Research Foundation
The City University of New York
Department of Human Resources
230 West 41 Street
New York, NY 10036
212 417 8300
212 417 8689 fax
www.rfcuny.org
REHIRE ACKNOWLEDGEMENT APPLICATION
PLEASE PRINT OR TYPE ALL INFORMATION
Please complete this form if you are being rehired by a Research Foundation project after a break-service. This mandatory for all rehires and must be in the rehire
packet.
EMPLOYEE’S NAME_____________________________________________________________________________________________________________
________________________________________
LAST
FIRST
M.I.
EMPLOYEE ID#
LEGAL
ADDRESS:_____________________________________________________________________________________________________________________________________________________________________________
NUMBER
STREET
APT.#
CITY
STATE
ZIP CODE
Post Office Box and School Address are unacceptable
MAILING
ADDRESS: :_____________________________________________________________________________________________________________________________________________________________________________
NUMBER
STREET
APT.#
CITY
STATE
ZIP CODE
If different than legal address
PLEASE PROVIDE YOUR WORK ADDRESSIF LIVING AND WORKING OUT OF STATE:
__________________________________________________________________________________________________________________________________________________________________________________________
EMAIL ADDRESS:_____________________________________________________________________
TELEPHONE NUMBER: (
)______________________________________________
COLLEGE NAME:______________________________________________________________________________________________________________________________________________________________________
Project#
Sub
Yr.
Title Code Start date (mm/dd/yy) End Date(mm/dd/yy)
Rate of Pay
Hrs/P.P
Salary Encumbrance
Salary:
Hourly:
Are you currently employed on CUNY or TAX LEVY Payroll?
Yes
No
STATUS OF POSITION:
REGULAR:
These positions have a predefined work schedule and a predefined appointment period (usually more than 90 days).
TEMPORARY:
Employees are employed on a full-time or part-time basis for one job only for a set duration of no more than 19 weeks in any 12 month
period, have not substantial expectancy of continued employment, and have been notified of this fact. These employees are not eligible for
annual leave
ON CALL:
Employees are employed for no more than 19 hours a week, working sporadically with not established pattern of regular continuing
employment. They do not have a fixed scheduled , are not required to be at or near the work site, can refuse an assignment when offered, and
are only paid for actually hours worked. These employees are not eligible for annual leave.
Military Service Record
1.
Have you ever been in the armed forces?
2.
If you are a disabled Veteran or a Vietnam Veteran and would like to be so identified under our Affirmative Action program, please indicate by checking box:
Disabled Veteran
Yes
Vietnam Rea Veteran
No
Dates of Active Duty: From: _______/________/___________ To _______/_________/_________
Special Disabled Veteran
Other Protected Veteran
Newly Separated Veteran
1.
Have you been told the essential functions of the job or have you been shown a copy of the job description listing the essential functions of the job?
Yes
No
2.
Can you perform these essential functions of the position for which are applying? If no, please explain on a separate paper.
Yes
No
3.
Are legally eligible for employment in the United States?
Yes
No
4.
Have you ever been convicted of, pled guilty to, or “no contest” to:
Yes
Yes
No
No
Yes
Yes
No
No
(a) Felony?
(b) Misdemeanor?
(if yes – Check t appropriate jurisdiction):
State Court
City Court
Federal Court
(c) Traffic Violation (other than a minor violation*)
(d) Denied a Bond?
*NOTE: Driving without a license, DWI, DUI, reckless, and ‘hit and run ‘are not minor’ violations.
**If yes to any or all of the questions in section 4, you must explain, in detail, on a separate sheet of paper.
________________________________________________________________________________
PROJECT DIRECTOR OR AUTHORIZED SIGNATORY
DATE
________________________________________________________________________________
EMPLOYEE SIGNATURE
DATE
NOTE: All employees must complete both W-4 and IT-2104 or IT-2104E. Students are not automatically exempt from paying taxes. Please read instructions on the withholding forms
before forwarding to the Research Foundation, or contact the IRS for additional information. Non-Residents should contact the Payroll Manager for any special tax considerations.
Revised: 8/18/14
Important Information Regarding Your Employment with
The Research Foundation of The City University of New York (RFCUNY)
Please initial each statement in the space provided and complete the signature section at the bottom of this page.
I am
I am not
employed on another RFCUNY project concurrently. (*See PAF page 1 if employed concurrently.)
Initials:
I certify that my scheduled hours for this appointment do not conflict with any other concurrent RFCUNY appointment or other employment including a CUNY
or Tax Levy position. I understand that any conflicts of this nature may result in the immediate termination of this or any subsequent appointments.
Initials:
I accept the position and salary described above w ith the understanding that my employment is subject to availability of funds. I understand that in this position,
or any subsequent position, I am an employee of RFCUNY. I acknow ledge that this Personnel Action Form (PAF) is NOT a contract of employment and that my
employment is not fixed for any period or term.
Initials:
I understand that unless otherwise governed by terms of a collective bargaining agreement, all decisions respecting my employment and terms of my employment
including but not limited to decisions respecting job promotions, salary increase and terminations are at the sole discretion of RFCUNY.
Initials:
I understand that if I am employed in a position that is covered by a collective bargaining agreement between RFCUNY and the Professional Staff Congress which
requires the payment of union dues or any agency fee, my failure or refusal to timely pay such union dues or agency fees may result in the termination of my
employment.
`
Initials:
I understand that regular attendance is a requirement for all RFCUNY employment and that I am subject to RFCUNY policies, procedures, rules and regulations
for employees.
Initials:
I acknowledge that I have been informed that RFCUNY is an E-Verify Employer and that as a condition of my employment my work authorization documents will
be verified through the Social Security Administration and the Department of Homeland Security.
Initials:
I acknowledge that as a condition of employment with RFCUNY, I must sign a disclosure notice and authorization for a background check. In addition, RFCUNY
administers program that are funded by the US Governement, either directly or as pass-throughs. Pursuant to Executive Order 13224, new hires and rehires are
checked against lists of restricted parties maintained by the US General Services Administration (GSA), US Office of Foreign Assests Control (OFAC), and the
System for Award Management (SAM), among others, to determine their eligibility to receive federal funds through the Research Foundation. I understand that
my employment is contingent upon the outcome of these checks.
Initials:
I acknowledge that if I am eligible to accrue annual leave, the payment of any remaining balances of accrued leave at the end of my appointment is not guaranteed
and is subject to sponsor regulations and availability of sponsor funds. I also acknowledge that if I am advanced any type of leave, I will either accrue or repay the
amount of leave that was advanced on or before my appointment end date. I agree that the dollar amount of advanced leave may be deducted from regular pay for
this purpose.
Initials:
I acknowledge that if I am employed on a project sponsored by the NYC Dept. of Ed., or any other project sponsor and am deemed by them to be ineligible to
provide services under the project, I am subject to the immediate termination of my appointment and will not be entitled to receive any additional compensation.
Initials:
I acknowledge that if my duties and responsibilities expose me to confidential, private or proprietary information, I agree to maintain such information in
confidence and not to disclose it other than to RFCUNY employees or its agents who have a legitimate business need to know.
Initials:
I acknowledge that where an appointment letter or PAF makes my position contingent on the maintenance of graduate student status, suspension or loss of student
status shall constitute sufficient cause for RFCUNY’s suspension or termination of my employment.
Initials:
I acknowledge that as a condition of employment, I am required, if eligible, to participate in RFCUNY’s Retirement Program. If TIAA-CREF does not receive
investment instructions from me via their on-line enrollment process, my plan contributions will be invested in the plan's default investment option. I further
understand that should my employment end before I have completed the vesting requirement, I will not receive any benefits attributable to the employer
contributions made on my behalf. If I later return to work, however, I may be entitled to have the benefits attributable to my earlier service restored (see the
Summary Plan Description for further details).
Initials:
I acknowledge that I have been given a copy of RF Policy No. 548, Combating Trafficking in Persons , and agree to its terms.
Initials:
I acknowledge that I have received the “Notice of Employee Rights” under the “NYC Earned Sick Time Act.”
Initials:
I have been given a copy of this PAF (Employee Signature ):
Telephone Number:
Research Foundation of CUNY
Revised: 06/03/2015
Date:
E-mail Address:
PAF Page 2 of 2
Policy No. 548
mbatting Traffficking in Peersons Policcy
Com
PURPOSE
E
The Researrch Foundation
n (hereinafter referred
r
to as “Foundation”) iis committed too the adoption of a zero-tolerrance
policy com
mbatting the traafficking of perrsons. By adop
pting a policy eenforcing the ssafeguards impposed by law, thhe
Foundation
n informs its em
mployees of th
heir obligationss under law andd raises the aw
wareness of a prroblem that afffects
the human rights of millions of personss worldwide.
BILITY
APPLICAB
This policy
y is applicable to all individuals engaged in the performannce of any Founndation award,, including
uncompenssated individuaals whose serviices are contrib
buted as either in-kind or cosst matching serrvices.
DEFINITIONS
Foundation
n “employee” is
i defined as an
ny individual directly
d
engageed in the perforrmance of a graant, contract orr
cooperative agreement ad
dministered by
y the Foundatio
on, including unncompensated individuals whhose services aare
d as either in-k
kind or cost maatching servicess.
contributed
n “federal conttract employee”” is defined as any individuall directly engagged in the perfformance of a
Foundation
federal con
ntract administered by the Foundation, inclu
uding uncompeensated individduals whose services are
contributed
d as either in-k
kind or cost maatching servicess.
EMENTS
REQUIRE
All Foundaation employeees are prohibiteed from engagiing in severe foorms of traffickking in persons during the
performancce of the award
d; procuring co
ommercial sex acts during thee performance of the award; and from usingg
forced labo
or of any kind in
i the performaance of the aw
ward.
v
of thiis policy immeediately to the H
Human Resourrces
All Foundaation employeees are required to report any violation
Departmen
nt at the Found
dation.
ontract employ
yees are requireed to sign a staatement acknow
wledging this ppolicy and agreeeing
All Foundaation federal co
to its termss.
ONS
SANCTIO
Any Found
dation employeee who violatess this policy may
m be subject tto disciplinary action, includiing terminationn. Any
employee convicted
c
of a violation of an
ny criminal Traafficking in Perrsons statute foor activity whicch contraveness this
policy willl be subject to similar
s
discipliinary action.
ENTATION
IMPLEME
This policy
y will be impleemented immed
diately.
NOTICE OF EMPLOYEE RIGHTS
YOU HAVE A RIGHT TO SICK LEAVE, WHICH YOU CAN USE FOR THE CARE AND
TREATMENT OF YOURSELF OR A FAMILY MEMBER.
AMOUNT OF SICK LEAVE:

January 1,2015

RATE OF ACCRUAL:


DATE ACCRUAL BEGINS:
DATE SICK LEAVE IS AVAILABLE FOR USE:


ACCEPTABLE REASONS TO USE SICK LEAVE:



December 31,2015
FAMILY MEMBERS:








ADVANCE NOTICE:
DOCUMENTATION:
UNUSED SICK LEAVE:
YOU HAVE A RIGHT TO BE FREE FROM RETALIATION FROM YOUR EMPLOYER
FOR USING SICK LEAVE.





YOU HAVE A RIGHT TO FILE A COMPLAINT.