ࡱ> MOL#` >bjbj .D 4&tF^^^^9T,}$hd ]99^^222 ^^}2}22^ @>d0F,H!H!H! ;=2s;;;:;;;F d  Certification of F-1 and J-1 Student On-Campus Employment for Social Security Number Application  Instructions: This form may be typed on-line but must be printed on department letterhead. The hiring department must complete Section A including an original signature. The students must then take this form, along with passport, I-20 or DS-2019 and I-94 card, to the Slutzker Center for endorsement in Section B. Once endorsed, this form must accompany all other required materials when the student applies for a number at the Social Security Administration Office. Please note that international students in F-1or J-1 status may work no more than 20 hours per week while classes are in session during the fall and spring semesters, but are permitted to work unlimited hours during annual school breaks (i.e., summer, winter and spring breaks).  SUNY-ESF Hiring Department Information First name of the student (as it appears on Form I-20 or DS-2019)  FORMTEXT      Last name of the student (as it appears on Form I-20 or DS-2019)  FORMTEXT      Student s SUNY-ESF ID #:  FORMTEXT      Name of the on-campus employer/department (e.g., Library, Academic Department, etc):  FORMTEXT      Employer Identification Number (EIN): 14-6013200 Employer / Department address (include city, state, and zip code);  FORMTEXT      Nature of Student s employment (research assistant, library aide, dining staff):  FORMTEXT      Employment start date: (MM/DD/YYYY) Number of hours per week:  FORMTEXT      Name of student s immediate supervisor:  FORMTEXT      Title of student s immediate supervisor:  FORMTEXT      Supervisor s telephone number:  FORMTEXT       __________________________________________ _______________________ Signature of Student s Immediate Supervisor Date Signed  Certification of Designated School Official at the Slutzker Center for International Services This section will be endorsed only after section A is completed and signed This is to certify that the student named above is an F-1_____ or J-1_____ student attending SUNY-ESF. The student is working or has been offered on-campus employment as described above. The student may apply for a Social Security Number on or after _______________________. defgt : E Q R S T { | } ŻnŻ]OhPlCJOJQJ^JaJ hPl6CJOJQJ]^JaJ hPl56CJOJQJ^JaJ hPl6>*CJOJQJ^JaJhPlCJOJQJ^JaJhPl5CJOJQJ^JaJhPlCJOJQJ^JaJhPlOJQJ^JhPl5CJ OJQJ^JaJ &hPl5B*CJOJQJ^JaJph&hPl5B*CJ OJQJ^JaJ phhPldefgQ R WHHH$% &P#$/Ifkd$$Ifl+,  t 6P%  330,644 lap 33 $% &P#$/If$$% &P#$/Ifa$>R S T { | {e{$ & F$% &P#$/Ifa$h$% &P#$/If^hqkd$$Ifl+, t 6P% 0,644 la| }   ~mmmmmx$% &P#$/IfkdY$$Ifl+,  t 6P%  330,644 lap 33         ݜwݎePeeFhPlOJQJ^J)jhPlCJOJQJU^JaJ#jhPlCJOJQJU^JaJ,j{hPl5CJOJQJU^JaJhPlCJOJQJ^JaJ hPl6CJOJQJ]^JaJ1jhPl5CJOJQJU^JaJmHnHu,jhPl5CJOJQJU^JaJhPl5CJOJQJ^JaJ&jhPl5CJOJQJU^JaJ  6xfUUUUx$% &P#$/Ifkdc$$IflF!+L t 6P% 0,6    44 la 6xz$&(*"Ŭ𞐆oŬXŬ,jFhPl5CJOJQJU^JaJ,j?hPl5CJOJQJU^JaJhPlOJQJ^JhPlCJOJQJ^JaJhPlCJOJQJ^JaJ1jhPl5CJOJQJU^JaJmHnHu&jhPl5CJOJQJU^JaJ,j"hPl5CJOJQJU^JaJhPl5CJOJQJ^JaJxz(yhhx$% &P#$/Ifkd$$Ifl0l+, t 6P% 0,644 la(*{{x$% &P#$/Ifskd$$Ifl+, t 6P% 0,644 la@BDFHJLNP{hhhhhhhhx$% &P#$/IfK$x$% &P#$/Ifskd$$Ifl+, t 6P% 0,644 la "<>@T(*,两ƍtjSt,j hPl5CJOJQJU^JaJhPlOJQJ^J1jhPl5CJOJQJU^JaJmHnHu,jhPl5CJOJQJU^JaJ&jhPl5CJOJQJU^JaJhPlCJ OJQJ^JaJ hPl5CJOJQJ^JaJhg5CJOJQJ^JaJhPlCJOJQJ^JaJhgCJOJQJ^JaJPRkdM$IfK$L$lִ t06    44 laytPlRT,hkdY$$Ifl0+8 t 6P% 0,644 lax$% &P#$/If [\]ռխխ~ռխm^J^FhPl&hPl5B*CJOJQJ^JaJphhPl5CJ OJQJ^JaJ hPl56CJOJQJ^JaJ,j hPl5CJOJQJU^JaJhPlCJOJQJ^JaJhPlOJQJ^JhPl5CJOJQJ^JaJ1jhPl5CJOJQJU^JaJmHnHu&jhPl5CJOJQJU^JaJ,jv hPl5CJOJQJU^JaJyhhhx$% &P#$/Ifkd $$Ifl0+8 t 6P% 0,644 layjjjjj$% &P#$/Ifkd $$Ifl0+8 t 6P% 0,644 la[\|fP$h$% &P#$/If^ha$$ & F$% &P#$/Ifa$$$% &P#$/Ifa$qkd $$Ifl+, t 6P% 0,644 la\]z<{<<w==~ll]WWWWWW$If$&#$/If$$% &P#$/Ifa$kdQ $$Ifl+,  t 6P%  330,644 lap 33 Name of Designated School Official/Responsible-Alternate Responsible Officer:____________________________________________ ____________________________________________ ________________________ Signature of International Student Advisor- Date Signed Designated School Official/Responsible-Alternate Responsible Officer Syracuse University Slutzker Center for International Services 310 Walnut Place Syracuse, NY 13244-2380 Phone: (315) 443-2457 Fax: (315) 443-3091 <L<z<<y===>>>hPl5CJOJQJ^JaJhPl hPl56CJOJQJ^JaJhPlOJQJ^JhPl5CJOJQJ^JaJUhPl5CJOJQJ^JaJ =>9>J>d>>>>trskd $$Iflq +, t 6P% 0,644 la$$% &P#$/Ifa$$If,1h/ =!"#$% $$If!vh5,#v,:V l  t 6P%  330,65,/ p 33$$If!vh5,#v,:V l t 6P% 0,65,/ $$If!vh5,#v,:V l  t 6P%  330,65,p 33tDText1tDText2tDText3$$If!vh5L55 #vL#v#v :V l t 6P% 0,65L55 tDText4$$If!vh55,#v#v,:V l t 6P% 0,655,tDText5$$If!vh5,#v,:V l t 6P% 0,65,tDText6$$If!vh5,#v,:V l t 6P% 0,65,$IfK$L$q!vh55555555#v#v:Vl t655ytPltDText8$$If!vh585#v8#v:V l t 6P% 0,6585tDText9vDText10$$If!vh585#v8#v:V l t 6P% 0,6585vDText11$$If!vh585#v8#v:V l t 6P% 0,6585$$If!vh5,#v,:V l t 6P% 0,65,/ $$If!vh5,#v,:V l  t 6P%  330,65,p 33$$If!vh5,#v,:V lq t 6P% 0,65,@@@ NormalCJ_HaJmH sH tH b@b Heading 1 $$% &P#$/@&a$5CJOJQJ\^JDAD Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List ^B@^ Body Textd% &P#$/6CJOJQJ^JaJj@j g Table Grid7:V0 DdefgQRST{|}(VW L`a%&Nb4'()tu   ^     00000 0000 00 00 000 00 0 000 00 000 000 0,00 00000000 0 0 0 00 0 000 0 000000 00 00"0 @0<00000000000000 0 0 0000 00 ">  R |  x(PR\=> !>  &BNTLX^#NZ` FFFFFFFFFF8@0(  B S  ? 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