ࡱ> MOL#` Q=bjbj .B' :::::::N4 tNBBBBT,$Xh! Q:xxx ::BB\x :B:Bx::]B~ _Ed>")dr01,""]":]$:Y9  t"xxxxNNN$ rdNNNrNNN::::::  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).  Syracuse University 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 SU ID #:  FORMTEXT      Name of the on-campus employer/department (e.g., Library, Catering, Schine Dining, etc):  FORMTEXT      Employer Identification Number (EIN): 15-0532081Employer / 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 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 University. 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 __________________. 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