PERSONNEL ACTION FORM - DOC

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					                    UT SYSTEM PERSONNEL ACTION FORM --- NEW HIRE/REHIRE                                     (revised 9/2005)
                    USE THE TAB KEY TO NAVIGATE TO EACH FIELD

                                                                                                  Contact
                               On-Line instructions                                     Budget Staff  512/499-4267
                          www.utsystem.edu/bud/payroll.htm                              OHR Staff    512/499-4587

EMPLOYEE AND ACCOUNT INFORM ATION                             JOB POSTING I NFORMATION

Employee Name:             Last, First, MI                     Nepotism Information                    No
SSN or UTEID:              xxx-xx-xxxx                            Name:
Department:                                                       Relationship:
Replacement for:                                                   Dept/Position:
Job Posting No.:                                               Working in Texas?                            No        Yes
                                                               (if no, an Out of State Employment Supplement must be submitted with this PAF)

NEW MONTHLY APPOINTMENT

Account Number:                                                Account Number:
Budget Page:                                                   Budget Page:
Item Number:                                                   Item Number:
# Hours worked /week:                                          # Hours worked /week:
Percent Time:                                                  Percent Time:
Annual Rate:                                                   Job Class Code:
Title:
Begin Date:                     mm/dd/yyyy                     End Date:                               mm/dd/yyyy
NEW HOURLY APPOINTMENT (appointment must be vouchered for salary payments)

Account Number:                                                Begin Date:                             mm/dd/yyyy
Budget Page:                                                   End Date:                               mm/dd/yyyy
Item Number:                                                   Title:
# Hours worked /week:                                          Job Class Code:
Hourly Rate:                                                   Percent Time:

OTHER I NFORMATION (all information in this section must be completed)

Was employee notified BRP included in
                                               YES                        Initials
salary if determined eligible?
                                                                                         Hiring Official
                                                                           List all codes that apply
Is this position Security Sensitive?
See www.utsystem.edu/ohr/sspcodes.htm          YES            Code(s)                                             NO

DEPARTMENT NOTES:


APPROVED:                                                                     DATE:          11/18/2009 (will update when printed)

PREPARED BY :                                                                 PHONE :

                         RETURN COMPLETED FORM TO THE OFFICE OF THE CONTROLLER – ASH 5
FOR BUDGET STAFF USE ONLY

DOC ID#:                                      DATE:                           APVL:
DOC ID#:                                      DATE:                           APVL:                                     CAR:

*DEFINE: ________       OTIS: ___________    MM: __________    WD:                          FINAL:                      DATE:




                                                       11/18/2009 7:31 PM