Full Time Classified Staff Packet Checklist

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2 Full Time Classified Staff Packet Checklist 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 Employment Packet CUNY (Part One) (Part Two) Personnel Information Form Employee s Withholding Allowance Certificate (W-4 and IT-2104) External Employment Appointment Processing and Fees Amended Constitutional Oath Upon Appointment Time and leave System (Kronos) Agency Shop Fee Agreement Listing of various policies/procedures on BMCC HR. Web IT Security If applicable, complete and return: Direct Deposit of Net Pay Enrollment Transit Benefit Enrollment/Wage Works 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 Print Name Signature G:\GC\Forms\Full Time Classified Staff Packet Checklist

3 Office of Human Resources Management Campus HR Advisory Services 205 East 42nd Street, 10th floor New York, N.Y Fax 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 hereunder: 1. You are required to pre-register prior to going to fingerprint location by: a) Calling to speak with a Customer Service Representative (CSR) so they can capture demographic data and make $87.25 payment; or b) Visit MorphoTrust USA website at and submit your demographic data and make payment. 2. At the time of registration, you will need to provide the following information: CUNY ORI#: NY931680Z Name of College you are applying to: Borough of Manhattan Community College College ID Code you are applying to: 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. Driver s 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 Dependents ID, Coast Guard Merchant Mariner ID, Native America Tribal Document, Canadian Driver s 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. Please see reverse side Rev

4 5. Payment for fingerprinting services is required at the time of the fingerprinting appointment. MorphoTrust USA accepts personal check, money order, business check, credit card, e-check, and escrow account transactions. 6. Fingerprint technicians do not have access to credit card machines at the fingerprint locations, so applicants cannot pay for their fingerprinting by credit card on location. This will need to be done via the web at or by calling into the call center at 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 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 Mon, Tue, Thu & Fri 9:00-5:00; Wed 9:00-6:00; E/O Sat 10:00-2:00 Bronx - Third Ave - Between 147th & 148th St Bronx, NY. 2804a Third Ave Mon- Fri 9am-12pm & 1pm-8pm; Sat 9:00am-12pm & 1pm-5:00pm Brooklyn Brooklyn, NY. (2174 Fulton St) Mon - Thu 9am - 6pm; Fri 9am - 7pm; E/O Sat 9am - 5pm Brooklyn - Flatbush Brooklyn, NY. (1772 Flatbush Ave - Between Ave's J & K) M, Tues, Thurs, Fr 9-12 & 1-9; Wed 9-12 & 1-6; E/O Sat 10-1 & 2-6 Jackson Heights New York - Broadway New York - Park Place Jackson Heights, NY. ( rd St, Ste 1e New York, NY Broadway, 17th FL Mon - Fri 9am-1pm & 2pm-4pm New York, NY. 22 Park Place, 4th Floor Mon-Thurs. 9:00am-1:00pm & 1:30pm-6:00pm Fri 3:00pm-9:00pm Sat 10:00am-1:00pm & 1:30pm-6pm Mon 9am-6pm; Tues & Fri 9am -5pm; Wed 9am-7pm; Thurs 9am- 5:30pm; E/O Sat 9am-1pm New York - W 35th St New York, NY. 247 W 35th St, Ste 201 M, W, F 9-1:30 & 2:30-5:30; Tues & Thurs 9-1:30 & 2:30-6:30; Sat 10-4 Queens - Jamaica Jamaica, NY st St Mon - Fri 7:00-8:00; Sat 8:30-3:00 Staten Island Yonkers Staten Island, NY. 159 New Dorp Plz, Ste 201 Yonkers, NY. 35 East Grassy Sprain Rd Suite 304c] M,W 10-1 & 3-5; Tues, Thurs,Fri 9-1 & 2-3; Fri 9-12 & 2-3; E/O Sat 19-1 & 2:00-3 Mon, Weds, Thurs, & Fri 10am-2:45pm & 3:45pm - 5pm; Tues 10am-2:45 & 3:45-7pm; Sat 10am- 2pm Rev

5 Name Position College THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION - PART ONE Dept. Important Notice to Applicants Our Commitment to Diversity Diversity and inclusion are core values of The City University of New York (CUNY or The University). We believe adherence to these values creates an environment that best allows our students, faculty and staff to learn, work and succeed. As a University, we strive to respect differences, but more importantly, we seek to leverage the talents of all members of the University community in order to foster academic and administrative excellence. These values make CUNY a great place to learn and work! Equal Opportunity and Non-Discrimination Policy The University is committed to a policy of equal employment and equal access in its educational programs and activities. Diversity, inclusion, and an environment free from discrimination are central to the mission of the University. It is the policy of the University-applicable to all colleges and units-to recruit, employ, retain, promote, and provide benefits to employees (including paid and unpaid interns) and to admit and provide services for students without regard to race, color, creed, national origin, ethnicity, ancestry, religion, age, sex (including pregnancy, childbirth and related conditions), sexual orientation, gender, gender identity, marital status, partnership status, disability, genetic information, alienage, citizenship, military or veteran status, status as a victim of domestic violence/stalking/sex offenses, unemployment status, or any other legally prohibited basis in accordance with federal, state and city laws. It is also the University s Policy to provide reasonable accommodations, when appropriate, to individuals with disabilities, individuals observing religious practices, employees who have pregnancy or child-birth related medical conditions, or employees who are victims of domestic violence/stalking/sex offenses. All questions or concerns regarding the University s non-discrimination policy or procedure, or the application of that procedure, should be addressed to the College s Chief Diversity Officer. Inquiries or complaints concerning sex discrimination and sexual misconduct may be referred 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. 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. Post Offer Pre-Employment Credit History, Medical Examination, Drug Screening, and Physical Fitness Assessment For some positions, a credit history, medical examination, drug test, and/or physical fitness assessment may be required as a condition of employment. If any investigation, examination or assessment is required, it will be stated in the Position Vacancy Notice and will be processed per applicable laws. Employment Eligibility and Identity Documents Verification Newly hired employees must complete Section 1 of the Dept. of Homeland Security/U.S. Citizenship & Immigration Services I-9 Form no later than the first day of employment. CUNY is required to verify evidence of identity and employment authorization within 3 business days of the employee's first day of employment. Verification of Credentials and Professional References Check 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. Criminal Background Check For some positions, a criminal background check may be required following a conditional offer of employment. CUNY follows all applicable procedures related to criminal background checks. CUNY EMPLOYMENT APPLICATION-PART ONE Page 1 Rev

6 THE CITY UNIVERSITY OF NEW YORK APPLICATION FOR EMPLOYMENT- PART ONE Application for Employment - Part One (Employment and Educational History of the Applicant) Applicants should submit this form at the time of the initial interview to the search committee. College Position Title Job ID# Full-time Part-time If part-time, hours available Contract Title Personal Information A.M. P.M. Last Name First Name Middle Initial If known by another name, please provide Address Apt. # City State Zip Code Daytime Phone # Evening Phone # Do you have any relatives employed in the department for which you are applying? No relatives Yes, I have (a) relative (s) If yes, please explain Are you permitted to work in the United States? Yes No Will you now or in the future require a visa sponsorship for employment at CUNY Yes No 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; - Under federal law, I will submit Form I-9 no later than the first day of work. CUNY is required to verify my employment eligibility and identity within three days of my reporting to work and I will provide appropriate supporting documents within that time period. Signature CUNY EMPLOYMENT APPLICATION-PART ONE Page 2 Rev

7 A. Education (Please indicate highest equivalent grade of education completed): Doctorate Professional Degree Masters Baccalaureate Associate Trade/Vocational School High School/GED List schools attended, beginning with most recent (university, college, business school, vocational or trade school, high school, etc.) School Name School Name School Name Location Location Location Major Study Major Study Major Study Credits completed Degree received Credits completed Degree received Credits completed Degree received School Name School Name School Name Location Location Location Major Study Major Study Major Study Credits completed Degree received Credits completed Degree received Credits completed Degree received IF REQUIRED FOR POSITION: Provide driver's license number, professional/trade license/certification numbers. Attach page, if necessary B. Employment History: Begin with present (or last job if currently unemployed) 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. Employer Name Job Title Address CUNY Contract Title, if applicable Telephone Briefly describe duties Name/Title of Immediate Supervisor employed from employed to Telephone Reason for leaving Full-time Part-time Average hours worked per week part-time Salary (Indicate one): Gross Annual Hourly Gross Weekly Employer Name Job Title Address CUNY Contract Title, if applicable Telephone Briefly describe duties Name/Title of Immediate Supervisor employed from employed to Telephone Reason for leaving Full-time Part-time Average hours worked per week part-time Salary (Indicate one): Gross Annual Hourly Gross Weekly CUNY EMPLOYMENT APPLICATION-PART ONE Page 3 Rev

8 Employer Name Job Title Address CUNY Contract Title, if applicable Telephone Briefly describe duties Name/Title of Immediate Supervisor employed from employed to Telephone Reason for leaving Full-time Part-time Average hours worked per week part-time Salary (Indicate one): Gross Annual Hourly Gross Weekly Employer Name Job Title Address CUNY Contract Title, if applicable Telephone Briefly describe duties Name/Title of Immediate Supervisor employed from employed to Telephone Reason for leaving Full-time Part-time Average hours worked per week part-time Salary (Indicate one): Gross Annual Hourly Gross Weekly Have you ever left a position for any disciplinary reason? Yes No If yes, explain briefly: Attach additional pages, if necessary 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. CUNY EMPLOYMENT APPLICATION-PART ONE Page 4 Rev

9 D. Professional References: The University may conduct a background investigation including, but not limited to, contacting references that you provide. 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. 1. Name 2. Name 3. Name Title Title Title Company Company Company Address Address Address Daytime Phone # Daytime Phone # Daytime Phone # G. How did you learn about this position? Check all that apply: College Human Resources Office College Website CUNY Website (cuny.edu or cuny.jobs) Someone I know who works at CUNY Union office Search Engine (Bing, Google) Printed Advertisement External Job Board Government Job Bank or Resource Agency (Veterans' Vocational Rehabilitation, Other) Job Fair, Conference, or Convention Professional or academic group, contact, or referral Social Media (LinkedIn, Facebook, Academia.edu, Other) Search Firm Other General Category (Please explain) COLLEGE USE ONLY Reviewed by Chair of Search Committee: Name Signature CUNY EMPLOYMENT APPLICATION-PART ONE Page 5 Rev

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11 College Name of Candidate Position sought Authorization to Release Reference Information I have applied for a position with The City University of New York (CUNY) and would like CUNY to be fully informed of my qualifications for the position. I hereby authorize any current or former employer, professional reference, and education/training provider, to disclose in good faith any information they may have regarding and pertaining to my qualifications and fitness for employment. I agree to hold such employers, references, educational/training institutions and any other persons giving references harmless from liability or damages for providing the requested information. A photocopy or fax of this authorization shall be as valid as the original. Signature The City University of New York is an equal employment / affirmative action employer and does not discriminate on any basis protected by federal, state or local laws CUNY EMPLOYMENT APPLICATION-PART ONE Page 7 Rev

12 Name Position College Dept. THE CITY UNIVERSITY OF NEW YORK EMPLOYMENT APPLICATION - PART TWO POST-CONDITIONAL OFFER OF EMPLOYMENT This form should be completed only after a conditional job offer has been made. Accommodation required to perform Essential Job Functions It is the University's policy to provide reasonable accommodations, when appropriate, to individuals with disabilities, individuals observing religious practices, employees who have pregnancy or child-birth related medical conditions, or employees who are victims of domestic violence/stalking/sex offenses. If you require an accommodation to perform the essential job functions for the position for which you have received a conditional offer of employment, please contact the HR Director. Confidential Criminal Background Information As a candidate with a conditional offer of employment, you must provide criminal background information for our review. A conviction record will not necessarily disqualify you from the position for which you are applying. However, failure to provide truthful responses will, when discovered, automatically result in the withdrawal of the conditional offer of employment or your termination, if employed. In accordance with Article 23-A of the New York State Corrections Law, the following factors shall be considered concerning previous criminal convictions: - the public policy of New York State, to encourage the licensure and employment of persons previously convicted of one or more criminal offenses - the specific duties and responsibilities necessarily related to the license or employment sought or held by the person - the bearing, if any, the criminal offense or offenses for which the person was previously convicted will have on his /her fitness or ability to perform one or more such duties or responsibilities - the time which has elapsed since the occurrence of the criminal offense or offenses - the age of the person at the time of occurrence of the criminal offense or offenses - the seriousness of the offense or offenses - any information produced by the person, or produced on his behalf, in regard to his/her rehabilitation and good conduct - the legitimate interest of the public agency or private employer in protecting property, and the safety and welfare of specific individuals or the general public Before any adverse action is taken based on a previous criminal conviction, CUNY will - furnish a written copy of the criminal history inquiry to the candidate in a manner determined by the New York City Commission on Human Rights ( NYCCHR ) - provide a written Article 23-A analysis to the candidate in a form determined by the NYCCHR, together with supporting documents which formed the basis and reasons for the adverse action; and - after providing the candidate with the required documentation, allow him or her at least three business days to respond and, during that time, hold the position open for the candidate. CUNY EMPLOYMENT APPLICATION - PART TWO Page 1 of 3 Rev

13 THE CITY UNIVERSITY OF NEW YORK APPLICATION FOR EMPLOYMENT - PART TWO Application for Employment - Part Two (Confidential Background Information) Only candidates who have received a conditional job offer should complete this form. For questions and concerns, candidates may request guidance from the Office of Human Resources. The completed form should be submitted to the Office of Human Resources only. College Position Contract Title Job ID# Full-time Part-time A.M. P.M. Personal Information Last Name First Name Middle Initial If known by another name, please provide Address Apt. # City State Zip Code Daytime Phone # Evening Phone # Please complete Page 3 CUNY EMPLOYMENT APPLICATION - PART TWO Page 2 of 3 Rev

14 Confidential Criminal Background Information: 1. Have you ever been convicted of an offense anywhere, including felonies, misdemeanors or penal law violations? Yes No DO NOT include traffic violations or convictions sealed, expunged, or set aside under federal law or state law. However, you are required to disclose all other criminal convictions, even if you have a Certificate of Relief from Disabilities or a Certificate of Good Conduct in connection with one or more offenses. If you have a Certificate of Relief from Disabilities or a Certificate of Good Conduct, please provide it with this form. 2. Are there any criminal charges or penal law violations (except for traffic violations) currently pending against you? Yes No 3. Please explain below all past convictions or currently pending criminal charges against you (as specified in Questions 1 and 2 above). Attach additional pages, as necessary. Offense of conviction Name and location of Court Disposition including incarceration Offense of conviction Name and location of Court Disposition including incarceration Offense of conviction Name and location of Court Disposition including incarceration Offense of conviction Name and location of Court Disposition including incarceration Applicant Attestation: By my signature below, I declare and affirm that I have read and fully understand that: Any misrepresentation or material omission of facts on this form shall be sufficient cause to end further consideration of my candidacy for the position for which I have received a conditional offer of employment or shall be sufficient cause for disciplinary action up to and including termination, in the event I am hired. Signature COLLEGE USE ONLY Received by the Director of Human Resources Name Signature CUNY EMPLOYMENT APPLICATION - PART TWO Page 3 of 3 Rev

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16 Borough of Manhattan Community College 199 Chambers Street The City University of New York New York, NY te.l fax 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 HR

17 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 of my ability according to the best Name: Signature: Address: :

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21 Report of External Employment for Classified Staff 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: Completed B. CUNY Primary Position Title: College: Department: Regular Work Schedule Number of Hours per Week of Appointment CUNY Secondary Position Title: College: Regular Work Schedule Department: Number of Hours per Week of Appointment 1

22 C. External Employment Employer: Address: Telephone & Fax Numbers: Job Title: Department: Supervisor Name & Title: Regular Work Schedule Number of Hours per Week 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 2

23 Sections E & F & G are for Office Use Only F. Supervisor/Department Head Approval Comments: 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. Signature Print Name Title G. Human Resources Director Approval: Comments: 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. Signature Print Name Title 3

24 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 Print Name Please return to the HR Director Retain original document in employee file 4

25 Department of Taxation and Finance Employee s Withholding Allowance Certificate New York State New York City Yonkers First name and middle initial Last name Your social security number IT-2104 Permanent home address (number and street or rural route) Apartment number City, village, or post office State ZIP code Single or Head of household Are you a resident of New York City?... Yes No Are you a resident of Yonkers?... Yes No Complete the worksheet on page 3 before making any entries. 1 Total number of allowances you are claiming for New York State and Yonkers, if applicable (from line 17) Total number of allowances for New York City (from line 28)... 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 New York City amount Yonkers amount... 5 Married Married, but withhold at higher single rate Note: If married but legally separated, mark an X in the Single or Head of household box. I certify that I am entitled to the number of withholding allowances claimed on this certificate. Employee s signature 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. 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 Employee claimed more than 14 exemption allowances for NYS... A B Employee is a new hire or a rehire... B First date employee performed services for pay (mm-dd-yyyy) (see instr.): Are dependent health insurance benefits available for this employee?... Yes No If Yes, enter the date the employee qualifies (mm-dd-yyyy): Employer s name and address (Employer: complete this section only if you are sending a copy of this form to the NYS Tax Department.) Employer identification number Changes effective for 2016 Form IT-2104 has been revised for tax year The worksheet on page 3 and the charts beginning on page 4, used to compute withholding allowances or to enter an additional dollar amount on line(s) 3, 4, or 5, have been revised. If you previously filed a Form IT-2104 and used the worksheet or charts, you should complete a new 2016 Form IT-2104 and give it to your employer. Who should file this form This certificate, Form IT-2104, is completed by an employee and given to 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. If you do not file Form IT-2104, your employer may use the same number of allowances you claimed on federal Form W-4. Due to differences in tax law, this may result in the wrong amount of tax withheld for New York State, New York City, and Yonkers. Complete Form IT-2104 each year and file it with your employer if the number of allowances you may claim Instructions is different from federal Form W-4 or has changed. Common reasons for completing a new Form IT-2104 each year 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. You owed tax or received a large refund when you filed your personal income tax return for the past year. Your wages have increased and you expect to earn $106,950 or more during the tax year. The total income of you and your spouse has increased to $106,950 or more for the tax year. You have significantly more or less income from other sources or from another job. You no longer qualify for exemption from withholding.

26 Form W-4 (2016) Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes. Exemption from withholding. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2016 expires February 15, See Pub. 505, Tax Withholding and Estimated Tax. Note: If another person can claim you as a dependent on his or her tax return, you cannot claim exemption from withholding if your income exceeds $1,050 and includes more than $350 of unearned income (for example, interest and dividends). Exceptions. An employee may be able to claim exemption from withholding even if the employee is a dependent, if the employee: Is age 65 or older, Is blind, or Will claim adjustments to income; tax credits; or itemized deductions, on his or her tax return. The exceptions do not apply to supplemental wages greater than $1,000,000. Basic instructions. If you are not exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations. Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages. Head of household. Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information. Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances. Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you may owe additional tax. If you have pension or annuity income, see Pub. 505 to find out if you should adjust your withholding on Form W-4 or W-4P. Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details. Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form. Check your withholding. After your Form W-4 takes effect, use Pub. 505 to see how the amount you are having withheld compares to your projected total tax for See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married). Future developments. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted at Personal Allowances Worksheet (Keep for your records.) A Enter 1 for yourself if no one else can claim you as a dependent A You are single and have only one job; or B Enter 1 if: { You are married, have only one job, and your spouse does not work; or... B Your wages from a second job or your spouse s wages (or the total of both) are $1,500 or less. C Enter 1 for your spouse. But, you may choose to enter -0- if you are married and have either a working spouse or more than one job. (Entering -0- may help you avoid having too little tax withheld.) C D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return D E Enter 1 if you will file as head of household on your tax return (see conditions under Head of household above).. E F Enter 1 if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit... F (Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.) G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information. If your total income will be less than $70,000 ($100,000 if married), enter 2 for each eligible child; then less 1 if you have two to four eligible children or less 2 if you have five or more eligible children. If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter 1 for each eligible child.. G H Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) H { If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions For accuracy, and Adjustments Worksheet on page 2. complete all If you are single and have more than one job or are married and you and your spouse both work and the combined worksheets earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 that apply. to avoid having too little tax withheld. If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below. Separate here and give Form W-4 to your employer. Keep the top part for your records. Employee's Withholding Allowance Certificate Form W-4 Department of the Treasury Whether you are entitled to claim a certain number of allowances or exemption from withholding is Internal Revenue Service subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS. 1 Your first name and middle initial Last name OMB No Your social security number Home address (number and street or rural route) City or town, state, and ZIP code 3 Single Married Married, but withhold at higher Single rate. Note: If married, but legally separated, or spouse is a nonresident alien, check the Single box. 4 If your last name differs from that shown on your social security card, check here. You must call for a replacement card. 5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5 6 Additional amount, if any, you want withheld from each paycheck $ 7 I claim exemption from withholding for 2016, and I certify that I meet both of the following conditions for exemption. Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and This year I expect a refund of all federal income tax withheld because I expect to have no tax liability. If you meet both conditions, write Exempt here Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete. Employee s signature (This form is not valid unless you sign it.) 8 Employer s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) 9 Office code (optional) 10 Employer identification number (EIN) For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No Q Form W-4 (2016)

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28 To: From: Subject: All Members of the Classified Staff Human Resources 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 at the five college entrances. 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 Signature SwipePolicy3 2/29/16

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30 THE CITY OF NEW YORK PAYROLL MANAGEMENT SYSTEM DIRECT DEPOSIT OF NET PAY Enrollment/Cancellation TYPE OF ACTION SUBMIT COMPLETED FORM TO: YOUR AGENCY DIRECT DEPOSIT COORDINATOR OR YOUR PAYROLL OFFICE Attach a voided check or most recent savings statement. Check all that apply. New Change of Name Change of Change of Change of Enrollment Cancelation on Account Account Number Account Type ABA Number EMPLOYEE SECTION FIRST M.I. LAST EMPLOYEE IDENTIFICATION SOCIAL SECURITY NUMBER WORK TELEPHONE PERSON(S) NAMED ON ACCOUNT (PRINT EXACTLY-INCLUDE TRUSTEE OR HOINT OWNER): PERSON 1 PERSON 2 Enrollment ABA NUMBER* ACCOUNT NUMBER** ACCOUNT TYPE (CHECK ONLY ONE) SAVINGS CHECKING *ABA BANK NUMBER: CHECKING ACCOUNTS The ABA number is the first nine(9) numbers prior to the account number at the bottom left corner of the check SAVINGS ACCOUNTS---Contact your bank for ABA number, if not known. EMPLOYEE AUTHORIZATION I hereby authorize The City of New York to deposit my net pay directly into my checking or savings account as requested. 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 guidelines and rules. The City of New York can only reverse the amount of the incorrect direct deposit. I agree that this authorization will remain in effect until I provide to my agency a written cancelation to terminate the service. Employee Signature / / I hereby authorize The City of New York to cancel my direct deposit agreement. Cancelation Employee Signature AGENCY PAYROLL SECTION DOCUMENT # CHECK DIGIT JSN PAYROLL / / ENROLLMENT REJECTION REASONS: INACTIVE LEAVE STATUS PAYCYCLE IS A OTHER AGENCY REP NAME SIGNATURE DATE (PLEASE PRINT) DATA ENTRY OPERATOR NAME SIGNATURE DATE (PLEASE PRINT)

31 THE CITY UNIVERSITY OF NEW YORK COMMUTER BENEFITS PROGRAM TRANSITBENEFIT PLANS Submit completed form to: Your College TransitBenefit Coordinator EMPLOYEE ACTION NEW (Enroll) CHANGE PERSONAL INFORMATION (Change Mailing address, or Telephone) CHANGE DEDUCTION (Change Transit Plan and/or Amount Deducted 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 #* D.O.B MM / DAY / Name (First/Middle/Last) Address Line 1 Address Line 2** City/State/Zip Address Telephone * Located on your pay statement or check stub. ** Apt.#, Fl.# or Box# if applicable. TRANSIT PLAN AUTHORIZATION ACCESS-A-RIDE ($3.05 Monthly Admin Fee through Payroll Deductions) Employee Initials Monthly Deduction Amount* PAY DATE TO SUSPEND DEDUCTION $ Employee Initials Monthly Deduction Amount* *For the Commuter Card Unrestricted, Transit Pass and Access-A-Ride plans you may elect any amount up to $800 per month where the first $245 will be deducted pre-tax and any amount over $245 will be deducted post-tax. SUSPEND TRANSIT PLAN DEDUCTION (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.) COMMUTER CARD - Unrestricted ($1.77 Monthly Admin Fee through Payroll Deductions) $ Employee Initials PAY DATE TO RESUME DEDUCTION TRANSIT PASS ($3.05 Monthly Admin Fee through Payroll Deductions) Monthly Deduction Amount* 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 Wageworks at or MONTH DAY YEAR MONTH DAY YEAR $ EMPLOYEE CERTIFICATION I hereby authorizetthe City University of New York to deposit my payroll deduction as indicated above into my Wageworks 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 guidelines 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 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-Ride Commuter Card-Unrestricted Transit Pass FEE $3.05 $1.77 $3.05 CHARGE METHOD Deducted from post-tax pay Deducted from post-tax pay. Deducted from post-tax pay. I grant authorization for The City University of New York to provide my enrollment information, including mailing address, phone number and address to Wageworks 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 Wageworks and are accessible online at or by calling Wageworks Customer Service at WageWorks ( ). MONTH DAY YEAR Employee Signature DATE AGENCY PAYROLL SECTION Payroll # Personal information updated in PayServ /PMS (check all that apply): Mailing Phone Address Address Number PMS ENTRY DATE MONTH DAY YEAR I certify that the above data was entered in PayServ / PMS via EForms: Prepared By (Please Print) Signature WW-TRANSITBENEFIT-FORM Jan 2013)