Employment History

List all prior work experience starting with the current or most recent employer for at least the past ten (10) years. Account for any gaps in employment. Applicants may include volunteer and military service. This section must be completed.

Pre-Employment Physical Notice

A pre-employment physical examination is required for all positions in Stony Brook Medicine and the Long Island State Veterans Home. A pre-employment physical examination may be requried for West Campus/HSC positions where job related or required by law.

Acknowledgement & Authorization

I hereby affirm that this application contains no willful misrepresentation and that the information given by me is true and complete. I understand that any false statements or misleading omissions made by me in connection with my application, or in responding to request for information, can be sufficient grounds for my rejection as a candidate for employment or for my immediate termination and/or referral for criminal prosecution. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying documents, if any) to provide any relevant information that may be needed to arrive at an employment decision.

I agree, if employed, to abide by all rules, polices and regulations of the Faculty Student Association. I certify that the information that I have provided is complete and accurate.

The Faculty Student Association is an Affirmative Action, Equal Opportunity Employer and does not discriminate on the basis of race, sex, color, national origin, religion, marital status, age, sexual orientation, veteran status or disability in employment.