Research Corporation of the University of Hawaiʻi

Research Corporation
of the University of Hawai‘i
Human Resources Department
NEW-HIRES/REHIRES
Personnel Action Form
1
Name: Last First MI
2
Type of Action:
New Hire
Rehire- date last employment
Change in Present Employment (skip to line 9)
3
Employment Category Regular Temporary Student Intermittent Relief Relief Probation Non-Regular Other:
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Recommended Appointment Period:
From: To:
5
Project(s): Project A Project B Project C Project D Project # (use 6 digit proj. #):
Budget Category (use 4 digit B.C.):
% of Charge (must total 100%): % % % %
6
Program Name or Department:
Work Location: City/Island:
Country (if not in the USA): Payroll Distribution Code:
Position Title (& Position # for Regular Hires)
State:
Base Pay Rate (select one type): $ per month at %FTE
$ per hour at %FTE
$ total lump sum
List payment schedule for multiple payments:
7
8
A. Is Selectee currently an RCUH employee?
B. Is Selectee currently an employee of a governmental agency?
C. Does the Selectee currently have relatives employed with RCUH, UH
or the State of Hawai’i that have a direct relationship with your project? * If you answered yes to any question, please explain:
Yes* No Yes* No
Yes* No
CHANGES
X
EFFECTIVE DATE
CHANGE
CURRENT
TO
9
Purchase Order/ Project Number(s) (use 6 digit proj. #), Budget Category (ies) (use 4 digit B.C.) & % of Charge
(must total 100%)
Proj # BC % Charge A. %
B. %
C. %
D. %
Proj # BC % Charge A. %
B. %
C. %
D. %
X
EFFECTIVE DATE
CHANGE
CURRENT
TO
10
FTE%
11
Pay Rate
12
Pay Range
13
Position Title
14
Other
RCUH Form D-4 INCOMPLETE/INCORRECT FORMS WILL BE RETURNED FOR COMPLETION/CORRECTION revised 03/04/98, 3/28/16, 11/07/16
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Justification of Requested Changes:
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Signature of Principal Investigator and/or Authorized Designee
Principal Investigator and/or Authorized Designee [Please Print] Date
Signature of Fiscal Administrator
Fiscal Administrator [Please Print] Date
Contact Person Regarding this Action Phone Number for Inquiries
For Regular Hires, Please Insure Applicant Review & Selection Summary Form and Selection Documents are Attached
FOR RCUH USE ONLY
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Approved – I certify that to the best of my knowledge, this personnel transaction has been made in compliance with RCUH policies, employment laws, and statutes of the State of Hawai’i.
Director of Human Resources or Authorized Designee Date
Check List:
I-9 Health Pers/Tax Flex Dir Dep Dual Drug-Free Family Hand/Vet SVOE
Coding:
Visa Code: ___________ or N/A Visa Start : ___________ or N/A
Work Auth Exp: __________ or N/A FICA Exempt: Y or N FLSA: Eor NE SDI Exempt: Y or N OT: YorN AP: _________ or N/A
Checked/Coded By:
Leave: Stnd or Other __________________ Start Date: _____ / _____ / _____
Term Date: _____ / _____ / _____
Probation Date: _____ / _____ / _____ Authorized By: __________________________ Emp # (rehires): _________________________ TIAA/CREF Reactivate: Y or N Entered By: ___________ On: _____________