Spreadsheet: 1981a528-af59-4631-901f-5eabef7711a7
Sheet: PAF.OriginalRevised

 | ALCORN STATE UNIVERSITY
 | PERSONNEL ACTION FORM
 | To avoid processing delays, please ensure all applicable sections are complete and accurate.
 | Personal Data
 | 1 | Last Name |  |  | Suffix | First Name |  |  |  | Middle |  |  |  |  | Prefix | SSN / ID |  |  |  | Current Date
 |  | Current Date |  | SSN |  |  | Date of    Birth |  |  |  |  | Home Phone #
 |  | Street Address |  |  |  | City |  |  |  | County |  | State |  |  |  |  |  |  |  |  |  | Zip Code
 |  | Type of Action |  |  |  |  |  | Action Dates |  |  |  |  |  | Comments
 | 2 | Original Appointment |  |  | Complete Section 4A |  |  | Effective date provided by HR |  |  |  |  | Use the section below for further explanation
 |  | Re-Employed (break in employment) |  |  | Complete Section 4A |  |  | Effective date provided by HR
 |  | Extension of Employment (no break) |  |  | Complete Sections 4A and 4B |  |  | Effective Date
 |  | Promotion / Merit / Annual Inc. |  |  | Complete Sections 4A and 4B |  |  | Effective Date
 |  | Transfer |  |  | Complete Sections 4A and 4B |  |  | Effective Date
 |  | Release Time (Projects Only) |  |  | Complete Sections 4A and 4B |  |  | Effective Date
 |  | Separation |  |  | Complete Section 4B |  |  | Last Date Worked
 |  | Other (specify): |  |  |  |  |  | Effective Date
 | Position Data
 |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] (select for NEW Adjunct Faculty, RECENTLY RETIRED, or to RENEW former members if there has been more than 1 year break in service, otherwise include on Overload or Summer Assignment Action Form)
 | 3 | A.  Position Type: |  |  | Staff |  |  | Faculty
 |  | [NAME], if [NAME]: |  |  | Instructor |  |  | Assistant Professor |  |  |  |  | Associate Professor |  |  |  | Professor |  | OR |  | NON FACULTY
 |  | [NAME]: |  |  | 9 Months |  |  | 10 Months |  |  |  |  | 11 Months |  |  |  | 12 Months |  |  |  | Other
 |  | [NAME]: |  |  | Monthly |  |  | Bi Weekly |  |  |  |  | One Time Pay at END of the: Semester/Summer Session/Assignment
 |  | [NAME]: |  |  | Full Time |  | 2 | Part-time   -   FTE for part-time:
 |  | F.  Assignment: |  |  | Regular |  |  | Regular (Temporary Funding Source)-End Date: |  |  |  |  |  |  |  |  | Temp Employment - End Date:
 |  | [NAME]? |  |  | No |  |  | Yes  -  Retirement Date:
 |  | H.  Total Salary: |  | Per Year |  |  | Per Hour |  |  |  | Per Other
 |  | I.  HOME ORGANIZATION (or HOME DEPARTMENT):  If this is a Restricted Project, Indicate a Department from the E&G printed budget's Table of Contents that most closely relates to the project, or
 |  | indicate the department to which the employee's check should be distributed.
 |  |  | Home Organization Code: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 | 0
 |  | Receiving Department
 | 4A | POSITIONS CONTAINING E&G FUNDS: budget managers should assign a position from your printed budget.  If the position is temporary, an applicable pooled position number should be assigned.
 |  | 100% RESTRICTED FUNDS:  the position number will be assigned by a Grants & Contracts Accountant
 | To | Position Number |  |  |  | Position Title
 |  | Source of Funding (RECEIVING DEPARTMENT)
 |  | E&G Budget Line # | Budget Page # |  | Fund Code |  | Organization Code |  | *Account Code |  |  | Budget / Grant Name |  |  |  |  |  | **Percentage of Funds |  | Salary Amount Per Account
 |  |  | *Account Code: Indicate 611000 for instructional compensation allotment,     612000 for all other monthly compensation,     622000 for biweekly compensation |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | **Percentage of funds: to be carried 2 decimal places. Do not round
 |  | Releasing Department
 | 4B | Position Number |  |  |  | Position Title
 | From | Source of Funding (RELEASING DEPARTMENT)
 |  | E&G Budget Line # | Budget Page # |  | Fund Code |  | Organization Code |  | Account Code |  |  | Budget / Grant Name |  |  |  |  |  | **Percentage of Funds |  | Salary Amount Per Account
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL
 | Approvals
 | 5 | Funds Approval
 |  |  |  | Grants and Contracts |  |  |  |  |  |  |  | Budget Office
 |  | *I UNDERSTAND THAT NO INDIVIDUAL SHALL BE ALLOWED TO START A WORK ASSIGNMENT WITHOUT PRIOR AUTHORIZATION OF HUMAN RESOURCES*
 |  | Approvals Required for Section 4A (RECEIVING DEPARTMENT) |  |  |  |  |  |  |  |  | Approvals Required for Section 4B (RELEASING DEPARTMENT)
 |  | Budgetary Authority: |  |  |  |  |  |  | Date |  | Budgetary Authority: |  |  |  |  |  |  |  |  |  | Date
 |  | [NAME] or [NAME]: |  |  |  |  |  |  | Date |  | [NAME] or [NAME]: |  |  |  |  |  |  |  |  |  | Date
 |  | Area Vice President: |  |  |  |  |  |  | Date |  | Area Vice President: |  |  |  |  |  |  |  |  |  | Date
 |  | President (if applicable): |  |  |  |  |  |  | Date |  | President (if applicable): |  |  |  |  |  |  |  |  |  | Date
 | Approvals Required for Original Appointment/Re-Employed Only |  |  |  |  |  |  |  |  |  | Signature (Original Appointments & Re-Employed Only)
 | 6 | Dir. of Human Resources |  |  |  |  |  |  | Date |  | Employee |  |  |  |  |  |  |  |  |  | Date
 | Human Resources or Payroll Use Only
 | 7 | Is Position Exempt under FLSA? |  |  | Yes o  No o |  | Effective Date of Hire: |  |  |  | Date |  |  |  | Date to HR |  |  | Date
 |  | EEOC CODE: |  |  | EClass: |  | Payroll Review: |  |  |  | Date |  |  |  | Banner Entry Date |  |  | Date