Forms
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House Staff Application
Write your name exactly as it appears on your Social Security Card. It is important that you complete the application in its entirety. If it does not apply to you please put N/A. - Tax Forms (Federal and City/State) -- please return both forms even if you do not live in New York City or State
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I-9 Form (Employment Eligibility)
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4 coats per person
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Choose a numbered size (i.e. 8 or 10, not Small). Your order will NOT be processed if you write Small, Medium or Large.
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Attach a voided check
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You may switch banks at any time
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Please note that not all will be on DD by July 1
(If you do not have a social security number they will not put you on DD)
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Fill out 1st box on page one
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Print and sign (in 3 places) on the 2nd page
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Please send back to House Staff for approval
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Primary Source Medical School Verification
For American medical school graduates ONLY -
Verification of Post-Graduate Training
Please fill out one form for each institution that you were affiliated with. - Conflict of Interest Disclosure







