NOTIFICATION of APPOINTMENT – Form is routed to HR Consultant by department Department Name: _____________________________________ Department Contact Name: ______________________________ Department Contact Email: _________________ Type of Background Check: _____Standard _____Standard plus Education Is this employee an authorized adult under AD39? (will have routine contact with minors)
Yes No Has the employee worked/volunteered for Penn State University in the last 6 months?
Yes No Insert specific instructions for the background check below.
1. Employee Information:
Employee Name __________________________________ PSU ID# _________________ Employee Email Address: ________________________ Employee Start Date _________________ Employee End Date:____________________
Employee Office Phone # _____________________
Employee Office Address: ______________________________
Employee Physical Office Address: _______________________________
2. EJMS # _____________________ Position Number (To be filled by HR Consultant):____________
3. Staff/Faculty – Provide information on Teaching Schedule (if applicable):
Fall Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________
Spring Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________
4. Title:_________________________________ Appointment Type (STN,FTM,FT1,FT2):_____________
Rank (Academic):_____ Grade (Grad Assist./Tech. Service):____ Level (Staff):____ FTE (HR88 only)___%
5. Compensation Salary Plan: _______________ (12 months, 36 Weeks, etc…)
Salary Amount: Yearly: ________________ Monthly: __________________
Years of Tenure Credit: ____________
6. Budget Information Home Budget: ____________ Pay Budget: ____________Fund:___________ Cost Center:_________
Non-teaching responsibilities to be included in offer letter -
7. Dept Head Name/Title to be cc'd on offer letter:
Please list only those applicants that were interviewed, but not selected for your position. Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Budget Administrator Signature: ______________________________ Human Resources Signature: __________________________________
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