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• Name: Full name as it appears on the social security card
• Home Department: Name of employing department
• Employment Begin Date: Date employee begins work
• Salary
  • Monthly: Monthly rate of compensation for exempt staff
  • Hourly/Unit: Hourly rate of compensation for nonexempt staff or pay based on units produced for either exempt or non-exempt employees
  • Appointment Period: Amount to be paid during a designated time period for employees (academic only)
  • Academic Year: Salary base for the academic year (academic only)
  • FTE: Percentage of full time equivalence, i.e. 1.00, .50, etc.

Benefit Eligibility as Defined in HR-101

• Eligible To Enroll In Benefits: Indicate eligibility for health and welfare benefits (medical, dental, LTD, Life, AD&D, etc.)
• Eligible For Retirement Benefits: Indicate eligibility for retirement benefits
• Eligible For Tax Deferred Annuity Only: Check if this is the only benefit program available to this employee

Academic Appointments

• Academic Title: Any title designated as academic and identified by ¾Ã²ÝÈȾòÝÊÓƵ Occupational Group Code 2. If individual also has an administrative title, complete Title section under Administrative, Service and Support
• Rank: Professor, Associate Professor, or Assistant Professor. Includes titles such as Research Associate Professor, Clinical Professor, etc., as identified by Salary & Wage Account Codes in Job Code Table
• Tenure Home: Name of the department responsible for recommending tenure. Leave blank if nonregular academic appointment
• Academic Discipline: Name of discipline association, i.e. English, Mathematics, Civil Engineering, etc.
• Appointment Type: Select less than 9 months if appointment is for an academic semester. Select 9-10 months if appointment is for the academic year; otherwise, select 11-12 months
• Employment Terms (Check applicable tenure status):
  • If regular, tenured faculty, enter date tenure was awarded
  • If regular, tenure track faculty, a specific end date (generally no more than one year, but may be longer or shorter than one year at the ¾Ã²ÝÈȾòÝÊÓƵ's discretion, but shall not exceed three years) must be used; enter years toward tenure and tenure notification date which must be August 1st of the year following the mandatory tenure review year

Administrative, Service and Support Appointment

• Title: Any title designated as administrative, service or support and identified by ¾Ã²ÝÈȾòÝÊÓƵ Occupational Groups 1,3, 4, 5, 6, & 7 Includes titles such as President, Chancellor, Dean, etc. If individual has an academic title, also complete the Academic Appointment section
• Eligible For Vacation, Sick Leave, and Personal Days: Indicate eligibility for vacation, sick leave, and personal days
• Employment Terms: All appointments are indefinite and may end at any time. Only for nonregular employees with an employment duration of less than nine months should a date be entered in this box
• Approvals: Signature as defined by delegation of authority in Human Resources policy HR-201, Authorization for Personnel Actions

This form must be completed for new hires, rehires and transfers involving changes from benefit eligible to non-benefit eligible or the reverse and from academic to administrative, service and support or the reverse. This form should not be used for any student employees unless transferring into a position with a non-student title.