NOTIFICATION of APPOINTMENT – Form is routed to HR Consultant by department Department Name: _____________________________________ Department Contact Name: ______________________________ Department Contact Email: _________________ Type of Background Check: _____Standard _____Standard plus Education Is this employee an authorized adult under AD39? (will have routine contact with minors)

Yes No Has the employee worked/volunteered for Penn State University in the last 6 months?

Yes No Insert specific instructions for the background check below.

1. Employee Information:

Employee Name __________________________________ PSU ID# _________________ Employee Email Address: ________________________ Employee Start Date _________________ Employee End Date:____________________

Employee Office Phone # _____________________

Employee Office Address: ______________________________

Employee Physical Office Address: _______________________________

2. EJMS # _____________________ Position Number (To be filled by HR Consultant):____________

   

         

3. Staff/Faculty – Provide information on Teaching Schedule (if applicable):

Fall Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________

Spring Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________ Class_____________ Section________ Credits__________ Enrollment__________

4. Title:_________________________________ Appointment Type (STN,FTM,FT1,FT2):_____________

Rank (Academic):_____ Grade (Grad Assist./Tech. Service):____ Level (Staff):____ FTE (HR88 only)___%

5. Compensation Salary Plan: _______________ (12 months, 36 Weeks, etc…)

Salary Amount: Yearly: ________________ Monthly: __________________

Years of Tenure Credit: ____________

6. Budget Information Home Budget: ____________ Pay Budget: ____________Fund:___________ Cost Center:_________

Non-teaching responsibilities to be included in offer letter -

 

         

7. Dept Head Name/Title to be cc'd on offer letter:

Please list only those applicants that were interviewed, but not selected for your position. Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Name ___________________________________Reason for Rejection: Budget Administrator Signature: ______________________________ Human Resources Signature: __________________________________