PS Recruiting

Yes

No
2. Employee Name (last, first, middle as appears on Social Secutiy Card) 3. EMPLID 4. Social Security Number

University of Missouri

1. Appl. ID (HR Use Only)

Personnel Action Form
For Data Entry Purposes Only
11. Home Dept. (Code) 12. Job Code 10. Business Unit

5. Effective Date

6. Action

7. Reason

8. Expected Job End Date 9. Position Number (If Applicable)

13. Benefit Status Regular Temporary 16. Std. Hrs.

14. Full Time

15. Empl Class 5 - JVA 8 - Per Diem 22. FICA Status 9 - Non-Emp A - Student

2 - Fac 9/9 3 - Fac 9/12 4 - Med Res 1 - Oth F/S Part Time 17. FTE 19. Holiday Schedule 18. Pay Group 20. EE Type 21. Tax Location None UM

23. Compensation Frequency/Rate Code

H

S

E

N

Hourly/ NAHRLY

Monthly/ NAANNL

Contract/ NAANNL

24. Compensation Rate

25. Comp. Freq.

26. Job Description ID

27. Benefits Eligibility Date 28. UM Working Title

29.1-9 Expir. Date

30. Work Auth. Date

31. Shift Diff Code 32. Ben. Service Date
(Hospital Use Only)

33. Probation Date

34. End Date (If applicable)

35. Academic

Yes

JOB EARNINGS DISTRIBUTION
36. Effective Date 37. Business

Unit

38. Department

39. Job Code

40. Earn

Code (3)

Continuation Sheet Attached Choose One Combination Code 41. Comp Rate 42. Distrb % 43. MoCode (5) 44. Account (6) (Monthly/Contract Only)

45. Benefit Record No.
(HR Use Only)

46. ABBR (HR use only)

47. Elig Fld 1 (Leave Plan)

48. Benefit Program Effective Date

49. Benefit Program

EXVAC

NEVAC

Nurses

None

DBP

CONTRACT INFORMATION
50. Contract Effective Date

Payment Terms
52.

53. Monthly Frequency

Begin 54a. Contract 54b. Payment

End

51. Contract Pay Type (If Applicable) 9 Over 9 9 Over 12

Pay over 12 months
Pay over months

Pay Over Contract

M

Pay Over Contract

ACADEMIC INFORMATION
55. Tenure Status Non Tenure Not On Track Non Tenure On Track Tenure 62. Comments