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