ࡱ> ac`Y   bjbjWW "^==]|||||||dl}  $sg|$$$\||\\\$||||||$\\ rPT||`$@<(:" STATE UNIVERSITY OF NEW YORK REQUEST FOR APPROVAL OF PROFESSIONAL APPOINTMENT (CONTINUING AND PERMANENT STATUS AND SABBATICAL LEAVES)FORM UP-3 C2629-778INSTRUCTIONSComplete for all appointment processes requiring approval of the Chancellor or the Board of Trustees. Forward first three copies to the Director, University-Wide Human Resources Appointments cannot be processed unless a copy of the appropriate Oath of Office is attached, or is on file in Albany. Use Remarks section for explanation of dual appointments with other campuses, academic rank for M/C appointees, etc. CAMPUSEMPLOYEE  FORMDROPDOWN First Name  FORMTEXT      MI  FORMTEXT      Last Name  FORMTEXT      Social Security Number  FORMTEXT      Date of Birth: Mo. Day Year  FORMTEXT       Degrees Held  FORMDROPDOWN   FORMDROPDOWN   FORMDROPDOWN   FORMTEXT      Retired Public Employee?  FORMCHECKBOX  NO  FORMCHECKBOX  YESUS. Citizen: FORMCHECKBOX  YES  FORMCHECKBOX  NO IF NO:Applied for First Papers: FORMCHECKBOX  YES  FORMCHECKBOX  NONon-Citizen: Visa Type  FORMDROPDOWN   FORMTEXT       Has Immigration Authorized Employment?  FORMDROPDOWN PRIOR SERVICEPrior Service In State UniversityDate  FORMTEXT       -  FORMTEXT        FORMTEXT       -  FORMTEXT        FORMTEXT       -  FORMTEXT      Title  FORMTEXT        FORMTEXT        FORMTEXT      Campus  FORMTEXT        FORMTEXT        FORMTEXT      Non-SUNY Prior Service Credit (Academic Staff)a. Number of Years  FORMTEXT      b. Institution(s)  FORMTEXT      Present Title, Salary and Employer (if known)  FORMTEXT       ,  FORMTEXT       -  FORMTEXT      APPOINTMENTTitle  FORMTEXT      Employee Status  FORMCHECKBOX  Management/Confidential  FORMCHECKBOX  Academic Employee  FORMCHECKBOX  Professional EmployeeDivision and Department  FORMTEXT      Item No., Budget Title and GradeDuration  FORMCHECKBOX  Continuing  FORMCHECKBOX  Permanent  FORMCHECKBOX  Term, Ending  FORMTEXT        FORMCHECKBOX  At Pleasure  FORMTEXT        REF Pres_title \h  ,  FORMTEXT      Salary and Effective Date  FORMTEXT        FORMTEXT      LEAVEType FORMCHECKBOX  Extended Sick  FORMCHECKBOX  Maternity Extension  FORMCHECKBOX  With Pay: Salary Rate  FORMTEXT      Professional Obligation  FORMCHECKBOX  College Year  FORMCHECKBOX  Academic Year  FORMCHECKBOX  Calendar YearPeriod of Leave From:  FORMTEXT       To:  FORMTEXT      OATH OF OFFICEAcademic Staff: Form B69R  FORMCHECKBOX  All Others: G 110-665  FORMCHECKBOX  FORMCHECKBOX  Attached  FORMCHECKBOX  Previously submitted  FORMTEXT      Vita Attached?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoAFFIRMATIVE ACTION DATAAppointment has complied with AAO Procedures:  FORMCHECKBOX  Yes  FORMCHECKBOX  No If  No , why exempt?  FORMTEXT      REMARKS (Attach a separate sheet of paper if necessary)  FORMTEXT      APPROVED:Campus President DateUNIV.-WIDE HR-SUP ONLYUniversity-wide Human Resources Reviewed By: _____________________________ Date: _____________________________ OATH OF OFFICE  FORMCHECKBOX  Received  FORMCHECKBOX  On File Initials ______________ APPROVED: CHANCELLOR Date: SECRETARY OF THE UNIVERSITY  FORMCHECKBOX  Approved by Board of Trustees  FORMCHECKBOX  Reported in Minutes Date:Distribution: Forward one (1) copy to University-wide Human Resources, State University Plaza. 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