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Career Center Registration

Please call 516-485-5000 with any questions regarding this form.

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*=Required fields

Application Date:

Do you need an interpreter?*

Are you registered for Selective Service?*

NY Drivers License

Are you a U.S. Citizen?*

If no, are you authorized to work in the US?

Ethnicity / Race

Note: The Ethnicity and Race questions are voluntary.  Information is confidential and will only be used for record keeping and affirmative action requirements.  You will not be penalized if you do not want to answer. 

Race (Select all that apply):

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