Clear Fields Print Form HR 203 (10/01) The Texas A&M University System Statement of Selective Service Registration Status With few exceptions, you have the right to request, receive, review and correct information about yourself collected using this form. Under HB 558, enacted by the 76th Texas State Legislature, if you are currently of the age and gender requiring registration with Selective Service, but knowingly and willfully fail to do so, you are ineligible for employment with an agency in any branch of Texas state government. Any offer of employment is contingent on your compliance with Selective Service law. Exemptions Almost all male U.S. citizens, and male aliens living in the U.S., who are 18 through 25 years of age, are required to register with Selective Service. Some noncitizens are required to register and others are not. Non-citizens not required to register include men who are in the U.S. on student or visitor visas, and men who are part of a diplomatic or trade mission and their families. Almost all other male non-citizens are required to register, including illegal aliens, legal permanent residents, and refugees. Non-Registrants If you are not registered as required, you are presently not eligible to be hired and should register promptly at a United States Post Office. A Certificate of Mailing may be obtained from the Post Office at such time that you mail your registration and may be used as proof of your application until you receive your Selective Service Registration Card. Privacy Act Statement Because information on your registration status is essential for determining whether you are in compliance with Selective Service law, failure to provide the information requested by this statement will prevent any further consideration of you for employment. This information is subject to verification with the Selective Service System and may be furnished to federal agencies for law enforcement or other authorized use in implementing the law. False Statement Notification A false statement may be grounds for not hiring you, or for dismissal, if you have already begun work. Review Should any question arise regarding your registration or eligibility for an exemption, you may request an official "status information" letter from the Selective Service System by calling 1-847-688-6888. As an alternative, you may send a written request to the Selective Service System at P.O. Box 94638, Palatine, IL 60094-4638. Certification of Registration Status ( ) I certify that I am a male age 18 through 25 and am properly registered with the Selective Service System. ( ) I certify that I am not currently of the age required to register with Selective Service. ( ) I certify that I have been determined by the Selective Service System to be exempt from the registration provisions of Selective Service law. ( ) I certify that I have not reached my 18th birthday and understand I may be required by law to register at that time. I understand that under HB 558, enacted by the 76th Texas Legislature, I must be registered with the Selective Service System according to the requirements of federal law in order to be employed with an agency in any branch of Texas state government. I further certify that the information provided on this form is true, complete and correct to the best of my knowledge. I understand that any false statements may void my application for employment and that the information provided on this form will be used only for evaluation of eligibility for employment. ______________________________________________ Name (please print) ___________________________ Social Security Number or UIN Original Signature Required _____________________________________________ Signature ___________________________ Date ________________________ Date of Birth Clear Fields Print Form HR 181 (9/15) The Texas A&M University System Employee Personal Data With few exceptions, you have the right to request, receive, review and correct information about yourself collected using this form. Name: Last First Middle UIN: Birthdate: Month Citizenship: Day Year Visa type: Country If other than U.S. citizenship Province for Canadians: Male Highest Female Education Level 1–Less than high school 2–High school/GED 4–Baccalaureate degree 5–Master’s degree 7–Special professional (D.D.S., D.V.M., J.D., M.D., etc.) 3–Associate degree 6–Doctoral degree You are not obligated to respond to the asterisked items below (Veteran and Former Foster Child Status) and on Page 3; however, your response is important to meet federal and state reporting requirements. Information you provide will remain confidential in accordance with applicable federal and state regulations. Your employment will not be adversely affected by information you furnish. EEO Ethnicity/Race (See Page 2.) *Veteran Status (See Page 2. Check all that apply.) 3-Hispanic or Latino? Yes If you selected “Yes”, you will be identified as Hispanic or Latino for federal and state reporting purposes, even if you select any of the races below. Select all that apply. 1–White 2–Black or African American 4–Asian 5–American Indian or Alaska Native 6–Native Hawaiian or Other Pacific Islander 8–Decline to provide information If you selected more than one race (not including Hispanic or Latino), you will be identified as “Two or More Races” for federal and state reporting purposes. Veteran Armed Forces Service Medal Veteran Active Duty Wartime or Campaign Badge Veteran Recently Separated Veteran (within last three years) If yes, indicate armed services separation date Orphan of a Veteran Surviving Spouse of a Veteran An option for disabled veterans is provided on Page 3. *Former Foster Child Status I am 25 years of age or younger and was under the permanent managing conservatorship of the Texas Department of Family and Protective Services on the day Yes No preceding my 18th birthday. Residence address: Mailing address: Street: Street/P.O. Box: City: Phone: ( State: ZIP: City: ) State: Phone: ( ZIP: ) Do you have relatives who are A&M System employees? In event of emergency notify: Name: Yes Relationship: No If yes, give name, title, relationship and organization: Address: City: Phone: ( State: ZIP: ) State law gives you the right to choose whether The Texas A&M University System should allow public access to your home address, home telephone number, emergency contact information, Social Security number, and whether you have family members. If you do not declare this personal information as confidential, it will be open to the public. If you are a “peace officer,” your home address and telephone number are automatically confidential. Mark one box in item 1 and one box in item 2. 1. Yes, I want my personal information to be confidential. 2. I am a certified peace officer. No, I do not want my personal information to be confidential. I am not a certified peace officer. Please read and sign Pages 2 and 3 of this form before returning it. Employer should complete the following for employee: PIN: ADLOC: Emp-Loc code: Chk-Dist code: A&M System email address: Campus or office address: Street/Bldg: City: Office phone: ( Zip Code: Mail Stop: 1 ) HR 181 (9/15) This employer is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans [41 CFR 60-300.5(a)]. As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified “protected veteran” category. If you believe you belong to any of the categories of protected veterans listed, please indicate by checking the appropriate box (choose all that apply). If you are a disabled veteran, it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with VEVRAA, as amended. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment, and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed. Protected veterans may have additional rights under USERRA – the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll-free, at 1866-4-USA-DOL. The following definitions are provided for your information and assistance in completing the Employee Personal Data form: EEO Ethnicity/Race Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. White. (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American. (Not Hispanic or Latino) A person having origins in any of the Black racial groups of Africa. Asian. (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native. (Not Hispanic or Latino) A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. Native Hawaiian or Other Pacific Islander. (Not Hispanic or Latino) A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. *Veteran Status Veteran. The individual has served in the army, navy, air force, coast guard, or marine corps of the United States or the United States Public Health Service, the Texas military forces, or an auxiliary service of one of those branches of the armed force, and who has been honorably discharged from the branch of the service in which the person served. Armed Forces Service Medal Veteran. The individual is a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Services Medal was awarded pursuant to Executive Order 12985 (61 Fed. Reg. 1209). Active Duty Wartime or Campaign Badge Veteran. The individual has served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of Defense. A list of campaigns and expeditions meeting this criteria is on Page 4. Recently Separated Veteran. The individual is any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service. Orphan of a Veteran. The individual is an orphan of a veteran if the veteran was killed on active duty. Surviving Spouse of a Veteran. The individual is a surviving spouse of a veteran who has not remarried. I have read and understand this material and I certify that the information provided by me is true and correct to the best of my knowledge. This document is executed in good faith. Original Signature Required Employee signature Date The Texas A&M University System is an Equal Opportunity/Affirmative Action/Veterans/Disability Employer. 2 The Texas A&M University System HR 181-Disability (9/14) Disabled Veteran Status (continued from the Employee Personal Data form) With few exceptions, you have the right to request, receive, review and correct information about yourself collected using this form. Because this form contains protected health information about you, it will not be placed in your personnel file. Name: Last First UIN: Middle Birthdate: Month Do you claim to be a Disabled Veteran*? Yes Day Year No A disabled veteran is (1) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation under laws administered by the Secretary of Veterans’ Affairs or (2) an individual who was discharged or released from active duty because of a service-connected disability. *You are not obligated to respond; however, your response is important to meet federal and state reporting requirements. Information you provide will remain confidential in accordance with applicable federal and state regulations. Your employment will not be adversely affected by information you furnish. I have read and understand this material and I certify that the information provided by me is true and correct to the best of my knowledge. This document is executed in good faith. Original Signature Required Employee signature Date The Texas A&M University System is an Equal Opportunity/Affirmative Action/Veterans/Disability Employer. This employer is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans [41 CFR 60-300.5(a)]. As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified “protected veteran” category. If you believe you belong to any of the categories of protected veterans listed, please indicate by checking the appropriate box (choose all that apply). If you are a disabled veteran, it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with VEVRAA, as amended. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment, and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed. Protected veterans may have additional rights under USERRA – the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll-free, at 1-866-4USA-DOL. 3 OTHER PROTECTED VETERAN STATUS CRITERIA CAMPAIGN/EXPEDITION DATES START Armed Forces Expeditionary Medal (AFEM) Afghanistan (Enduring Freedom) 09/11/01 Afghanistan (Iraqi Freedom) 03/19/03 Berlin 08/14/61 Bosnia (Joint Endeavor, Joint Guard & Joint Forge) 11/20/95 Cambodia 03/29/73 Cambodia Evacuation (Eagle Pull) 04/11/75 Congo 07/14/60 Congo 11/23/64 Cuba 10/24/62 Dominican Republic 04/28/65 El Salvador 01/01/81 Global War on Terrorism 09/11/01 Grenada (Urgent Fury) 10/23/83 Haiti (Uphold Democracy) 09/16/94 Iraq (Northern Watch) 01/01/97 Iraq (Desert Spring) 12/31/98 Iraq (Enduring Freedom) 09/11/01 Iraq (Iraqi Freedom) 03/19/03 Korea 10/01/66 Kosovo 03/24/99 Laos 04/19/61 Lebanon 07/01/58 Lebanon 06/01/83 Libyan Area (Eldorado Canyon) 04/12/86 Mayaguez Operation 05/15/75 Panama (Just Cause) 12/20/89 Persian Gulf (Earnest Will) 07/24/87 Persian Gulf (Desert Thunder) 11/11/98 Persian Gulf (Desert Fox) 12/16/98 Persian Gulf (Southern Watch) 12/01/95 Persian Gulf (Vigilant Sentinel) 12/01/95 Persian Gulf Intercept Operation 12/01/95 Quemoy and Matsu Islands 08/23/58 Somalia (Restore Hope & United Shield) 12/05/92 Taiwan Straits 08/23/58 Thailand 05/16/62 Vietnam and Thailand 07/01/58 Vietnam Evacuation (Frequent Wind) 04/29/75 Navy Expeditionary Medal and Marine Corps Medal Cuba 01/03/61 Indian Ocean/Iran 11/21/79 Iranian/Yemen/Indian Ocean 12/08/78 Lebanon 08/20/82 Liberia (Sharp Edge) 08/05/90 Libyan Area 01/20/86 Panama 04/01/80 Panama 02/01/90 Persian Gulf 02/01/87 Rwanda (Distant Runner) 04/07/94 Thailand 05/16/62 CAMPAIGN/EXPEDITION END Other Campaign and Service Medals Army Occupation of Austria Army Occupation of Berlin Army Occupation of Germany Army Occupation of Japan China Service Medal (Extended) Korea Defense Service Medal Korean Service Kosovo Campaign Medal (KCM) Operation Allied Force Kosovo Campaign Medal (KCM) Operation Joint Guardian Kosovo Campaign Medal (KCM) Operation Allied Harbor Kosovo Campaign Medal (KCM) Operation Sustain Hope/Shining Hope Kosovo Campaign Medal (KCM) Operation Noble Anvil Kosovo Campaign Medal (KCM) Task Force Hawk Kosovo Campaign Medal (KCM) Task Force Saber Kosovo Campaign Medal (KCM) Task Force Falcon Kosovo Campaign Medal (KCM) Task Force Hunter Navy Occupation of Austria Navy Occupation of Trieste SW Asia Service Medal (Desert Shield/Storm) Units of the Sixth Fleet (Navy) Vietnam Service Medal (VSM) Rwanda (Distant runner) Thailand Present Present 06/01/63 Present 08/15/73 04/13/75 09/01/62 11/27/64 06/01/63 09/21/66 02/01/92 Present 11/21/83 03/31/95 Present 12/31/02 Present Present 06/30/74 Present 10/07/62 11/01/58 12/01/87 04/17/86 05/15/75 01/31/90 08/01/90 12/22/98 12/22/98 Present 02/01/97 Present 06/01/63 03/31/95 01/01/59 08/10/62 07/03/65 04/30/75 *TBD – To Be Determined 10/23/62 10/20/81 06/06/79 05/31/83 02/21/91 06/27/86 12/19/86 06/13/90 07/23/87 04/18/94 08/10/62 4 HR 181 (9/14) DATES START END 05/09/45 05/09/45 05/09/45 09/03/45 09/02/45 07/28/54 06/27/50 07/27/55 10/02/90 05/05/55 04/27/52 04/01/57 TBD* 07/27/54 03/24/99 06/10/99 06/11/99 TBD* 04/04/99 09/01/99 04/04/99 07/10/99 03/24/99 07/20/99 04/05/99 06/24/99 03/31/99 07/08/99 06/11/99 TBD* 04/01/99 11/01/99 05/08/45 10/25/54 05/08/45 10/25/54 08/02/90 05/09/45 07/04/65 04/07/94 05/16/62 11/30/95 10/25/55 03/28/73 04/18/94 08/10/62 Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2017 Page 1 of 2 Why are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: • • • • • Blindness Deafness Cancer Diabetes Epilepsy • • • • • Autism Cerebral Palsy HIV/AIDS Schizophrenia Muscular dystrophy • • • • Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs • • • • Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation) Please check one of the boxes below: YES, I HAVE A DISABILITY (or previously had a disability) NO, I DON’T HAVE A DISABILITY I DON’T WISH TO ANSWER Your Name Today’s Date 5 Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2017 Page 2 of 2 Reasonable Accommodation Notice Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete. 6 TEXAS A&M UNIVERSITY-KINGSVILLE STATEMENT OF PRIOR STATE EMPLOYMENT With few exceptions, you have the right to request, receive, review and correct information about yourself collected using this form. Name: SS#: Department: Extension: Date of Hire: Please check all that apply: I have not been employed by the State of Texas at any time prior to this current employment with Texas A&M University-Kingsville. I am a current employee of Texas A&M University-Kingsville at the time I was hired for this job. I have previous employment with Texas A&M University-Kingsville. I have been employed by the State of Texas prior to my employment with Texas A&M University-Kingsville. The State Agencies at which I have been employed are listed below: (Please include any employment with Texas A&M University if applicable) Name of Agency: Agency Phone Number: City, State, Zip: Department: Employment Dates: Position Held: Name Used During Employment: Name of Agency: Agency Phone Number: City, State, Zip: Department: Employment Dates: Position Held: Name Used During Employment: Name of Agency Agency Phone Number City, State, Zip: Department: Employment Dates: Position Held: Name Used During Employment: Signature Rev. 03/05-dkw Date Human Resources‐ EEO/AA 700 University Blvd. MSC 107 Kingsville, TX 78363‐8202 Voice (361) 593‐3705 Fax (361) 593‐3604 TAMUK Faculty/Staff Information Date: __________________ Phone (H): __________________ Phone (W): ________________ Last Name: _____________________ First Name: _____________________ Middle: ____________ Home Address: ________________________________________________________________________ Employment date with TAMUK: _______________ Position Title: ___________________________ Department: ____________________ Building: ____________________ Room #: ____________ Birthplace (City, State): ___________________ High School from which graduated: ________________ Spouse’s Name: _________________________ Children Names: _______________________________ College/Universities Attended (Please provide information below): Institution Name: _______________________ Dates Attended: ________________________________ Degree Received: _______________________ Major: ____________________ Date: ______________ Institution Name: _______________________ Dates Attended: ________________________________ Degree Received: _______________________ Major: ____________________ Date: ______________ Institution Name: _______________________ Dates Attended: ________________________________ Degree Received: _______________________ Major: ____________________ Date: ______________ School honors, offices, honorary societies, etc: _______________________________________________ Title of thesis and/or dissertation: _________________________________________________________ TEXAS A&M UNIVERSITY­KINGSVILLE NEW EMPLOYEE INFORMATION FOR STAFF COUNCIL NAME: ______________________________________________________________________ FIRST MIDDLE LAST DATE OF HIRE: ________________ CLASSIFICATION ______ Non‐faculty Professional = 2 Technical = 3 CAMPUS BOX: _______________ Secretarial and Clerical = 5 Crafts = 6 CAMPUS PHONE: _____________ Services = 8 THE TEXAS A&M UNIVERSITY SYSTEM System Risk Management NOTICE TO EMPLOYEES OF WORKERS' COMPENSATION INSURANCE Notice is hereby given to all persons employed in the service of and on the payroll of the institutions and agencies under the direction and governance of the Board of Regents of The Texas A&M University System that Workers' Compensation Insurance coverage is provided in accordance with Chapter 502 of the Texas Labor Code. I hereby acknowledge receipt of this notice that Workers' Compensation Insurance has been provided as above stated. Date: ____________________ Employee's Printed Name: ___________________ Employee's Signature: _________________________ UIN: ____________________ System Member: ____________________ Department: _____________________ TAMUS Form - 8 This form may not be altered. Retain in Employee’s Personnel File Rev 06/12 301 Tarrow Street, 5th Floor • College Station, Texas 77840-7896 979.458.6330 • 979.458.6247 fax • www.tamus.edu Direct Deposit Authorization Form Privacy Notice: State law requires that you be informed that you are entitled to: (1) request to be informed about the information collected about yourself on this form (with a few exceptions as provided by law); (2) receive and review that information; and (3) have the information corrected at no charge. INSTRUCTIONS: This form is used by employees to request direct deposit of their payroll check into a bank or credit union. It is the employee’s responsibility to provide accurate routing and account number information. If in doubt, contact your financial institution to ensure accuracy prior to submitting this form. Please print clearly and legibly to prevent errors. If your direct deposit will be to a financial instiution OUTSIDE the United States, please also complete the Texas A&M University OFAC Compliance Form found on the Payroll Services website. This Direct Deposit Authorization Form is for payroll payments only not reimbursements for travel and/or purchases. EMPLOYEE IDENTIFICATION Name UIN Email Home Phone Department Work Phone Mail Stop ACTION REQUESTED Cancel Service: Do not complete the Financial Identification Section. Sign and Date Below. ACTION REQUIRED & FINANCIAL IDENTIFICATION Initial Set-up Update Data Name of Bank/Credit Union Phone Bank Address Electronic deposit routing number (obtain from bank/credit union) Checking Account number Do NOT attach a check. Do NOT attach a deposit slip. Your Name Your Address Refer to the example check for assistance in completing the Financial Identification section. Bank/Credit Union Name Routing Number Account Number Savings Check Number EMPLOYEE AUTHORIZATION – PLEASE READ I authorize Texas A&M University-Kingsville to deposit by electronic transfer my payroll amounts to the financial institution and account indicated above. I acknowledge responsibility for providing complete and accurate information on this authorization form and understand that Texas A&M University-Kingsville may contact my financial institution to confirm accuracy of information. I also acknowledge that I will receive an electronic notification of earnings from Texas A&M University-Kingsville which will be an email confirming that my payroll data is available on HR Connect. A&M Kingsville reserves the right to reverse an incorrect posting; however, I fully understand that A&M Kingsville must notify me on or before the settlement date (payday) and explain the reason for the reversal. I further understand that if changes occur in my account, i.e., switching deposit from checking to savings, closing account, changing banks, etc. it is my responsibility to contact Payroll Services immediately. _______________________________________________________ Signature Office Use Only Verified Direct Deposit Authorization ___________________________________ Date SUBMIT TO: Questions Payroll Services payrollprocessing@tamu.edu Fax (979) 845-4134 payrollprocessing@tamu.edu Nereida Ramirez 979-862-2898 Kim Garza 979-845-4737 Confirmed Entered Revised 05/01/2014 Page 1 of 1 TEXAS A&M UNIVERSITY– KINGSVILLE TEACHERS RETIREMENT SYSTEM (TRS) OF TEXAS NEW EMPLOYEE ELIGIBILITY QUESTIONS Name: ______________________________________________________________________________ Last name First name Maiden Name (If Applicable) Social Security Number: __________________________ Hire/Start Date: _________________________________ 1. Have you ever worked for a TRS‐covered *employer? _____________________________ *State supported universities, medical and dental schools, junior/community colleges, public schools, regional education service centers, certain charter schools. If the answer to #1 is NO: Go to the bottom of this form ‐ sign, date and return. If the answer to #1 is YES: Name of Employer: ____________________________________ 2. Did you contribute to TRS during this period of employment? ________________________ 3. If the answer to #2 is YES: Have you withdrawn your funds from TRS? ________________________ 4. If the answer to #3 is NO: Do you receive a monthly retirement check from TRS? ________________________ (Payroll Office use: If the answer is yes only report on the Employment of Retired Members Report) 5. If the answer to #4 is YES: What is your retirement date? ________________________ ¾ ___________________________________________________________________ Signature of Employee DATE FOR PAYROLL OFFICE USE ONLY: Account: _______________________________________________________ (If TRS account is active on TRAQS website, do not set up a 90 day end date in BPP screen 104) Verified in TRAQ by: ______________________________________________ Date: ___________________________________________________________ TAMUK Confidential June 2008 PAYROLL-01 Clear Fields The Texas A&M University System External Employment Application and Approval Form Print Form HR 202A (10/12) With few exceptions, you have the right to request, receive, review and correct information about yourself collected using this form. Employee name: First Middle Last Title: Department: I request permission to accept external employment. The proposed employment will not interfere with my assigned duties. In such external employment, I will act as an individual and not as a representative of The Texas A&M University System, and, if I am a faculty member, such external employment is not directly related to my professional discipline. 1. Name and address of employing firm, agency or individual: 2. Nature of work: 3. Release time requested? ________Yes _________No. If yes, the following is my basis for requesting release time (provide remuneration, value to System, professional enhancement): Note: External Employment requests will not be granted for a period longer than one year. All authorizations, regardless of length, will terminate on August 31 of the current fiscal year. All employees/faculty members must reapply for authorization each fiscal year, defined as September 1 – August 31. 4. Period of request: through Date Date (No later than August 31 of current fiscal year) Total release time requested for period (if none requested, state N/A): Total release time (including previous approvals): 5. Equity ownership involved? If so, the amount and type of equity interest owned: I understand that external employment may not be undertaken on that portion of time covered by federal grants or contracts. I further understand that this request applies only to that portion of my time for which I am employed by The Texas A&M University System. I agree to furnish reports and additional details of employment as required. I certify that there will be no conflict of interest between this external employment and my responsibilities as an employee of The Texas A&M University System. I also certify that this external employment will be conducted at no expense to The Texas A&M University System. I fully agree and understand that official release time is contingent upon this activity being of value to The Texas A&M University System and an enhancement to my relationship thereto, and so long as I receive no remuneration for the work performed. Otherwise, I will take vacation or accumulated compensatory time for such absences, as applicable. I certify that I have read System Policies 07.01 Ethics, and 31.05 External Employment and Expert Witness, and System Regulation 31.05.02 External Employment, and agree to conduct my external employment in accordance with the provisions contained therein, including the requirement that I will not engage in external employment prior to receiving the requisite approvals. If I am a faculty member, certify that all external employment requested will not be directly related to my professional discipline. Employee signature Universal Identification Number Approval recommended: Date Release time recommended? Yes Department Head Approved: No Date Release time approved? Yes No Date Date President/Chief Executive Officer of System Member Date COMPUTING & INFORMATION SERVICES MSC 185 KINGSVILLE, TX 78363 www.cis.tamuk.edu 361/593-2401 FAX 361/593-2696 HELPDESK 361/593-4357 Faculty/Staff UserID Application (NO SERVICES WILL BE CREATED WITH THIS APPLICATION) For Faculty/Staff with active employment status The information on this form will be used to create an individual UserID. The UserID is required for access to any computer services provided by CIS. This form does not grant you access to any computer services. Requests for email and computer access (NT) services must be done online at: http://www.cis.tamuk.edu/email.asp. Your signature on this form makes you responsible for any computer services requested by you. Please allow up to 3 working days from the time CIS receives this form to apply for any computer services online. Individual User Information: Name:________________________________________________________________________ First Middle Last Department:__________________________ Position: __________________________________ Building: _________________________________ Room: _____________ Work Phone: ________________ Alternate Contact Phone Number(s) Home: (____)_____________ Cell: (____)_____________ Date Of Birth:_________________ (MM/DD/YYYY) Signature:_________________________________________ HR USE ONLY: Employee UIN:_____________________ ___Faculty ___Staff/Admin ___GA Start Date:____________________ | Full-Time___ Half-Time___ Part-Time___ Other________ Termination Date:____________________ Name:_____________________________________ Date: ____________________ Signature:___________________________________________ Please note, this form will not be processed if any information is missing or incomplete, including signatures! FOR CIS USE ONLY: Accepted by:_____________________________________ Date:____________________________ Time: ____________________ Ticket #: ___________________ Assigned tp:_____________________________ Assigned Date:___________________________ UserID:______________________ BannerID:______________________ Closed by:___________________ Closed Date:________________ Comments:____________________________________________________________________________________________________________ Notified by:_____________________________________Date:______________________________Time:_______________________________ HR USERID FORM Rev. 06/03/2008 COMPUTING & INFORMATION SERVICES MSC 185, 700 UNIVERSITY BLVD. KINGSVILLE, TEXAS 78363-8202 HELPDESK (361) 593-4357 FAX (361) 593-2696 www.cis-web.tamuk.edu Faculty/Staff User ID Application (Page 2) (NO SERVICES WILL BE CREATED WITH THIS APPLICATION) For Faculty/Staff with active employment status This information submitted with the form (page 1) will be used to create an individual UserID. The UserID is required for access to any computer services provided by CIS. The submitted form does not grant you access to any computer services. Request for email and computer access (NT) services must be done online at: http://www.cis.tamuk.edu/email.asp. Please allow up to 3 working days from the time CIS receives this form to apply for any computer services online. To help you become more familiar with services provided by the Computing and Information Services department, please visit our home page at http://cis.tamuk.edu. You may also contact our HELPDESK at 361.593.HELP (4357). HUMAN RESOURCES-EEO/AA MSC 107 · 700 UNIVERSITY BLVD. KINGSVILLE, TEXAS 78363 361-593-3705 · FAX 361-593-3604 ACKNOWLEDGEMENT OF RECEIPT OF REQUIRED INFORMATION FOR NEW EMPLOYEES EMPLOYEE COPY UIN ___________________ I acknowledge and certify that I have received materials on the following topics: • Policy Letters from Office of the President • 34.04.03 HIV/AIDS in the Workplace & Learning Environment & HIV/AIDS FACT SHEET • 34.02 Drug and Alcohol Abuse & 34.02.01 Drug and Alcohol Abuse & Rehabilitation Programs • 31.01.09 Overtime • 08.01.01 Civil Rights Protections & Compliance & 08.01.01 Civil Rights Compliance • Overview Voluntary Supplemental Retirement Savings Programs • Privacy Practices Notice • Standards of Conduct for State Employees • Hazard Chemicals Employee Notice • Contacts for reporting Fraud, Waste or Abuse Additionally, I acknowledge that I have been informed of the system‐required trainings that must be completed within 30 days of hire. • Orientation to the A&M System • Ethics (complete within 30 days of hire and every 2 years thereafter) • Creating a Discrimination‐Free Workplace (complete within 30 days of hire and every 2 years thereafter) • Information Security Awareness (complete within 30 days of hire and every 2 years thereafter) • Reporting Fraud, Waste & Abuse (complete within 30 days of hire and every 4 years thereafter) TAMUK administrators should also complete the following: • Sexual harassment: What supervisors Need to Know (within 30 days of hire) • Managing Employee Performance (within 60 days of hire) How to access and your required online Training: 5. Logon Single Sign On (SSO) https://sso.tamus.edu 6. Below the UIN and password fields, you will see three links. If you are a new employee, select the top link “New employees‐ Set up your password” and follow the instructions. If you are a returning employee, initially enter your UIN and password directly on the single sign on menu. 7. Select HR Connect from the SSO menu, and click on the “training” tab at the top of the screen. 8. Select the training you are to complete and click “start selected courses 9. “View My Transcript” provides the course/class name, status, start date, completion date, and score. 10. You MUST complete ALL courses successfully before credit can be given. If you have any questions, please contact the Human Resources Office at 361‐593‐4998. Equal Employment Opportunity/Affirmative Action Employer PAYROLL DEPARTMENT MSC 121 · 700 UNIVERSITY BLVD. KINGSVILLE, TEXAS 78363 PHONE (361) 593-3705 · FAX (361) 593-3604 To: All New Employees Subject: New Employee Welcome! Welcome to Texas A & M University Kingsville! We know this is a busy time, transitioning to a new job. Please take a minute to read this letter which will introduce you to some of the services we offer and the many items you can elect on-line through the Single Sign On website. You may visit our office located in College Hall, room 210 if you require further assistance. All staff and faculty employees will be paid on the first work day of each month. Student and temporary employees are paid bi-weekly. The bi-weekly schedule can be found on our website. On our website- www.tamuk.edu/payroll you will find lots of payroll information; such as: *Contact Information *Electronic Personnel Action (EPA) Procedures *Forms *Extended Pay Plan (EPP) for 9month faculty *Calendar/Schedules *Direct Deposit & Pay Stubs *System Policy Manual *Longevity Links to: *Canopy for EPA *Glacier for Employment of Foreign Nationals *IRS *Retirement Plans (TRS, ORP, TDA) *Social Security Single Sign On (SSO): Payroll Data tab Sign up for direct deposit & electronic receipt of your pay stub Complete Form W-4 Employee’s Withholding Allowance Certificate (Employment of Foreign Nationals may require additional forms, contact the Payroll Office) View & request electronic receipt of your Form W-2 Wage & Tax Statement View wages; year-to-date totals View pay stubs View your total compensation report Personal Data tab Update your email address, home & work address, phone numbers & more! To set up an account in “Single Sign On” you will need your UIN, Adloc and birth date. Call the Payroll Dept. to obtain these numbers. Open Internet Explorer. Go to https://sso.tamu.edu/logon.aspx You should get the BCS Single Sign On main page. If you are new to this website go to “New Employees set up your password” UIN: A university assigned number unique to you. Replaces your social security number. ADLOC: Administrative Location-This is a number assigned to the department that you work in. Birth date: Your birth date must be entered in MM/DD/YYYY format. Continued on Next Page Page 2: Payroll Department Texas A & M University - Kingsville New Employee Welcome Once you are logged on to the Single Sign select HRConnect Click on the Payroll or Personal Data tab, depending on what you need to do. Occasionally there is a need to make corrections (credits & debits) on an employee’s pay check. Our policy has been to notify you about the changes by telephone or email whichever is more efficient. In order to expedite changes and save you time and travel to the payroll office, we are requesting your signature to give permission to make necessary adjustments to your pay when necessary. Please sign at the bottom of this letter and return to the Payroll Department, College Hall, Room 210 or MSC 121. Welcome to Texas A & M University Kingsville! Sincerely, The Payroll Staff Turn in to the Payroll Department, MSC 121, College Hall, room 210 -----------------------------------------------------------------------------------------------------------My signature below authorizes Payroll Department to make adjustments to my pay while employed at Texas A & M University Kingsville. ___________________________ Printed Name _______________________ Signature _______ Date THE TEXAS A&M UNIVERSITY SYSTEM Office of Risk Management/Benefits Administration Annual Eligibility Notice for 403(b) Tax Deferred Plans Here’s your opportunity to save for retirement by participating in the A&M System’s voluntary 403(b) Tax-Deferred Account (TDA) plan. You can choose to make pre-tax contributions with a traditional TDA or after-tax contributions with a Roth TDA. How can I start? You can start contributing at any time and you can begin with as little as $25.00 a month! First, complete a salary reduction agreement, available on our website at: http://www.tamus.edu/benefits/publications/forms/17.pdf . You also need to choose a vendor and establish an account with one of them. A list of our seven active vendors can be found at: http://www.tamus.edu/benefits/retirement/orptda.html. This list also has advisors and counselors in your area that can help you choose your investments. You’ll need to submit a copy of the vendor’s application for your account and your salary reduction agreement to your Human Resources or Payroll office. What types of investment products are available? Two types of investment options are available - annuities (fixed and variable) and mutual funds. An annuity is a contract with an insurance company in which you contribute through a retirement plan, and the company makes payments back to you at a later time, retirement, for a specified period. If you invest in variable options, the value of your account will change according to the performance of the options you choose. Your financial advisor can help you choose which options suit you. A mutual fund is a professionally managed collective investment that pools money from many investors and invests it in stocks, bonds, short-term money market instruments, etc. Mutual fund options include lifecycle funds, target date funds, and asset allocation funds. These funds automatically rebalance according to the mutual fund’s objectives. There are also options available for investors who prefer to manage their own portfolio. How much can I contribute? In general, you may contribute up to $16,500 in 2009. This amount is the general limit and is adjusted annually. Additional catch-up contributions are allowed if certain criteria are met, such as if you have at least 15 years of service with the A&M System and/or you are at least 50 years old by year’s end. Find out more about A&M System Retirement Programs through our new brochure online at: http://www.tamus.edu/benefits/retirement/Retirement%20Booklet/RPB.pdf. This Notice is not intended as tax or legal advice. Neither the A&M System nor the investment providers offering retirement savings products under the plan can provide you with tax or legal advice. Employees are encouraged to contact their financial representative or tax professional with any questions. 200 Technology Way, Suite 1120 • College Station, Texas 77845-3424 979.458.6330 • 979.458.6247 fax • www.tamus.edu