RESEARCH PERSONNEL NEW HIRE FORM

Please use this form to generate information for hiring a staff member who will be salaried by sponsored research funds.
POSITION/TITLE *
EMPLOYEE NAME * First Last
EMPLOYEE ADDRESS *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
DEPARTMENT *
OFFICE/LABORATORY LOCATION
OFFICE/LABORATORY TELEPHONE NUMBER - ### - ### ####
COST CENTER/GRANT 7-DIGIT ACCOUNT NUMBER *
EMPLOYMENT STATUS *
FULL TIME PART TIME ONE-YEAR TEMPORARY
START DATE * / MM / DD YYYY
Please provide any notes if needed regarding start date.
END DATE (if temporary) / MM / DD YYYY
DO YOU WISH THE OFFER LETTER TO BE EXPLICIT ABOUT THE 3-MONTH PROBATIONARY PERIOD POLICY? *
YES NO
BASIS OF APPOINTMENT *
12-MONTH 9-MONTH OTHER
ADMINISTRATIVE/PROFESSIONAL?
12-MONTH 9-MONTH OTHER
PROPOSED SALARY RANGE (only include if position is administrative/professional)
STAFF?
12-MONTH 9-MONTH OTHER
HOURLY RATE (only include if staff)
HOURS PER WEEK (only include if staff)
PAY GRADE (only include if staff)
BENEFIT ELIGIBLE? *
YES NO
IF YES:
MEDICAL PENSION DENTAL LIFE & LTD OTHER
(Please Note: Dental and Life & LTD Benefits have delayed start dates.)
ARE THERE TEACHING RESPONSIBILITIES WITH THIS POSITION?
YES NO OTHER
SUPERVISOR/PRINCIPAL INVESTIGATOR *
DEPARTMENTAL CONTACT AND TELEPHONE NUMBER
PLEASE PROVIDE BRIEF JOB DESCRIPTION *
PLEASE ATTACH RESUME *
ACKNOWLEDGEMENT AND ELECTRONIC SIGNATURE REQUIRED:
By checking this box, I confirm that I have reviewed Haverford College’s Hiring Procedures, including information about appropriate employee title and salary band. *
I agree I do not agree
Date * / MM / DD YYYY