EMPLOYEE APPOINTMENT FORM
EMPLOYEE INFORMATION (please complete all fields)
Dr.
Ms.
Mr.
Miss
Mrs.
Current SUNY Employee:
Gender:
Last Name:
Yes
No
Birth Date:
M
First Name:
US Citizen
Student Status:
SUNY Undergrad
Veteran Status:
Yes
No
Non-Citizen not in US
Non-Citizen in US on VISA
Ethnic Origin: (select all that apply)
American Indian or Alaska Native
Hispanic or Latino
Native Hawaiian/Other Pacific Islander
White
Education Level Reached:
Social Security or EE #
Do you have immediate prior service at SUNY, another US College or University, or Private Non-Profit Research Organization?
Nationality:
F
Middle Initial:
Asian
Permanent Resident
Black or African American
VISA Type:
J01
Type of Degree Expected:
No
Primary Language for Correspondence:
English
Other: _________________________
H01
SUNY Grad
Yes
F01
Other ______________________
TN COUNTRY ______________________
If Full-Time SUNY Student :
Date Degree Expected:
ASSIGNMENT (department completes all fields)
Date of Hire:
Salary End Date:
Working Hours:
37 ½
40
Physical Working Location:
Job Title:
FTE %: (represents hours worked)
Supervisor/Timesheet Approver:
Search #:
Department:
NOTE: For less than 100% FTE the ANNUAL salary should the annualized (100%) salary times the FTE percentage. The salary should NOT reflect the annualized 100% salary unless a 100% position.
Salary: Annual $
B/W
OR, Hourly Rate (must attach certification form) $
LABOR DISTRIBUTION (If more lines are needed, continue on Labor Distribution Form)
Project
Task
Award
Expenditure Type – HR/LD Use Only
Organization
Start Date
DECLARATION AND AUTHORIZATION
I accept the position indicated above as an employee of The Research Foundation for The State University of New York. I understand this
position is subject to final approval by the Research Foundation and is terminable at will. I also agree to abide by all policies and
regulations of the Research Foundation. I have read the Patent Waiver and Release Agreement and the Computer Software Policy of The
Research Foundation for The State University of New York and accept them both as a condition of employment.
Employee Signature:______________________________________________________
This appointment is consistent with sponsored program terms and
conditions and with Research Foundation policies.
Date:________________
Additional Campus Signatures as Required
Project Director/
Co-Project
Director______________________________________________
Signature
Date
___________________________________________________
Human Resources Signature
Date
Operations
Manager______________________________________________
Signature
Date
___________________________________________________
Signature
Date
Input by __________ Date _____________
9/17/2015
Reviewed by__________ Date__________
End Date
FTE on Account
% of Salary
HUMAN RESOURCES USE ONLY
I-9 Status
Yes
No Non-Resident ______________
Work Authorization Date: ___________________________
Mail Stop:__________________ notes on reverse
Appointment Type
Assignment Category
Regular
Exempt
Summer
Extra Service
Nonexempt
Hourly
EE Category
Admin
Sponsored
Student credits/semester____________________________
Exempt SS/Medicare:
Yes
No
PeopleSoft Employee:
Yes
No
SUNY Salary Verified _____________________________
Form 195(1) ____ App letter ____ Time/Attend_________
Benefit packet ____________________________________
Initial payroll review ___________________ JD attached
Retro:___________________________________________
Rehire?
Yes
No
Form logged _______ SUNY ID ______________________
LD Input by ____________ Date ____________