ࡱ> JLI#` <bjbj .B5  , l%*d4hjjjjjj$hCQ hhT r>R " T0%(,11T1T:|(e::: :::%    Certification of F-1 and J-1 Student Off-Campus Employment for Social Security Number Application  Instructions: This form may be typed on-line but must be printed on company/organization letterhead. The hiring company/organization must complete Section A including an original signature. The student must then take this form, along with his/her 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 off campus only with immigration work authorization.  Hiring Company/Organization 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 SU ID #:  FORMTEXT      Name of the off-campus employer  FORMTEXT      Employer Identification Number (EIN):  FORMTEXT      Employer address (include city, state, and zip code);  FORMTEXT      Nature of Student s employment (research assistant, etc.):  FORMTEXT      Employment start date:  FORMTEXT      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 Students 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 Syracuse defgt # U `  > ? 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The student is working or has been offered employment as described above. The student may apply for a Social Security Number on or after _________________________. 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  66`77V8 9T::V;<<56CJOJQJ^JaJ OJQJ^J5CJOJQJ^JaJ5CJOJQJ^JaJU 9P:V;X;<<<<sqqskdQ $$Iflq f+, t 6P 0+644 la $ /If$ &P#$/If,1h/ =!"#T$h% $$If!vh5+#v+:V l  t 6P  f0+65,/ p f$$If!vh5+#v+:V l t 6P 0+65,/ $$If!vh5+#v+:V l  t 6P  f0+65,p ftDText1tDText2tDText3$$If!vh5855 #v8#v#v :V l t 6P 0+65L55 tDText4tDText5$$If!vh55#v#v:V l t 6P 0+655,tDText6$$If!vh5+#v+:V l t 6P 0+65,tDText7$$If!vh5+#v+:V l t 6P 0+65,tDText8tDText9$$If!vh55#v#v:V l t 6P 0+6585vDText10vDText11$$If!vh55#v#v:V l t 6P 0+6585vDText12$$If!vh55#v#v:V l t 6P 0+6585$$If!vh5+#v+:V l t 6P 0+65,/ $$If!vh5+#v+:V l  t 6P  f0+65,p f$$If!vh5+#v+:V lq t 6P 0+65,@@@ NormalCJ_HaJmH sH tH b@b Heading 1 $$% &P#$/@&a$5CJOJQJ\^Jd@d Heading 2 $$% &P#$/@&a$5CJOJQJ^JaJDAD Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List ^B@^ Body Textd% &P#$/6CJOJQJ^JaJ5 Bdefg>R)=>t23[o@345  m  2 3 4 7 00000 0000 00 00 000 00 00 000 00 0 00 0 00 0 00 00 000 00 000 0 000000 00 0ي0"0 000000000000 0 00 66<   z, 9<  < >JP)5;t*0[gm5 FFFFFFFFFFFF Text1Text2Text3Text4Text5Text6Text7Text8Text9Text10Text11Text12?*u\7  Q<1n7 塞42"'\l|T$"|܄ 7       7  9*urn:schemas-microsoft-com:office:smarttagsplace= *urn:schemas-microsoft-com:office:smarttags PlaceType=*urn:schemas-microsoft-com:office:smarttags PlaceName8*urn:schemas-microsoft-com:office:smarttagsCity s      7   7 33>R()=t2[o7 7  eW"\^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. 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