School of Nursing
TEACHING ASSISTANT
MONTHLY EMPLOYEE WITHOUT TIMESHEETS
Selected Candidate:
You are required to disclose your social security number pursuant to IRS reporting requirements for Payroll purposes only.
In keeping with the University’s status as an Equal Opportunity Employer, this information will not be used in any decisions affecting hiring or any
personnel action following employment:
Social Security Number:
PID:
Date of Birth:
Sex:
Email Address:
Ethnic Background:
Citizenship:
(Aliens who are authorized to work temporarily in the US are required to present their I-766 card to the
School of Nursing Human Resources Office.)
Where is the TA’s current Academic Department of Major:_______________________________________________
Does the TA work in another UNC Department? (circle)
Yes
or
No
If yes, please have the TA complete the following for each individual department they are paid from:
Department Name:______________________________________
Department Name:___________________________________
Appointment title or position type: ________ ( TA, RA or Fellow)
Appointment title or position type: ________ ( TA, RA or Fellow)
Effective date of employment: Started________ Ending ________
Effective date of employment: Started_______ Ending _______
Stipend amount: $______________
Stipend amount: $______________
Acct Number (required): ______
ledger
__________ _______
acct ID
SON Appointment Begin Date:
Acct Number (required): ______
object line
ledger
__________ _______
acct ID
object line
SON Appointment End Date:
Salary Source (full account number):
Source End Date:
Source Name:
Appointment Type: Please read and check the appropriate classification.
NOTE: Payment for the Teaching Assistant classification is a flat monthly rate, paid the last working day of each month employed.
Payment for partial months employed is prorated. Appointments may not exceed 12 months. Reappointment for a period not
exceeding 12 months per reappointment is possible.
A graduate student who qualifies for classification as a Teaching Assistant may also qualify for Tuition Remission and Graduate
Student Health Insurance. If the student is deemed eligible, then the fund source will be required to contribute to the monthly cost.
Teaching Assistant Classifications: Check the most appropriate.
Instructional Assistant:
Instructional Assistants are graduate students who are primarily involved in assisting a faculty member with a course. In this capacity,
the assistant rarely gives a formal presentation to a class, although some tutoring or assessment work with exams and required papers
may be performed, the faculty member has the responsibility for assigning grades.
Teaching Associate:
Teaching Associates are graduate students who are involved in some classroom, recitation, or laboratory teaching, but do not have full
responsibility of a class as described for a Teaching Fellow.
Teaching Fellow:
As Teaching Fellows, graduate students have full responsibility for a section of a multi-section course, or, less commonly, a
freestanding course. Teaching Fellows have primary responsibility for teaching a course for credit and/or for assigning final grades.
As senior Teaching Fellows, graduate students may coordinate the activities of other Teaching Assistants or have full responsibility
for a course including curricular design.
CONTINUED ON BACK
SON HR
TAhiringform.doc
December 2006
Hourly Rate:
Maximum Hours Per Week:
Total # of weeks working (deduct time for holidays and breaks employee is not expected to work. Maximum # should not
exceed 50):
Duties:
Pre-Employment Conditions:
Infectious Disease:
If employment involves professional contact/interaction with patients, clients, families, or human subjects; exposure to patients, or
clients; works in a health care facility or needs a UNC Hospital-ID card the student is required to notify the Director of Enrolled
Students in Room 1200 to find out whether or not they are in compliance and proceed accordingly
The following may be required of students whose employment involves professional contact/interaction with patients, clients,
families, or human subjects; exposure to patients, or clients; works in a health care facility or needs for a UNC Hospital-ID card.
___TB screening*
___Varicela affidavit*
___Hep B vaccination*
___CPR certification*
___NC RN license*
___HIPAA or
___HIPAA (with Patients/Research Subjects)
___OSHA class and post-test*
___Malpractice insurance-$1,000,000/$3,000,000 level**
___Signed Universal Confidentiality Statement
___Accessing UNC Hospitals/other research sites
___Ethics and protection of human subjects training (if applicable)
May be completed online or video during the first week of work.
*Must be completed before Teaching Assistant has direct patient or subject contact.
**Must be completed before RN functioning in that role has direct patient or subject contact.
If employment does not involve professional contact/interaction with patients, clients, families, or human subjects; exposure to patient,
client, or human subject blood or other bodily fluids; working in a health care facility or the need for a UNC Hospital-ID card, then
student must complete a Health & Safety Orientation Session below.
Health & Safety Orientation:
This employee will be required to attend a one-time Health & Safety Employee Orientation based on their work environment. Please
select one and have the employee follow up appropriately:


_____Office environment: New Orientation for Office Environment training class
_____Laboratory environment: New Orientation for Laboratory Environment training class
To complete this requirement the supervisor should direct the new employee to the one-time Health & Safety Clinical Orientation
session on line at http://ehs.unc.edu/training/clinic/clinic.shtml, and select either “Office or Laboratory”. The employee will need
their PID number. If they do not know or remember their PID# please contact the SON Human Resources office at (919) 843-6761.
APPROVALS:
Hiring Supervisor Statement of Agreement: I understand that the above named employee may not begin work until his/her employment papers and employment
status have been reviewed and cleared by the School of Nursing Human Resources Division.
Signature of Hiring Supervisor
Date
Financial Services Review: I certify that I have reviewed the funding source for this hiring action and sufficient funds are available to cover this request.
Signature of Financial Services Representative
Date
Student & Faculty Services: I approve this hiring and confirm that this student has made contact regarding compliance.
Signature of Associate Dean
Date
Administrative Services Review: I approve the annual rate for this position.
________________________________________________________________________
Signature of Associate Dean
___________________________
Date
SON HR
TAhiringform.doc
December 2006