This information is requested solely for the purpose of determining compliance with Federal Civil Rights Laws and does not affect employment consideration.
ETHNIC ORIGIN (Please check one): ☐ Hispanic or Latino ☐ Non-Hispanic or Latino
RACE (Please check all that apply):
White, not of Hispanic origin. A person having origins in any of the original people of Europe, North Africa or the Middle East.
Black, not of Hispanic origin. A person having origins in any of the Black racial groups of Africa.
Hispanic. A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origins, regardless of race.
Asian or Pacific Islander. A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.
American Indian or Alaskan Native. A person having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.
| EMPLOYEE REGULAR WORK SCHEDULE: | |
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| EMPLOYEE DIRECT SUPERVISOR: | |
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| SUPERVISOR/DEPARTMENT CONTACT NUMBER | |
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| NUMBER OF EMPLOYEES SUPERVISED, (if any) | |
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HR USE ONLY: STATUS (check one) ☐ Exempt ☐ Non-Exempt
GUIDELINES: All employees, students, graduate assistants being employed through the use of this form are to report to and be cleared by the Office of Human Resources before any employment is offered and before starting to work. All students are to bring with them clearance from the Financial Aid Office, Statement of Account (fee receipt), and a class schedule. All prospective employees/students must bring a photo ID, social security card, birth certificate, certificate of naturalization, resident alien card, H1-B and J-1 visas, passport, and F-1/I-94. The latter six (6) documents do not apply to U.S. Citizens.
Documentation must be provided for review and approval by the Office of Human Resources before employment is offered.
| CLASS OF EMPLOYMENT (VISA STATUS): |
| TYPE | CODE | EXPIRES |
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| United States Citizen/Certificate of Naturalization | US | |
| Resident Alien | RA | |
| H-1 Visa (Distinguished Merit & Ability) | H1 | |
| J-1 Visa (Student Emp. FT Student at Kentucky State University) | F1 | |
| OPT (F-1 Visa-INS Prior Approval-“Practical Work Experience”) | F0 | |
PAF APPROVAL PROCESS CHECKLIST (Must have the information outlined below):
Approved Position Vacancy Authorization Form (applicable for new and replacement positions)
sition Vacancy Announcement (position advertised before processing PAF, if applicable)
ation for Employment Form Admin/Fac/Uncl Position (Civil Service application for Classified)
thority to Release (signed by employee) (submitted to Human Resources with Criminal/Background Check Form)
supervisory Criminal/Background Check Form (completed by employee/verified and signed by supervisor)
Exemptions Survey Form (signed by employee and budget head)
Proposed Employer Appointment
Proposed Employee Clearance
Restricted/Job Appointment/CS Rule 6.5g Letter of Justification (for classified, if applicable)