DATA CORRECTION FORM (CANDIDATE’S USE ONLY)

1 HUMAN CAPITAL The David N. Dinkins Municipal Building One Centre Street, New York, NY 10007 DP 148A (Rev. 6/2017) data CORRECTION form ( candidate S USE ONLY) THIS form IS BEING USED TO CORRECT/CHANGE: (CHECK ALL THAT APPLY) SOCIAL SECURITY NUMBER NAME ADDRESS TELEPHONE NUMBER EMAIL ADDRESSINSTRUCTIONS FOR USING THIS FORMP lease review and answer the following questions before using this form 1. Are you using this form to update your mailing address on file with DCAS? YES NO If you answered YES, please answer question 2 below. If you answered NO, you may use this form and submit as directed. 2. Are you currently employed by the City of New York? YES NO If you answered YES, please answer question 3 below. If you answered NO, you may use this form as directed. 3. Do you have access to Employee Self Service (ESS)? YES NO If you answered YES to questions 1, 2, and 3, DO NOT USE THIS form .

2 You MUST update your address with DCAS through ESS at: If you answered NO to any question above, you may use this form as instructed below and submit as directed. Please print all information legibly on this form , except your signature. If a change in Social Security Number or name is requested, appropriate supporting documentation will be needed in order to complete the change. For a Social Security Number change, acceptable identification is a social security card and photo ID. For a name change, acceptable identification is a marriage certificate, divorce decree, court order, Naturalization Certificate, old and new copies of State issued driver s license, State issued identification card, US government issued Passport, US government issued Military Identification Card, US government issued Alien Registration Card, Employer ID with photo, IDNYC, or Student ID with photo. THIS DOCUMENT MUST HAVE ALL THE REQUIRED FIELDS COMPLETED AND BE SIGNED IN ORDER FOR CHANGES TO BE PROCESSED.

3 SECTION I: EXAMINATION INFORMATION TITLE OF EXAMINATION EXAM NO. LIST SITE: ROOM NO. SECTION II: WRITE THE CORRECT INFORMATION THAT YOU WANT DCAS TO USE * Indicates information that MUST be provided for all CORRECTION /change requests *SOCIAL SECURITY NUMBER (all 9 digits) DAYTIME TELEPHONE NUMBER (include area code) EMAIL ADDRESS *LAST NAME (include suffix: , etc.) *FIRST NAME M. I. MAILING ADDRESS (include Street/Avenue/Blvd/Road/etc.) APT. #MAILING ADDRESS CONTINUED (if applicable: C/O, Private House, Floor, etc.) CITY OR TOWN STATE(2 letter abbreviation) ZIP CODE SECTION III: WRITE THE INCORRECT INFORMATION THAT YOU WANT DCAS TO REMOVE (Complete ONLY the boxes that are not correct) If your Social Security Number is wrong, write the INCORRECT number here (supporting documentation is needed to complete the change): If your name is wrong, write the INCORRECT name here (supporting documentation is needed to complete the change): If your address is wrong, write the INCORRECT address/part of the address here: If your daytime telephone number is wrong, write the INCORRECT number here: If your email address is wrong, write the INCORRECT email address here: SIGNATURE DATES ubmission Instructions Submit completed form if you HAVE NOT received your exam results to.

4 APPLICATION PROCESSING By mail or in person Monday to Friday, 9AM to 5PM 1 Centre Street, 14th Floor, Room 1448, New York, NY 10007 By fax 646 500 7190 By email scan completed form to the Online Application System help desk at with the subject data CORRECTION form Submit completed form if you HAVE received your exam results to: CERTIFICATION UNIT By mail or in person Monday to Friday, 9AM to 5PM 1 Centre Street, 21st Floor, Room 2150, New York, NY 10007 By fax 212 669 2453 By email scan completed form to with the subject data CORRECTION form FOR OFFICE USE ONLY CHANGE PROCESSED BY UNIT/STAFF/TYPE/DATE UNIT STAFF INITIALSTYPE OF CHANGE DATE