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Prefix Suffix Worksheet document sample
University of Colorado Phone: 303-735-6500 Payroll & Benefit Services Toll free: 877-627-1877 575 SYS Fax: 303-735-6599 3100 Marine Street, 6th Floor www.cu.edu/pbs Boulder, CO 80309-0575 Add a Person (POI) Worksheet Give this form to CU Affiliates who do not have a job record (POIs). Example: to track training for compliance purposes for an individual not paid by the University, or for security access to University systems. This form is designed to be utilized for entry into HRMS. The data may be entered online before printing. HRMS Navigation: Workforce Administration> Personal Information> Add a Person RETURN FORM TO SPONSORING DEPARTMENT - NOT TO PBS Biographical Details Effective Date: Date the relationship between the POI and CU becomes active Click here for Step by Step guide Add a Person First Name: Middle Name/Initial: Last Name: Date of Birth: (required) Gender: (required) Prefix: Suffix: Female Male ADDITIONAL BIOGRAPHICAL DETAILS REQUIRED IF POI IS REQUESTING ACCESS TO A UNIVERSITY SYSTEM RESOURCES SSN (required for Security Access POI Type) Most affiliates who are physically located external to any of the campuses of the University of Colorado use a VPN connection to their sponsoring campus' LAN to access University data and systems. Special arrangements have been made for a few organizations including The Children's Hospital, National Jewish Hospital, and NCAR. Your sponsor will probably know the status for your location. Providing the name of your local IT contact will help resolve access problems if necessary. Affiliated Organization Name IT Contact in POI Organization IT Contact Phone: Contact Information Mailing Address (Local): Address 2: City: State: Postal Code: Primary Phone Type: Phone Number: Campus1 Cellular Dorm Emergency Business Home Main Other Pager Additional Phone Type: Phone Number: Campus1 Cellular Dorm Emergency Business Home Main Other Pager Primary Email Type: E-mail Address: Campus1 Business Dorm Home Other Additional Email Type: E-mail Address: Campus1 Business Dorm Home Other A Add a Person (POI) Worksheet Page 2 of 2 First Name: Middle Name/Initial: Last Name: 0 0 0 Regional Ignore "Date Entitled to Medicare" and Citizenship Proof fields Ethnic Group: Select all groups that apply choosing one as primary. Military Status: (optional) African American Primary Not indicated 1 American Indian/Alaska Native Primary Asian Primary Caucasian Primary Hispanic/Latino Primary Native Hawaiian/Other Pacific Islander Primary Chose Not to Disclose Dept Information/Verifications Employment Eligibility Proof and Background Checks for HR use only Sponsoring Dept #: (required) Sponsoring Department Name: (required) Campus Box #: (required) Organizational Relationships Relationship: POI Type: Affiliate Affiliate - DHHA Affiliate - Kaiser Affiliate - NJH Affiliate - PSL POI - Person of Interest Affiliate - Rose Affiliate - VA COBRA participt Electronic Res. Admin. External Instructor External Trainee Other Pre-Employment Regent Security Access Student Athlete Summer Emplymt Gap Veterans Administration Visiting Scholar Volunteer Volunteer Clinical Faculty Relationship Data Sponsoring Dept #: Sponsoring Department Name: 0 0 Sponsor's Empl ID: Sponsor's Name Sponsor's Signature Sponsor's Phone #: (Must be a CU Employee): (Optional): Planned Exit Date: More information: Signature POI Signature: Date: Edit Date: 09-2010 $ NOTES TO SPONSORING DEPARTMENT: *Use this form to enter the POI information into HRMS and generate an 6-digit HRMS ID. *Inform the POI of his/her 6-digit HRMS ID. *The 6-digit HRMS ID must be on all Security Access Request forms before sending them to your campus security coordinator. *DO NOT send this form to PBS, UMS or your campus security coordinators. Destroy form or maintain with other sensitive department records. *A required "Official" email address is the official email for the university and by policy must be created by your campus IT department (not the affiliate department). After saving, contact your IT department and provide them with your new POI’s HRMS ID. The morning after the email has been created in the campus email directory, it will be loaded into HRMS and other University systems. *System access granted to POIs terminate not more than one year after the start date, but may be extended by contacting your campus security coordinators. Access will not be granted until the POI is set up in HRMS and all required trainings are verified.
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