Privacy: Personal information in connection with this form is collected under the authority of The York University Act, 1965 and will be used for educational, administrative and statistical purposes. If you have any questions about the collection, use and disclosure of personal information by York University, please contact: career@yorku.ca

Name Name * First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone 1 Phone 1 * - ### - ### ####
Phone 2 Phone 2 - ### - ### ####
Email *
CUPE Status:

CUPE Status: CUPE 3903 member - Unit 1 CUPE 3903 member - Unit 2 CUPE 3903 member - Unit 3 Previous CUPE 3903 member
If you were a previous CUPE 3903 member, what was the date of your last CUPE 3903 (Unit 1, 2 or 3) appointment contract? If you were a previous CUPE 3903 member, what was the date of your last CUPE 3903 (Unit 1, 2 or 3) appointment contract? / MM / DD YYYY
Academic Status:

Academic Status: Graduate Studies - M.A. Graduate Studies - Ph.D. Alumni
If you are an alumni, what was your graduation date? If you are an alumni, what was your graduation date? / MM / DD YYYY
Payment Information:

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Dossier Administrator
202 McLaughlin College
Career Centre
York University
4700 Keele Street
Toronto, ON, Canada M3J 1P3

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