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