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Prefix Suffix Worksheet University of Colorado Phone 303 735 6500 Payroll Benefit Services

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Prefix Suffix Worksheet University of Colorado Phone 303 735 6500 Payroll Benefit Services Powered By Docstoc
					                  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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