FDLFallSemsterFullPay.xls

	A	B	C	D	E	F	G	H	J	K	L	M	O	P	Q	R	S	T	U	W	X	Z	AA
1	This is a sample for a Faculty Development Leave (Fellowship) for 9/12 Fall Semester Only with full pay.
2	Employee Name Last											First							Middle Initial
3	Personnel #											SSN #
4			(Personnel # required on all changes/separations)											(SSN required for on all actions)
5	Organizational Unit Name													Org. Unit Number
6
7
8	Personnel Action Form
9
10
11	PAF Completed By									Phone #				Email							Date
12
13	PAY GRADE (Pay Scale Group)										JOB CLASS TITLE			Assoc Professor
14	EMPLOYEE SUBGROUP					K1					JOB CLASS CODE			49095152
15
16	EFFECTIVE DATES OF ACTION (MM/DD/YYYY): From												09/01/2005			To			02/28/06
17	SELECT AN ACTION (enter X in as many boxes as applicable)
18
19		New Hire								Rehire							Separation *
20
21		Student Hire Credit Hrs					required			Rehire as Volunteer							Separation with Pay or Benefits *
22
23	Hrs Worked						required			Rehire as Ancillary							Campus Transfer Out *
24
25		Ancillary Hire								Funding Change (for cost object change only)							LOA without Pay *
26
27		Volunteer Hire								Employment % - FTE Change *						X	LOA with Pay *
28
29		NonResAlien Hiring Addendum								Salary/Rate Change *						X	Return from LOA
30
31		Campus Transfer In								Organizational Change*						* Requires a Reason Code
32
33	ACTION (IT0000)
34
35	Reason Code		06					Position #		09085			Employee Group - U.S. Citizen ?								Yes	No
36
37	PERSONAL DATA (IT0002) refer to Personal Data Form
38
39	ORGANIZATIONAL ASSIGNMENT (IT0001) sets up employee relationship to entire University organization
40	Benefits % (Contribution percentage toward benefits for contractual period):												OR	Enter X if appropriate :
41
42	100		% for 12 months						% for 9 or 10 months						Ret/Ancil				Not Eligible
43
44	ALL CURRENT POSITIONS AT THE UNIVERSITY
45
46									Position Number							Staffing Percent
47			1						9085
48			2
49									TOTAL							=100%
50
51	ADDRESSES (IT0006) refer to Personal Data Form
52
53	PLANNED WORKING TIME (IT0007) sets up employee relationship to his/her current University contracts
54
55	Work schedule rule:					Salary		M-F@ 8hrs/day				Other Days/Hours			Shift				Actual Time Reporting (Positive)
56
57	Hours scheduled per week (check one):							Full Time (40 hours)				Other		hours
58
59	Leave Plan Code:									Contract Length Code:					02
60
61	Comments:			Faculty Development Leave Fall Semester 05 ONLY @ full pay
62	(Salary base of $120,000); Returning from LOA on 01/02/2006
63	(Admin. Stipends must be removed during leaves; Professorship stipends remain intact)
64
65	BASIC PAY (IT0008) sets up employee relationship to payroll
66
67	Wage Type		1008			Amt $	10000.000			hr	X	mo	Wage Type				Amt $				hr	mo
68
69	Wage Type					Amt $				hr		mo	Wage Type				Amt $				hr	mo
70
71
72	COST DISTRIBUTION (IT9027) NOTE: the last line of funding must show a 12/31/9999 end date; the funding dates are not the appointment dates
73	Funding Dates				Cost Center or WBS Element													$ Rate hourly or monthly		% of Cost Distribution
74	Begin		End		Cost Center or WBS Element								Position #	Wage Type				$ Rate hourly or monthly		% of Cost Distribution
75	09/01/2005		12/31/999		21-05XX-0001								9085	1008				10,000.000		100.00%			10,000.000
76																				0.00%
77																				#DIV/0!
78	Note: Percentage must equal 100% for any given period of time shown TOTAL =																			100%
79
80	PAID APPOINTMENTS (IT9001) overview of current paid positions, appointment dates, earnings and FTE
81	Appointment		Appointment						Title Modifier			Budgeted Annual Salary		OR		Total Amount To Be Paid				FTE % relative to full time
82	Start Date		End Date		Position #				Title Modifier			Budgeted Annual Salary				Total Amount To Be Paid				FTE % relative to full time
83
84
85
86
87	UNPAID APPOINTMENTS (IT9001) overview of current unpaid positions for reporting purposes
88	Appointment		Appointment										Title
89	Start Date		End Date		Title								Modifier	Organizational Unit Number
90
91
92	BANK DETAILS (IT0009) / TAX AREA (IT0207): NE / TAX WITHHOLDING W4/W5 (IT0210)
93	ADDITIONAL PERSONAL DATA refer to Personal Data Form
94	RESIDENCE STATUS (I-9) (IT0094)
95	RESIDENCE STATUS (I-9) (IT0094)								C - Citizen			N - Non-citizen			A - Alien, non-resident
96
97	DATE SPECIFICATIONS (IT0041) (MM/DD/YYYY)
98	I-9 Date required												Last Working Date
99	First Working Date required												University Service Date
100	Tenure Date												Leave Accrual Date