IDAHO STATE UNIVERSITY
Personnel Recommendation
Prepared by: Extension:
E-mail: Prepared Date:
Employee Name: Banner ID or Bengal/ISU ID:
Campus Work Location: City Work Location: State Work Location:
Home Address:
Forwarding Address (for resignation):
1. Action: New Appointment: Replaces (name): Re-Appointment
Leave without Pay Other (specify):
Resignation Dismissal Retirement End of Contract/Appointment - Last Day Worked:
2. Type of Employee: Classified Faculty Non-Tenure Track Faculty Tenure Track Non-Classified Other (see remarks)
3. Appointment Type (Check One):
Regular Appointment Temporary Benefitted Appointment
COMPLETE ALL APPLICABLE AREAS
CURRENT APPOINTMENT
PROPOSED NEW APPOINTMENT ACTION
Department
Title
Action Date, Position Number
and FTE (annualized % time worked)
Effective End Date
PCN
FTE
Effective Begin Date
PCN
Contract Dates (Faculty & Non-classified)
From:
To:
From:
To:
Pay Period Begin/End Dates
From:
To:
From:
To:
Pay Check Begin/End Dates
From:
To:
From:
To:
Appointment Months per Year
12 month 9 month Other ___ mo ___wk 12 month 9 month Other mo/ ___ wk
Salary Information
Annual Base
Bi-weekly
Hourly Rate
Annual Base
Bi-weekly
Hourly rate
Time Approver and/or T-Org
Budget to be charged
Index Number(s)
Amount
Percent
Index Number(s)
Amount
Percent
PI initial
Remarks on conditions of employment:
AUTHORIZING SIGNATURES
DEPARTMENT CHAIR Date UNIVERSITY BUSINESS OFFICER Date
DEAN OR DIRECTOR Date SIGNATURE AUTHORITY Date
For Human Resource and Finance Offices Use Only
Position Control Number:
Employee Class Code: IPAS No. Register Number:
Classification Number: Change Reason Code: Pay Grade:
HUMAN RESOURCES BUDGET GRANTS CONTRACT PAYROLL FILE DATE
(AS APPEARS ON SOCIAL SECURITY CARD)
End Date if Temporary
Form Revised: 10/10/2013
Date
(Instructions)