with joint account holders or to add a joint account holder to existing accounts, both signatures are required in Section D.

Section C: This section must be completed by your financial institution for new/additional accounts when directing funds into a savings account or into a checking account if a voided personal check is not attached. The employee’s name MUST appear on the account(s). As a representative of the below named financial institution, I certify that this institution is ACH capable and agree to receive and deposit the salary to the account shown above in accordance with Part 102 of the Codes, Rules, and Regulations of the State of New York and to be bound by such rules. Salary credited to the account below will be available to the depositor on payday.1. NAME OF FINANCIAL INSTITUTION __________________________________________ Account Type Savings Checking

Depositor’s Account Number (EFT Format) Routing Number ________________________________________________________ __ __ __ __ __ __ __ __ __

Print or Type Representative’s Name Signature of Representative Telephone Number Date

2. NAME OF FINANCIAL INSTITUTION __________________________________________ Account Type Savings Checking

Depositor’s Account Number (EFT Format) Routing Number ________________________________________________________ __ __ __ __ __ __ __ __ __

Print or Type Representative’s Name Signature of Representative Telephone Number Date

3. NAME OF FINANCIAL INSTITUTION __________________________________________ Account Type Savings Checking

Depositor’s Account Number (EFT Format) Routing Number ________________________________________________________ __ __ __ __ __ __ __ __ __

Print or Type Representative’s Name Signature of Representative Telephone Number Date

Section D: Employee/Joint Account Holders Certification: I certify that I read and understand the instructions to this form, including the authorization for recovery. In signing this form, I authorize my salary payment to be sent to the designated financial institution(s) to be deposited into the specified account(s). The joint account holder for accounts listed in Section B, if any, must sign on the corresponding line for new/additional accounts or account holder(s).

Employee Signature___________________________________________________________________________ Date __________________

B-1 Joint Account Holder ___________________________________________________________________________ Date ____________________

B-2 Joint Account Holder ___________________________________________________________________________ Date ____________________

B-3 Joint Account Holder ___________________________________________________________________________ Date ____________________

INSTRUCTIONS: Please complete the form as described below, and then forward it to your agency/department payroll or personnel office. You can also contact that office for assistance in completing the form.

NEW/ADDITIONAL ACCOUNT OR CHANGES IN ACCOUNT HOLDERS: Employee must complete Sections A, B, and D for each new/additional account or for changes in account holders. See instructions below for Section C.

Section A: Indicate your name, work phone number and Agency/Department code. For your personal privacy, enter only the last four digits of your social security number.

Section B: To enroll in direct deposit or add an account, place a check mark in the account type (checking or savings) and in the “New or Additional” column. For changes in account holders, place a check mark in the account type and in the appropriate “Change” column. Indicate the name of the financial institution, account number, and amount or percentage to be deposited.

Employees may choose up to seven fixed amount or percentage deposits, as well as one excess (net pay)deposit. This form accommodates up to three accounts. For more than three accounts or if you prefer to listeach financial institution on a separate form, use additional forms as necessary.Account number is obtained from a personal check, bank statement, or the financial institution.To deposit a fixed amount, enter a specific amount (may include cents, e.g. $100.25). To deposit a portion ofthe paycheck, enter a specific percent (must be a full percentage, e.g. 50%). Write the word “excess” to depositthe remainder of monies after all other distributions.

Section C: For Savings Accounts, this section must be completed by your financial institution(s). For Checking Accounts, this section must be completed by your financial institution(s) if you are not attaching a voided personal check. The employee’s name must appear on the account.

Section D: The Employee/Joint Account Holder Certification must be signed by the employee in all instances and any joint account holder if this is a new/added account. By signing this form, the employee and any joint account holder each allows the State, through the financial institution, to debit the account in order to recover any salary to which the employee was not entitled or that was deposited to the account in error. This means of recovery shall not prevent the State from utilizing any other lawful means to retrieve salary payments to which the employee is not entitled.

CHANGES TO MONEY OR PERCENTAGE AMOUNT: Employees may add, change or cancel the money or percentage amount deposited to an account by completing Sections A, B, and D of a new Direct Deposit Form. Section C does not need to be completed for these changes. In Section B, place a check mark in the appropriate “Change” column. New fixed amount or percentage direct deposits will be assigned a lesser priority than existing fixed amount or percentage direct deposits. For example, if an employee’s pay is not sufficient to cover all direct deposits, the most recently designated direct deposit(s) will not be taken.

To change direct deposit priorities, please contact your agency payroll or personnel office. Financial institution changes may take up to two payroll periods to become effective. Employees should maintain accounts canceled and replaced by new accounts until the new transaction is complete. If canceled accounts are not temporarily maintained until the new account receives the employee’s direct deposit transaction, employees may experience a delay in payments. Joint account holder’s signature is not required for these transactions.

CANCELLATIONS: The agreement represented by this authorization will remain in effect until canceled by the employee, the financial institution, or the State agency. To cancel the agreement, the employee must complete Sections A, B and D of a new Direct Deposit Form for the transaction(s) to be canceled. Joint account holder’s signature is not required. The financial institution may cancel the agreement by providing the employee and the State agency with a written notice 30 days in advance of the cancellation date. The financial institution cannot cancel the authorization without notification to both the employee and the State agency. The State agency may cancel an employee’s direct deposits when internal control policies would be compromised by this form of salary payment.

NOTE: Direct deposit advice statements are distributed by the enrollee’s agency. If the statement is unclaimed, it will be held by the agency for thirty (30) days after which time the statement will be destroyed.

Additional Information The information on this form is required pursuant to Part 102 of the Codes, Rules and Regulations of New York State (2 NYCRR 102). This form is a legal document and cannot be altered by the agency, employee or financial institution. If there are any changes, the employee must complete a new form. The information supplied by the employee will be provided only to the designated financial institution(s) and/or their agent(s) for the purpose of processing payments. Failure by the employee to provide the requested information may delay or prevent the receipt of payments through the Direct Deposit/Electronic Funds Transfer Program of the Bureau of State Payroll Services, NYS Office of the State Comptroller.

ADDENDUM DIRECT DEPOSIT OF SALARY

ENROLLMENT FORM

AUTHORIZATION FOR CANCELLATION BY EMPLOYEE'S COLLEGE FOR DIRECT DEPOSIT

In addition to the cancellation terms specified on the back of the ‘Direct Deposit of Salary Enrollment Form’ the agreement represented by this authorization may be canceled by the employing college by providing the employee with a written notice 10 working days in advance of the cancellation date.

A cancellation does not take effect until the State Comptroller's Office is notified.

____________________________________ ______________________________ Name (Print) Date

____________________________________ Name (Signature)

Note: This form must be signed and attached to the Direct Deposit of Salary Enrollment Form.

THE GRADUATE CENTER OFFICE OF HUMAN RESOURCES PERSONNEL DATA SURVEY

LAST NAME: FIRST NAME: MIDDLE INITIAL: S.S.#:

DEPT./PROGRAM: WORKSITE ADDRESS: START DATE:

HOME TEL#: Email: PLEASE CHECK THE APPROPRIATE TITLE

INSTRUCTIONAL TITLESAdjunct Prof. ___________________Adjunct Assoc. Prof. ____________Adjunct Asst. Prof. ______________Adjunct Lecturer ________________Assoc. Prof. ____________________Asst. Prof. ______________________Asst. to HEO ____________________Chief College Lab. Tech. __________College Lab. Technician __________College Security Dir. ______________Cont. Ed. Teacher (H) _____________Cont. Ed. Teacher (credit) __________Dist. Prof. ________________________Higher Education Officer ___________Higher Education Assoc. ___________Higher Education Asst. ____________Non-Teaching Adjunct* ____________ Professor ________________________

Sr. College Lab. Tech. _____________Visiting Prof. _____________________Visiting Assoc. Prof. ______________Visiting Asst. Prof. _________________Grad. Asst. A ______________________Grad. Asst. B_______________________Grad. Asst. C_______________________Grad. Asst. D _______________________.......................................................

*Lect. 04689, Instructor 04688, Asst. Prof. 04687, Assoc.Prof. 04686, Prof. 04685, CLT 04601

NON-INSTRUCTIONAL TITLESCamp. Peace Off. L I/III ______________Campus Sec. Asst. __________________College Accountant ________________College Accounting Asst. ____________College Assistant __________________College Graphic Designer ___________Coll. Print Shop Coord. ______________

Coll. Print Shop Asst. _____________Coll. Print Shop Assoc. ____________CUNY Admin. Asst. _______________CUNY Computer Aide _____________CUNY Office Asst. ________________CUNY Comp. Spec./ ________________Software IT Assistant ** _____________________IT Associate ** ____________________IT Senior Associate ** ______________IT Support Assistant ** _____________Mail Messenger Svc. Wrk. ___________Purchasing Agent _________________Pub. Safety Sgt. _________________Other** - (Please specify) ________________________________**If hourly, please indicate “H”

CIVIL SERVICE MANAGERIALAsst. College Security Dir. ____________Chief Admin. Supt. _________________College Sec. Dir. ___________________Computer Systems Mgr. _____________

EXECUTIVE COMPENSATION PLANAdministrator _____________________Asst. Administrator ________________Asst. Vice President ________________Assoc. Administrator _______________Dean _____________________________President _________________________Sr. Vice President __________________Vice President _____________________Other (Please specify) __________________________________

Degree(s) Earned:

Highest Degree/Diploma Earned: Year Conferred: Institution Name & Address where earned: Type of Institution: Public Private 2 Yr. 4 Yr. Major Field of Study/Discipline:

Other Degree Earned: Year Conferred: Institution Name & Address where earned: Type of Institution: Public Private 2 Yr. 4 Yr. Major Field of Study/Discipline:

Other Degree Earned: Year Conferred: Institution Name & Address where earned: Type of Institution: Public Private 2 Yr. 4 Yr. Major Field of Study/Discipline:

Ethnic Background Personal Data

White (Not Hispanic or Latino) Asian Date of Birth: Black or African American (Not Hispanic or Latino) American Indian or Alaskan Married: Yes NoHispanic or Latino (Not Puerto Rican) Italian American Country of Birth: Puerto Rican Native Hawaiian or Other Pacific Islander

Were you ever employed by the City University of New York? Yes No

If yes, in what title

Where When

The Graduate Center 365 Fifth Avenue, New York, NY 10016-4309

EMERGENCY CONTACT INFORMATION

Name: ____________________ Home Address:____________________________________ Phone #:__________________

Primary Contact Person: _______________________________________ Relationship: _____________________________ Home Address:_______________________________________________________________ Phone #:__________________ Alternate Phone#:_________________________ E-mail address: _____________________________

If the Graduate Center cannot get in touch with contact named above, name a friend or relative who may be called.

Secondary Contact Person: __________________________________________Relationship _________________________ Phone #:____________________________

Doctor’s Name: ___________________________ Address: _____________________ Phone #: ______________________

If none of the above can be reached, what do you wish the Graduate Center to do?

(It is understood that in the final disposition of an emergency case the judgment of the Center authorities will prevail. The recommendation indicated above will be respected as far as possible).

Identify any medications you are allergic to or any chronic conditions of which emergency personnel should be aware (optional):

I agree to notify the Office of Human Resources when/if the above information changes

Signature: _________________________________________________________ Date:______________________________

Release of Information Form

______________________________________________________________________________ Please print your full name

NON-RELEASE

I DO NOT AUTHORIZE The Graduate Center (GC) officials to supply information concerning my status with the GC, including salary information, on written requests from banks, retail organizations and (credit rating services), without first consulting me, I agree to come to the Office of Human Resources, upon request, every time there is any inquiry on my status and to sign a specific release if I wish information released.

Signature: ______________________________________ Date: ___________________

GENERAL RELEASE

I HEREBY AUTHORIZE The Graduate Center (GC) to supply information concerning my status, including salary information, on written request from banks, retail organizations, and (credit rating services). Such information may be given out further without consultation with me.

I understand that it is the policy of the GC not to release information over the telephone. In an instance where I wish to have information given to an authorized person over the telephone, I will sign a separate release.

Signature: ______________________________________ Date: ___________________

Office of Human Resources

365 Fifth Avenue New York, NY 10016-4309 212.817.7700 phone 212.817.1639 fax hr@.gc.cuny.edu www.gc.cuny.edu

Office of Human Resources The Graduate Center

AMENDED CONSTITUTIONAL OATH UPON APPOINTMENT (In compliance with Section 62 of the NY State Civil Service Law)

“I do 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

_________________________________________________________ (Contract Title)

according to the best of my ability.”

_________________________________________________________ (Print Name)

_________________________________________________________ (Signature)

_________________________________________________________ (Street Address)

_________________________________________________________ (Street Address)

_________________________________________________________ (City) (State) (Zip Code)

Date_______________

Under the New York State Retirement and Social Security Law, retirees collecting a pension from New York State or New York City

cannot (with certain exceptions) work at the University and continue to collect their pension. Accordingly, The City University of New

York requires individuals seeking University employment to disclose their public employment and pension plan history for the

purpose of establishing eligibility for employment. An employee who fails to disclose such information will be subject to appropriate

action, which may include disciplinary action to terminate their employment and/or suspension or diminution of the retiree's public

pension benefits.

Note: Retirees who are under age 65 and are collecting a pension may receive an annual income of up to $30,000 (Thirty thousand only) in a position in public employment without diminution of their pension benefits.

1. Candidates for employment must submit this form at the time of hire, prior to any appointment

2. All full-time and part-time employees are responsible for submitting this form, should their status change

3. Adjuncts must submit this form every semester in which their employment continues

THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION - PART THREE

CERTIFICATION OF NEW YORK STATE OR NEW YORK CITY PUBLIC SERVICE

CERTIFICATION OF COLLECTION OF PUBLIC PENSION FUNDS

CUNY Certification of NYS/NYC Public Service /Collection of Public Pension Funds Rev. 1-23-15

Date

Middle InitialLast Name First Name

Part-time Full-timeContract Title

DepartmentCollege

I am a New York State officer or employee (other than CUNY employee) and I receive compensation other than on a per diem basis

I am a member of the New York State Legislature

I am a New York State Legislative employee

I am a statewide elected official of New York State

Name of Employer

I am now working for another public service agency, organization, or jurisdiction funded by New York City or New York State

I am not currently working for another public service agency, organization, or jurisdiction funded by New York City or New York State, nor have I worked at any such entity during the calendar year

Current positions in Public Service (Please check appropriate box)

I am not collecting retirement benefit based upon this public service

Name of Pension Plan

I am collecting a retirement benefit from a public pension system (including ORP) maintained by the State or City of New York

I have no prior service with a public service agency, organization or jurisdiction funded by New York City or New York State

Prior positions in Public Service (Please check appropriate box)

of the City/State of New York, and I am former employee of

I hereby attest that the information I have provided above is correct to the best of my knowledge.

Signature Date

Name Signature Date

Office of Human Resources

TRANSIT BENEFIT UPDATE

This spring, The City University of New York (CUNY) senior colleges announced the change in their commuter benefits provider from WageWorks to Edenred Commuter Benefits Solution.

The Transit Program offers eligible employees the opportunity to use pre-tax earnings through payroll deductions to cover certain public transportation costs. This means you will not pay federal, state, city, Social Security, and Medicare taxes on your transit deduction up to the IRS limit. You can also put post-tax deductions in your account if you have monthly transit expenses exceeding the monthly pre-tax limit.

Below is a brief description of each of the plans available to you in the Program:

Commuter Card (Unrestricted) Plan – The Commuter Card is a stored-value card loaded with your pre-tax and post-tax payroll deductions that can be used to purchase transit passes and tickets at transit providers throughout the New York Tri-State area.

Transit Pass Plan – This plan allows you to arrange for home delivery of your transit provider passes and tickets through Edenred. You can select from their extensive catalog of transit providers and transit passes covering the New York Tri-State area.

Access-A-Ride/Paratransit Plan – This plan allows you to participate in Access-A-Ride if you are an employee who receives paratransit service from MTA New York City Transit.

Park-n-Ride Plan – This plan allows you to use your pre-tax and post-tax payroll deductions to pay for parking at or near a public transportation stop or station that you use to commute to work. Only transit-related parking is eligible. You must be jointly enrolled in one of the above transit options in order to enroll in this option.

Submit completed form to your college Benefits Officer EMPLOYEE ACTION

NEW CHANGE PERSONAL INFORMATION CHANGE DEDUCTION SUSPEND DEDUCTION CANCELLATION

SUSPEND TRANSIT PLAN DEDUCTION

EMPLOYEE CERTIFICATION

(Change Transit Plan and/or Amount Deducted from Pay each Month)

(Temporarily Stop Transit Plan Deduction from Pay)

(Terminate Your Transit Plan Payroll Deduction)

(Change Mailing Address,Email, or Phone)

(Enroll)

First Name ___________________________________________

Address ______________________________________________________________________________________________________________________

Email _______________________________________________________________ Phone ______________________________________________

M.I._________ Last Name ___________________________________________

EMPLOYEE IDENTIFICATION (Please fill out ALL fields completely. Please print.)

($1.25 Monthly Admin Feethrough Payroll Deductions)

($2.05 Monthly Admin Feethrough Payroll Deductions)

TRANSIT PLAN AUTHORIZATION (Please select ONE, enter your initials and the monthly deduction amount.)COMMUTER CARD – UNRESTRICTED TRANSIT PASS

login.commuterbenefits.com

TRANSIT BENEFIT PLANS

AGENCY PAYROLL SECTION

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

EmployeeInitials

MonthlyDeduction Amount*

EmployeeInitials

MonthlyDeduction Amount*

$ ________ . _____ $ ________ . _____

Submit at least 2 weeks before you want to suspend your payroll deduction. Remember, administrative fee deductions will continue whenapplicable. If you are also enrolled in the Park-N-Ride Plan, the parking plan will be suspended for the same period. Please note this will onlysuspend your payroll deduction. To also suspend your Transit Pass orders, you must do so directly with Edenred at (833) 584-8109 or online atlogin.commuterbenefits.com.

PAY DATE TO SUSPEND DEDUCTION PAY DATE TO RESUME DEDUCTION

MONTH DAY YEAR MONTH DAY YEAR

I understand, according to the Internal Revenue Code, that the average monthly amount of my transportation deductions should not exceed myaverage monthly cost of public transportation to and from work. If my average monthly cost of public transportation to and from work shouldchange, I will change my deduction plan to accommodate my new circumstance. Furthermore, no reimbursement will be provided for pre-taxtransportation fringe deductions. Upon termination, voluntary or otherwise, any funds remaining in my Transit Account will be available for usefor a period of 90 days from the effective date of termination. Residual funds remaining in the account beyond the 90 day period will be forfeited.

I understand there is a monthly non-refundable fee to cover administrative costs of the program. The administrative fee will be deducted from mypost-tax pay each month according to the following table:

I hereby authorize the City University of New York to deposit my payroll deduction as indicated above into my Edenred Commuter Benefit TransitAccount.

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 “NationalAutomated Clearing House Association” guidelines and rules, the City University of New York can only reverse the amount of the incorrect directdeposit.

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 for use exclusively related to the administration of the program. This authorization will remain in effect until I submit anew request for a change or cancellation.

I understand that my Transit Account balance and information will be maintained by Edenred and are accessible online atlogin.commuterbenefits.com or by calling Edenred Customer Service at (833) 584-8109.

Employee Signature ________________________________________ DATE

MONTH DAY YEAR

(02/2020)

Agency Code Personal information updated (check all that apply):

Mailing Address Email Phone

I certify that the above data was entered in Edenred & PayServ:

Prepared By (Please Print) Signature Date

MONTH DAY YEAR

ENTRY DATE

TRANSIT PLAN MONTHLY FEE CHARGE METHODCommuter Card-Unrestricted $1.25 Deducted from post-tax payTransit Pass $2.05 Deducted from post-tax pay

Date of Birth (MM/DD/YYYY)Employee N Number (Located on your paycheck stub) ______ ______ _________

EXECUTIVE COMPENSATI ON PLANFACT SHEET

HEALTH INSURANCE

Dental, optical, hearing aids, prescription drug plan, Death Benefit of $5,000 are available through the Professional Staff Congress/City University of New York (PSC-CUNY) Welfare Fund (www.psccunywf.org). Tuition Fee Waivers (employee only); Group Long Term Disability coverage becomes available after the first full year of appointment. Employee is covered for Term Life Insurance in the amount of $25,000 for the first twelve months of employment. Continuance of Term Life Insurance and Optional Disability Insurance is also available at an additional cost. McGraw-Hill Federal Credit Union (www.mcgrawhillfcu.org) and the Municipal Credit Union (www.nycmcu.org).

The two options available are the New York City Teachers' Retirement System (NYCTRS), a defined benefit plan, and the Optional Retirement Plan through Teacher's Insurance Annuity Association College Retirement Equity Fund (TIAA-CREF) at www.tiaa-cref.org/cuny , a defined contribution plan. Eligible employees elect a pension plan within 30 days of appointment. Those failing to complete the election process within the statutory time frame will be forced into membership with the NYCTRS by law (www.trsnyc.org).

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CUNY employees and their eligible dependents 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. After 365 days of employment, the employee will have the option of either remaining in the HIP HMO Preferred Plan or selecting a different health plan within 30 days before the end of the 365th day period. If a new health plan is selected, the new plan will be effective on the 366th day. There are approximately ten plans available through the City of New York Office of Employee Benefits. Several plans offer basic coverage at no cost; others offer optional benefits at a bi-weekly cost. For a summary of the plans, please visit www.nyc.gov/olr. All are effective upon appointment and available to eligible dependent family members and registered domestic partners.

A Work/Life Assistance Program is provided by CCA (Corporate Counseling Associates) Employee Assistance Program call CCA at (1-212-686-6827). Online tools are also available to you at www.ccainc.com. The Commuter Benefits Program provided by Edenred at www.commuterbenefitsnyc.com/program-details.aspx (1-833-584-8109); New York’s 529 College Savings Plan at www.ny529atwork.com (1-800-420-8580); Voluntary Retirement Saving Programs (TDA) with TIAA-CREF, Lincoln Life & Annuity Company – Represented by the Halliday Financial Group (1-516-759-4521), Teachers’ Retirement System (TRS), only for members enrolled in the TRS Defined Benefits Pension Plan at www.trsnyc.org (1-888-869-2877) and New York State Deferred Compensation Plan at www.nysdcp.com (1-800-422-8463).

OTHER BENEFITS PROGRAMS

RETIREMENT PLANS

BENEFITS

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IDENTIFICATION CARDS

In addition to serving as official CUNY identification, ID cards may be used in the Library and in Information Resources.

ANNUAL LEAVE Staff members in ECP titles earn twenty-five (25) days of annual leave per year. The annual leave year runs from September 1 through August 31. Members of the ECP title earn two (2) annual leave days per month, and receive one (1) additional day at the end of the anniversary month.

SICK LEAVE

Staff members in ECP titles earn sick leave at a rate of 1 day 4 hours 40 minutes per month, for a total of 20 days per year, to a maximum of 160 days.

HOLIDAYSStaff members in ECP titles receive thirteen (13) paid holidays. In addition, they receive unscheduled holidays, which may be used as floating holidays. Please visit the link below to review the employee holiday calendar and determine how many unscheduled holidays have been allotted for this calendar year. (http://www.gc.cuny.edu/About-the-GC/Administrative-Services/Human-Resources/Holiday-Closings)

Signature: Date:

This is Summary Fact Sheet detailing information on “terms and conditions” of

employment please consult the Agreement between the City University of New York

and the Professional Staff Congress/CUNY.

I have read the above and received enrollment information for health insurance and

retirement system membership:

Print Name:

Paydays are biweekly on Thursdays. Checks are issued on the preceding Wednesday beginning at 3:00 PM at The Graduate Center in Room 8105. Direct deposit is available, or staff may arrange to have checks mailed to their home if self-addressed stamp envelopes are provided.

PAY DAYS

ACKNOWLEDGEMENT