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Employee Assignment Form

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TheAstralMerchant
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20 views

Employee Assignment Form

Uploaded by

TheAstralMerchant
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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EMPLOYEE ASSIGNMENT FORM

Hire Date: (dd/mmm/yy) Rehire? Prev. Vested in Retirement? If Yes to Service Credit, indicate:
___Y ___N ___ SUNY
If no, Prior Service Credit? ___ Other College/University
____Y ____N ___Yes ___No ____N/A ___ Research Organization

PEOPLE DATA
Last Name: First Name: Middle Name:
Title: __Dr. __Miss ___Mr. ___Mrs. ___Ms. Gender: ___M __ F Type: Internal
Social Security #: Birth Date: (dd/mmm/yy)
Nationality: ___US Citizen ___ Non-Citizen in US on VISA ___Non-Citizen Not in US ___Perm. Resident
Ethnic Origin: (select all that apply) American Indian or Alaskan Native ____, Asian ___, Black or African American ___,
Hispanic or Latino ___, Native Hawaiian or Other Pacific ___, White ___

Further Name:
I-9 Status: __Yes __No __Pending Visa Type: I-9 Expiration Date:
Vets 100 Status: Vets 100A Status: New Hire: Include in New Hire Report
Mail Stop (Check Delivery Drop): Correspondence Language:
E-Verify Status: Date Authorized: Case Verification #:
SPECIAL INFO
Education Level: Degree Expected: Date Degree Expected:(dd/mmm/yy)
Other Special Info: ___Y ___N Specify:
ADDRESS
US Address (Primary Address in United States):
City: State: Zip Code:
County: Country:
Type: Primary: Y (this should be checked on the US address)
Telephone: ( )
E-Mail Address:
Address 2: ___US ___Foreign

City: State: Zip Code:


County: Country:
Type: Primary: N Telephone: ( )
ASSIGNMENT
Organization: Op. Location: Group:
Effort Reporting Status: N/A = Not Applicable
Job: Grade: Payroll:Biweekly
Location: Status: ____ Active Assignment ____SUNY Extra Service
Assignment Category: _____ Exempt Regular ______ Hourly ______ Nonexempt Regular
Supervisor: ________________________________ Employee Category: _______Adm__________SP___________Agy
Work Week Basis: _____37 ½ hours ____40 hours | Hourly-Benefits Eligible? __Y __N
Salary Basis: FTE: Work Region: Appointment Type:
SALARY
Proposal (Effective) Date:(dd/mmm/yy) New /Change Value:
Approved: X Reason:
Retro Required? ___No ___Yes: Begin Date: (dd/mmm/yy) Retro End Date:(dd/mmm/yy)

hafrm003 1 June 2018


EMPLOYEE ASSIGNMENT FORM
Input by: Date:

NAME: Employee #: SSN:


LABOR DISTRIBUTION
Schedule Hierarchy ___Assignment ___Element
Schedule Line Changes
LD LD
Project Task Award Organization Expenditure Type %
Start Date End Date

Input by: Date:

DECLARATION AND AUTHORIZATION


I accept the position offered as an employee of The Research Foundation for The State University of New York (“RFSUNY”). I understand this position is subject to final
approval by RFSUNY and is terminable at will. I also agree to abide by all policies and regulations of RFSUNY.

Intellectual Property Assignment


I have read The State University of New York’s Patents, Inventions and Copyright Policy (“SUNY Policy”) and RFSUNY’s Intellectual Property Policy (“RF Policy”). I
agree to abide by the SUNY Policy and the RF Policy, and by any additional terms and conditions imposed by any sponsor from which I accept support through
RFSUNY, including but not limited to the Patent and Trademark Amendments Act (i.e., Bayh-Dole Act) and its implementing regulations found in 37 CFR 401. I will
promptly disclose to RFSUNY or its designee any Intellectual Property (as defined in the SUNY Policy) subject to the SUNY Policy or sponsor requirements, and will
cooperate with RFSUNY, the sponsor, and the State University of New York, and execute any such documents as may be necessary to protect the subject Intellectual
Property. I understand that the prompt disclosure of Intellectual Property developed within the scope of my employment is required to enable its protection prior to U.S. or
foreign statutory bars and to establish the government’s rights, where applicable. I hereby assign to RFSUNY all rights in Intellectual Property subject to the SUNY
Policy, and will execute any documents required to effectuate such assignment to or as directed by RFSUNY.

As an Equal Opportunity/Affirmative Action Employer, the RFSUNY will not discriminate in its employment practices due to an applicant’s race, color, creed, religion,
sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital
status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance,
domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other
characteristics protected under applicable law. The RFSUNY will not discharge or in any other manner discriminate against employees or applicants because they have
inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.

Employee Signature:___________________________________________________________ Date:___________________________________

APPROVALS
This assignment is consistent with sponsored program terms and conditions and with Research Foundation policies.
Project Director/Co-Project Director:

(Signature) (Date)
Funds are in the account for this assignment.
Operations Manager:

(Signature) (Date)
Additional Campus Signatures as Required:

(Signature) (Date)

(Signature) (Date)

hafrm003 2 June 2018

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