Steps to Take in Employee Disciplinary

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					                                                                                                     Director / Vice President Use Only
                                                                                                       PRF Number

                                               MSUAASF INITIAL HIRE                                 Position Number

                                         CREDITABLE EXPERIENCE WORKSHEET                                Appt Status

      Human Resources


Name of Candidate:                                                                                            Date:

Department/Position:                                                                                        Range:



A. Degree/Professional Certification/Equivalency Requirement:

    Degree:                                                                                               Date:

    Educational Institution:

    Field of Study:
          OR

    Professional Certification:                                                                           Date:

    Granting Authority:
        OR

    Equivalent Combination of Education and Experience

    Education Information:

     Experience Information:




B. Creditable Experience Determination
    Type 1. Professional-level teaching & administrative experience within all MnSCU Colleges
       From          To                                                                                    FTE         Applicable   Creditable
     (mm/dd/yy)   (mm/dd/yy)            Position & Rank                           Institution          Determination     Years        Years




                                                                                                                           Total:
    Type 2. Professional-level teaching & administrative experience within all MnSCU Universities
       From          To                                                                                    FTE         Applicable   Creditable
     (mm/dd/yy)   (mm/dd/yy)                Position                              Institution          Determination     Years        Years




                                                                                                                           Total:




                                                               Page 1 of 3
Type 3. Professional-level teaching & administrative experience within higher education, 2 year colleges outside of MnSCU
  From          To                                                                                             FTE         Applicable   Creditable
(mm/dd/yy)   (mm/dd/yy)                  Position                                 Institution              Determination     Years        Years




                                                                                                                               Total:

Type 4. Professional-level teaching & administrative experience within higher education, 4 year universities outside of MnSCU
  From          To                                                                                             FTE         Applicable   Creditable
(mm/dd/yy)   (mm/dd/yy)                  Position                                 Institution              Determination     Years        Years




                                                                                                                           Total:
Type 5. Discretionary
5.1 Professional-level teaching & administrative experience in K-12 (e.g., teacher, librarian, principal, superintendent, etc.)
  From          To                                                                                             FTE         Applicable   Creditable
(mm/dd/yy)   (mm/dd/yy)                  Position                                  Agency                  Determination     Years        Years




                                                                                                                               Total:


5.2 Professional level experience outside education ONLY if work experience is directly related to the MSUAASF position upon hire
  From          To                                                                                             FTE         Applicable   Creditable
(mm/dd/yy)   (mm/dd/yy)                  Position                                  Agency                  Determination     Years        Years




                                                                                                                               Total:

5.3 Clerical/Technical/Paraprofessional Experience within/or outside MnSCU institutions ONLY if the work experience is directly related
to the MSUAASF position upon hire
  From          To                                                                                             FTE         Applicable   Creditable
(mm/dd/yy)   (mm/dd/yy)                  Position                                  Agency                  Determination     Years        Years




                                                                                                                            Total:




                                                              Page 2 of 3
   5.4 Graduate/teaching assistantships Experience within/or outside MnSCU institutions ONLY if the work experience is directly related to
   the MSUAASF position upon hire
      From               To                                                                                                        FTE         Applicable    Creditable
    (mm/dd/yy)        (mm/dd/yy)                        Position                                  Agency                       Determination     Years         Years




                                                                                                                                                   Total:
   5.5 Volunteer Experience: Professional-level experience ONLY if a) the work experience is directly related to the MSUAASF position
      From               To                                                                                                        FTE         Applicable    Creditable
    (mm/dd/yy)        (mm/dd/yy)                        Position                                  Agency                       Determination     Years         Years




                                                                                                                                                   Total:

   5.6 Minnesota Statute 192.261 requires recognition of years of military service which resulted from conscription (drafted) and which
   interrupted service in the Minnesota State Colleges and Universities system
      From               To                                                                                                        FTE         Applicable    Creditable
    (mm/dd/yy)        (mm/dd/yy)                        Position                                  Agency                       Determination     Years         Years




                                                                                                                                                Total:
                                                                                                                               Total of all Creditable
                                                                                                                                         Experience:
                                                                   Creditable Years in Equal or Higher MSUAASF, MnSCU Program Director, MnSCU
                                                                                         Program Supervisor and/or MnSCU Administrator Ranges:

C. Step Placement Determination
    Target Step Based on Creditable Years:
      Minimum Step Based on Creditable Years:
                    NOTE: a) at or below target (May not be more than two steps lower than target)
                             b) above target up to and including step 10 (university must retain market justification) or
                             c) above target over step 10 (university must receive prior approval from MnSCU OOC)

D. Approvals

   I attest that all statements and representations set forth above are true and accurate. Inaccurate statements or misrepresentations
   concerning my work experience may lead the University to take one or more of the following actions: withdrawal of an offer of
   employment; modification of starting salary; and in the event that I become an employee, disciplinary action up to and including
   discharge.


   Candidate Name                                                                                          Signature                                        Date



   Evaluator 1, (Supervisor or VP)                                                                         Signature                                        Date



   Evaluator 2, (HR Director/Designee)                                                                     Signature                                        Date

                                         This Form and all Attached Documentation Must be Retained in Human Resources.      Last Rev. 11/08




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