QUEENS COLLEGE

OF THE CITY UNIVERSITY OF NEW YORK

Flushing, New York 11367

APPLICATION FOR INSTRUCTIONAL POSITION

DIRECTIONS TO APPLICANT

1.    Please type the information requested on this page and on the Curriculum Vitae, except for the space on the

first page entitled “Recommendation.” This will be filled in by your department.

       Supply all other information requested.

       If extra space is needed for responses to any questions, please supplement the Vitae pages with good quality

       bond paper and continue your response using as much space as necessary. Copy the appropriate heading on

       any added pages.

2.    Type your name at the top of each page.

3.    If there is nothing to be entered under a heading, type “None.”

4.    Do not fill in any response to heading of “Date Submitted to CUNY Board of Trustees.”

5.    Sign the affirmation below.

                                                                                                                                                     DATE ______________________________

NAME: _______________________________________________________________________________________________________                                                                                                                                 

                           Last                                                                       First                                                                            Middle

*PLACE OF BIRTH _____________________________________________________________________________________________

                                              City                                                             State                                                                 Country

COUNTRY OF CITIZENSHIP: __________________________________________  If not U.S.A. state visa symbol  ______________

AFFIRMATION:

I certify that all the information on the application is true and accurate and I realize that material inaccuracies will

be cause for the College to withdraw any offer of appointment or terminate an existing appointment.

                                                                                                                                          ____________________________________________

                                                                                                                                       Signature of Applicant

*Every appointee is required to file an official birth or baptismal certificate for the Teachers’ Retirement System. In addition, he

will be required to obtain a Social Security number.

CURRICULUM VITAE

NAME ______________________________________________________ COLLEGE ______QUEENS ________________________

RECOMMENDATION FOR      APPOINTMENT __________________________      PROMOTION  ___________________________

                                                     REAPPOINTMENT   _______________________     REAPPOINTMENT WITH TENURE  ________

                                                     OTHER  ____________________________________________________________________________

                                                                                          (Designation as Vice President, Dean, etc.)

TITLE  _______________________________________________________  DEPARTMENT _________________________________

EFFECTIVE DATE  ____________________________________________  SALARY RATE _________________________________

(Subject to financial ability)

HIGHER EDUCATION

     A. Degrees                                            Dates                                                                      Date

Institution_______________________Attended__________Degree and Major____________Conferred________

     B. Additional Higher Education and / or Education in Progress 

                                                                  Dates                                         

Institution_______________________Attended__________               Courses, Etc.________________________

EXPERIENCE

      A. Teaching                                     

Institution_______________________Dates                                 Rank   ____                   Department______

     B. Other                                     

Institution_______________________Dates                                 Title________________________________

ACADEMIC AND PROFESSIONAL HONORS

PUBLICATIONS        (last five years only.)

MEMBERSHIP IN PROFESSIONAL SOCIETIES  (last five years only.)

REFERENCES     (List name, title and affiliation only. Excerpts from letters may be attached as a separate document.)

CHAIRMAN’S REPORT     (For reappointment, promotion or reappointment with tenure.)

STUDENT EVALUATION     (For reappointment, promotion or reappointment with tenure.)

RECORD AT COLLEGE

DATES____________________________________RANK____________________________SALARY RATE________

PERSONAL DATE

Address __________________________________________________________________________________________

Telephone No. ____________________________________________________________________________________

Military Status  ___________________________________________________________________________________

Social Security No.  ________________________________________________________________________________

Date of Birth  _____________________________________________________________________________________

Date Submitted to CUNY Board of Trustees  _______________________________________