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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 University 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 University'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 University 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.