April 2010 Version 2010/01
Nil Salaried Appointment Personal Information Form
(new appointees only)
HR Web Site: http://www.umanitoba.ca/admin/human_resources/
To be completed by the department:
Questions? For more information, please call Karen Kaluzny at 474-7160.
For appointees to nil salary academic positions who are not currently appointed or employed at the University of
Welcome to the University of Manitoba.
In order to initiate your appointment, we need the following information.
Please complete and return this form, together with a signed copy of the Letter or Offer, to:
Department enter this information: Name:
Address: (Room # and Building)
University of Manitoba,
Winnipeg, MB R3T 2N2
Salutation: Mr. Mrs. Ms Miss Dr. other (specify):
SURNAME: Date of Birth: (yyyy/mth/dd)
First Name: Gender: Female Male
Number and Street: Apt:
City and Province: Postal Code:
Primary Phone Number: Other Phone Number:
This personal information is being collected under the authority of the University of Manitoba Act and will be used to
maintain a record of personnel appointed through the University Human Resources Information System and other
systems, to make reimbursement, and to confirm employment status for the provision of University of Manitoba
computer accounts. It is protected by the Protection of Privacy provisions of the Freedom of Information and
Protection of Privacy Act. If you have any questions about the collection, contact the FIPPA Coordinator’s Office
(204) 474-8339, c/o Archives and Special Collections, 331 Dafoe Library, University of Manitoba, R3T 2N2.
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