Spreadsheet: 00be9607-3dc0-4853-abc6-16d29fe8fbcd
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | PCRC Approval | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20
PERSONNEL ACTION FORM
IMPORTANT:  Please complete all sections of this Personnel Action Form
Section I:   Position Information
[NAME] |  | Administrator |  |  | Academic |  |  |  | Exempt |  | Staff Non-Exempt |  |  |  |  | Technical Service
Position Title |  |  |  |  |  | Position Number |  |  |  | Job Description Code |  |  |  |  | Level |  | or |  |  | Levels
Department Name |  |  |  | Home Budget # |  |  | Position Mailcode |  |  |  | Position Room # |  |  |  | Position Phone Extension
Replacing Employee |  |  | Yes |  | NO |  |  |  |  | Did the person: |  |  |  | Terminate |  |  |  |  |  | Transfer
 |  |  |  |  |  |  |  |  |  | Date:
Person Replacing |  |  |  |  |  | PSU ID |  |  |  |  |  | Title
Is this position funded 100% by Research Grants? |  |  |  |  |  |  |  |  |  | Yes |  |  | No
Possibility of refunding? |  |  |  |  |  |  |  |  |  | Yes |  |  | No
Work Schedule: |  | Full Time |  |  | HR-88 |  |  |  | Wage-Payroll: |  |  | Regular |  |  |  |  |  |  | Temporary
If wage-payroll or Tech Service, indicate the maximum number of work hours per pay period:
If wage-payroll or Tech Service, indicate work hours: |  |  |  |  |  |  |  |  | From  ______________ to ________________  (e.g. 8 am - 12 pm)
Rotating weekend/holidays: |  |  |  |  | Yes |  |  |  | No |  |  | HR88   _____% Attach work schedule
Preferred Qualifications/Comments:  (if more space needed, attach separate sheet)
Department Manager: |  |  |  |  |  |  | Extension: |  |  |  | [NAME]:
Principal Investigator: |  |  |  |  |  |  | Extension:
Department Contact: |  |  |  |  |  |  | Extension: |  |  |  | Mail Code: |  |  |  | Fax:
[NAME] to: |  |  |  | User ID |  |  | Extension: |  |  |  | Mail Code: |  |  |  | Fax:
Section II:   Appointment Information
Standing (Full Time)
Fixed Term I: (minimum of 6 months) |  |  |  |  |  |  |  | …………………… |  | From:  _________________ to: ______________
 | Double Fill w/benefits: |  |  |  |  |  |  | …………………… |  | From:  _________________ to: ______________
Fixed Term II: |  |  |  |  |  |  |  | …………………… |  | From:  _________________ to: ______________
 | Percentage of Time Working: |  |  |  |  | %
Wage:  Staff (S) or Tech Service (T) |  |  |  |  |  |  |  |  |  |  |  | Provisional Tenure Credit Years:  _______
If Standing Academic Appointment, check tenure: |  |  |  |  |  |  |  |  | Tenure |  |  | Provisional Tenure
Section III:  [NAME] (as required) |  |  |  |  |  |  |  |  | Section IV:  Employee Information
Departmental Approval (Printed Name) |  |  |  |  |  | Date |  |  | (Please complete when position is filled)
 |  |  |  |  |  |  |  |  | Name |  |  |  |  |  |  | PSU ID #
Departmental Approval Signature |  |  |  |  |  | Date |  |  | Salary |  |  |  |  |  |  | Effective Date
Dean's Office Approval (Faculty Only) |  |  |  |  |  | Date |  |  | HR Department Use
 |  |  |  |  |  |  |  |  | Additional Information |  |  |  |  |  | [NAME]
Controller's Office Approval |  |  |  |  |  | Date
 |  |  |  |  |  |  |  |  | Vacancy # |  |  |  |  |  | Working Papers