Human Resources Action Form - Extranet · Non-employee has an existing assignment with primary...
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Human Resources Non-Employee Action Form Please Print Check one: New Revised Name Employee ID Rcd # Preferred Name (if different) Degree: Effective Date Business Title Division Dept #: Dept Name Sponsor* Will Center Immigration Support be required? Yes No Will this non-employee have a workspace and/or complete work in a Fred Hutch owned and/or operated building? Yes No Fred Hutch Phone ___________________ Other Phone________________________ Fred Hutch Mailstop __________________________ Other Mail Stop (if applicable) ____________________ Approx Hrs Per Week on Campus________ Check any that apply for this non-employee: Non-employee has an existing assignment with primary employer Requires access to Comparative Medicine or animal health research facilities Work is governed by a collaboration or research agreement with IP terms Name is expected to be listed in an IACUC protocol Position involves animal research Work involves development of intellectual property (IP) Needs access to IACUC records Brass Keys Arnold Library Card Background Check Directory Listing FMS Access HutchNet ID Security/Photo ID Badge NONE Identify the individual's primary employer: Seattle Children's Harborview Medical Center Howard Hughes Medical Institute Hutch Kids Institute of Systems Biology Seattle Cancer Care Alliance University of Washington VA Medical Center Other ____________________ Please complete and submit to HR The individual will also be required to complete additional documents before the record is created. The individual’s activities must support Center research or business to be eligible for a library card. Check one of the boxes below which describe the reason for the relationship with the Center: Scientific Affiliate Investigator (This role has divisional requirements, must have division approval and, depending on division, may need faculty vote.) Consortium Member (HR will use the approved consortium listing to validate.) Faculty Member (HR will validate the appointment with the Office of the Director.) Grad Student / Intern / Other Student Post Doc / Fellow / Research Assoc Research Tech / Lab Tech / Lab Aide Visiting Investigator Other Scientific ______________________ Non-Scientific Admin Support for Researcher / Scientist Consultant (A person engaged to give professional advice or services, generally for a fee, but is not acting as an employee. If the individual is paid through Fred Hutch Accounts Payable, a consultant agreement is on file.) Contractor (A person/company contracted to provide a service or equipment to the Center. The individual is paid by a third party. This DOES NOT include temporaries from outside agencies.) Hutch Kids Teacher / Hutch Kids Employee Institutional Review Board Member Seattle Cancer Care Alliance Clinic Staff Other Non Scientific ____________________ *As the sponsor you are responsible for submitting an off- boarding checklist to separate this non-employee when they no longer require access. Signatures required for processing General description of activities: ____________________________________________________________________________________ When do you anticipate this non-employee’s role with the Center will end? _____________________________ Sponsor Date Sponsor Phone # Mailstop Sponsor # Division Head/Designee Date Form Completed by / Admin Contact Phone # Shaded areas are completed by HR Action Form 8/18 - - - Email form to sp-[email protected], HR Action Tracking System (do not mail). For questions, call 206-667-4700 Check any required items for this non-employee:
Transcript of Human Resources Action Form - Extranet · Non-employee has an existing assignment with primary...
Human Resources Non-Employee Action FormPlease Print
Check one: New Revised
Name Employee ID Rcd #
Preferred Name (if different) Degree: Effective Date
Business Title Division Dept #: Dept Name
Sponsor* Will Center Immigration Support be required? Yes No
Will this non-employee have a workspace and/or complete work in a Fred Hutch owned and/or operated building? Yes NoFred Hutch Phone ___________________
Other Phone________________________
Fred Hutch Mailstop __________________________
Other Mail Stop (if applicable) ____________________
Approx Hrs Per Week on Campus________
Check any that apply for this non-employee: Non-employee has an existing assignment with primary employer Requires access to Comparative Medicine or animal health research facilities Work is governed by a collaboration or research agreement with IP terms
Name is expected to be listed in an IACUC protocol Position involves animal research Work involves development of intellectual property (IP) Needs access to IACUC records
Brass Keys Arnold Library Card Background Check Directory Listing
FMS Access HutchNet ID
Security/Photo ID Badge NONE
Identify the individual's primary employer: Seattle Children's Harborview Medical Center Howard Hughes Medical Institute
Hutch Kids Institute of Systems Biology Seattle Cancer Care Alliance
University of Washington VA Medical Center Other ____________________
Please complete and submit to HR
The individual will also be required to complete additional documents before the record is created.
The individual’s activities must support Center research or business to be eligible for a library card.
Check one of the boxes below which describe the reason for the relationship with the Center:
Scientific Affiliate Investigator (This role has divisional
requirements, must have division approval and, depending on division, may need faculty vote.)
Consortium Member (HR will use the approved
consortium listing to validate.)
Faculty Member (HR will validate the
appointment with the Office of the Director.)
Grad Student / Intern / Other Student Post Doc / Fellow / Research Assoc Research Tech / Lab Tech / Lab Aide Visiting Investigator
Other Scientific ______________________
Non-Scientific Admin Support for Researcher / Scientist Consultant (A person engaged to give professional
advice or services, generally for a fee, but is not acting asan employee. If the individual is paid through Fred Hutch Accounts Payable, a consultant agreement is on file.)
Contractor (A person/company contracted to provide
a service or equipment to the Center. The individual is paid by a third party. This DOES NOT include temporaries from outside agencies.)
Hutch Kids Teacher / Hutch Kids Employee Institutional Review Board Member
Seattle Cancer Care Alliance Clinic Staff
Other Non Scientific ____________________
*As thesponsor youare responsiblefor submittingan off-boardingchecklist to separate thisnon-employeewhen they no longer requireaccess.
Signatures required for processing
General description of activities: ____________________________________________________________________________________
When do you anticipate this non-employee’s role with the Center will end? _____________________________
Sponsor Date Sponsor Phone # Mailstop Sponsor #
Division Head/Designee Date Form Completed by / Admin Contact Phone #
Shaded areas are completed by HR
Action Form 8/18 - - - Email form to [email protected], HR Action Tracking System (do not mail). For questions, call 206-667-4700
Check any required items for this non-employee:
