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Get PS-404 - NYS Department Of Civil Service - New York State - Cs Ny

9 PS-404R (7/13) INSTRUCTIONS: READ AND COMPLETE BOTH SIDES/PAGES. PLEASE PRINT AND CHECK THE APPROPRIATE CHOICES. (All employees must complete) EMPLOYEE INFORMATION First Name MI 2. Social Security Number 3. Sex Male Female 1. Last Name 4. Street Address 5. Date of Birth 8. Marital Status Single 9. Covered under Medicare? City 6. Telephone Number Home ( ) Married Widowed Self B. 7. Divorced Separated Yes No 10. A. State Zip Is any of this information new? Yes No Marital S.

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