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This is a sample for an Office/Service REHIRE starting on March 18th.
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Employee Name LastFirstMiddle Initial
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Personnel #SSN #
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(Personnel # required on all changes/separations)(SSN required for all actions)
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Organizational Unit NameOrg. Unit Number
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Personnel Action Form
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PAF Completed ByPhone #EmailDate
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PAY GRADE (Pay Scale Group)
11JOB CLASS TITLEStaff Assistant
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EMPLOYEE SUBGROUPC2JOB CLASS CODE49011214
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EFFECTIVE DATES OF ACTION (MM/DD/YYYY): From03/18/XXXXTo12/31/9999
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SELECT AN ACTION (enter X in as many boxes as applicable)
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 New HireX Rehire Separation *
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 Student Hire Credit Hrsrequired Rehire as Volunteer Separation with Pay or Benefits *
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 Hrs Workedrequired Rehire as Ancillary Campus Transfer Out *
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 Ancillary Hire Funding Change (for cost object change only) LOA without Pay *
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 Volunteer Hire Employment % - FTE Change * LOA with Pay *
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 NonResAlien Hiring Addendum Salary/Rate Change * Return from LOA
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 Campus Transfer In Organizational Change* * Requires a Reason Code
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ACTION (IT0000)
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Reason CodePosition #XXXXXEmployee Group - U.S. Citizen ?XYesNo
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PERSONAL DATA (IT0002) refer to Personal Data Form
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ORGANIZATIONAL ASSIGNMENT (IT0001) sets up employee relationship to entire University organization
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Benefits % (Contribution percentage toward benefits for contractual period):
 OR
Enter X if appropriate :
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100% for 12 months% for 9 or 10 monthsRet/Ancil
Not Eligible
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ALL CURRENT POSITIONS AT THE UNIVERSITY
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Position NumberStaffing Percent
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1XXXXX100
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TOTAL =100%
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ADDRESSES (IT0006) refer to Personal Data Form
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PLANNED WORKING TIME (IT0007) sets up employee relationship to his/her current University contracts
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Work schedule rule:SalaryX M-F@ 8hrs/day Other Days/HoursShift
Actual Time Reporting (Positive)
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Hours scheduled per week (check one): XFull Time (40 hours) Other hours
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Leave Plan Code:1CContract Length Code: 12
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Comments:(Employee Name) is a rehire from the Press. Was working Temporary jobs at UNL & will now have this
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permanent Office/Service job. Vacant position was reclassified from Staff Secretary III to Staff Assistant. Set monitering date
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for Sept 18, XXXX. Was hired at regular rate not hiring rate. There will be no rate change after probation. Adjust Service Date.
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BASIC PAY (IT0008) sets up employee relationship to payroll
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Wage Type
1001Amt $11.219Xhrmo Wage Type
Amt $
hrmo
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Wage TypeAmt $hrmo Wage Type
Amt $
hrmo
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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
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Funding DatesCost Center or WBS Element$ Rate hourly or monthly% of Cost Distribution
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BeginEndPosition #Wage Type
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03/18/XXXX12/31/9999XX-XXXX-XXXXXXXXX100111.219100
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Note: Percentage must equal 100% for any given period of time shown TOTAL =
100%
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PAID APPOINTMENTS (IT9001) overview of current paid positions for reporting purposes
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AppointmentAppointmentTitle ModifierBudgeted Annual SalaryORTotal Amount To Be PaidFTE % relative to full time
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Start DateEnd DatePosition #
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03/18/XXXX12/31/9999XXXXX23,336100
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UNPAID APPOINTMENTS (IT9001) overview of current unpaid positions for reporting purposes
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AppointmentAppointmentTitle
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Start DateEnd DateTitleModifierOrganizational Unit Number
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BANK DETAILS (IT0009) / TAX AREA (IT0207): NE / TAX WITHHOLDING W4/W5 (IT0210)
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ADDITIONAL PERSONAL DATA refer to Personal Data Form
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RESIDENCE STATUS (I-9) (IT0094)
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X
C - Citizen
N - Non-citizen
A - Alien, non-resident
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DATE SPECIFICATIONS (IT0041) (MM/DD/YYYY)
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I-9 Date requiredXX/XX/XXXX Last Working Date
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First Working Date required03/18/XXXX University Service DateXX/XX/XXXX
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Tenure Date Leave Accrual DateXX/XX/XXXX