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SSN Application Form

This document is a form for a Carnegie Mellon University student to apply for a social security number for on-campus employment. It provides information about the student such as their name, date of birth, and employer details. The hiring department must fill out the position title, hours to be worked, and job duties. An OIE advisor verifies that the student is authorized to work based on their immigration status as an F-1 or J-1 student. The advisor signs to confirm the student can do restricted on-campus employment of up to 20 hours per week during the academic term.

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3K views1 page

SSN Application Form

This document is a form for a Carnegie Mellon University student to apply for a social security number for on-campus employment. It provides information about the student such as their name, date of birth, and employer details. The hiring department must fill out the position title, hours to be worked, and job duties. An OIE advisor verifies that the student is authorized to work based on their immigration status as an F-1 or J-1 student. The advisor signs to confirm the student can do restricted on-campus employment of up to 20 hours per week during the academic term.

Uploaded by

Abhinav
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Carnegie Mellon University

5000 Forbes Avenue


Warner Hall, Third Floor
www.cmu.edu/oie
Pittsburgh, PA 15213
Students & Scholars: oie@andrew.cmu.edu
Tel: 412.268.5231
Study Abroad: goabroad@andrew.cmu.edu
Fax: 412.268.7832

Social Security Number Form


- F-1 or J-1 Student On-Campus Employment -
Dear Social Security Administration officer:

The following student is a lawful non-immigrant at Carnegie Mellon University. This student is eligible for
employment; this information is supplied per federal regulation (20 CFR 422.105) and in support of the student’s
social security number application.

Carnegie Mellon department employer – to be completed by the hiring department/supervisor


NOTE: The information requested below should be completed electronically, not in pen or pencil.

Student’s Name Family Name Given Name Middle Name

Date of Birth (month/day/year)

Carnegie Mellon on-campus


employer or department name
Employer Address 5000 Forbes Avenue, Pittsburgh, PA 15213
Employer Identification Number 25-0969449
Position title
Employment start date
Number of hours per week the
student will be employed
Job duties (describe the work to
be performed by the student)

I certify that the student named above is working or has been offered the job described above:

______________________________________ ___________________________________
Hiring Department/Supervisor (Signature) Date Hiring Department/Supervisor (Printed Name) Telephone

For OIE use only:


Basis for employment authorization – verified by an OIE Advisor (signature below)
Authorization for the restricted employment can be found in the Code of Federal Regulations at 8 CFR 214.2(f)
for F-1 students; J-1 student authorization can be referenced at 22 CFR 62.23(g.) Students are allowed to work
part-time (up to 20 hours per week) while school is in session and full-time during vacation periods (such as
winter break or the vacation term.) For off-campus work, F-1 and J-1 students must apply for and receive work
authorization.

______________________________________ ___________________________________
OIE Advisor (Signature) Date OIE Designated School Officer PHI 214F 10187000
OIE Alternative Responsible Officer P-1-00292
Updated 01/2007

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