POSITION NUMBER
| JOB CLASS | |||
|---|---|---|---|
| JOB CODE | |||
| CAL ID |
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