POSITION NUMBER

EMPLOYMENT CATEGORY: ☐ 9-Month ☐ 12-Month ☐ Other (specify)

Academy Non-Academic Civil Service

Temporary Part-time( % of Full-time) Restricted

Tenure Undergraduate Student Job Appointment

Tenure Track Graduate Assistant Probationary

Other (specify) Retiree Return To Work Permanent Status

Length of Employment ___ To ___

Effective Date ___

Name ___ SS# ___ Sex ___ Race* ___

Position Title ___

Department ___

Check One □ Existing Position □ New Position *Visa Type (See Reverse Side) □

(Position vacancy authorization form must be processed and approved

Position vacancy authorization form must be processed and approved to fill existing and new positions. Position must be advertised before Expiration Date ___

processing PAF, if applicable.)

Years Experience: ___ Kentucky State University Experience ___

Degree(s): Type/Discipline (BA-Education): Institution/Location (KSU/Frankfort, Kentucky ___

Year:

___ ___

Current Employer ___

Check One ☐ New Appointment ☐ Continuation ☐ Sabbatical ☐ Leave of Absence

☐ Transfer ☐ Replacement ☐ Other (Specify) ___

RecommendedSalary ___ SalaryBudgeted ___

Source of Funds ___

Identify Budget: _____ Location _____

Form Code: ___ Page ___ Item # ___

Change of: From To

Position ___

Status ___

Salary ___ List total funds currently paid this employee by Kentucky State University:

List total funds currently paid this employee by Kentucky State University:

*See Reverse Side

Comments: (use back of form)

Source of Funds

Amount

erse Side Graduate School signature (if applicable): Page 44 of 218

Supervisor Date

Dean/Unit Head Date

Division Vice President Date Dean/Unit Head

Provost Date

Provost Date

Novost Date

Director of Human Resources Date Provost

Vice President of Finance and Administration Date

_____.

President Vice President of Finance and Administration Date

Date Chairman, Kentucky State University Board of Regents

Chairman, Kentucky State University Board of Regents Date

Date