New or Terminated Employee form
  1. PLEASE NOTE THAT ALL FIELDS MARKED WITH A (*) ARE REQUIRED. ALSO, IF YOU RETURN TO THIS FORM AFTER YOU PRESS THE "SUBMIT" BUTTON, YOU DID NOT FILL OUT ALL THE REQUIRED FIELDS! LOOK FOR TYPE IN RED TO INDICATE WHICH FIELDS ARE INCORRECT.
  2. Is this for a NEW HIRE - RETIREE or TERMINATION?(*)
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  3. Please indicate the Hire/Termination date.
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  4. Employee's Name(*)
    Please type the employee's name.
  5. Employee's Title
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  6. Department
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  7. Is this employee replacing a previous employee?
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  8. If replacing another employee, who?
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  9. Employee Status:
  10. Will this employee be PERMANENT or TEMPORARY?(*)
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  11. Employee's Birth Date
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  12. Will this employee need a photo for the web page?
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  13. Will this employee need computer access?(*)
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  14. Note: Please fill out this section if employee will need computer access and/or access to our network.
  15. Will this employee need a computer ordered for them?
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  16. Will this employee need a WebWork account?(*)
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  17. Will this employee need a WebWork KIOSK account?(*)
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  18. Will this emplyee need access to App Extender?
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  19. Will this emplyee need access to the Facilities Database?
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  20. Will this emplyee need access to Insight?
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  21. Will this emplyee need access to Lynx?
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  22. CONTACT/SETUP INFORMATION
  23. What is the employee's Blazer ID. (If this is unknown at this time, please forward to FAC-IT as soon as it is available.)
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  24. Please list the employees badge number found at the bottom right of their badge. (NOTE!!! THIS FIELD MUST BE FILLED OUT IF EMPLOYEE IS TO BE ADDED TO THE WEBWORK KIOSKS OR TIME KEEPING SYSTEM!)
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  25. What is the employee's HOURLY pay rate? (WebWork AND GORRIE/REGAN TIME KEEPING USERS ONLY)
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  26. What is the employee's GL account number? (WebWork AND TIME KEEPING (GORRIE/REGAN) USERS ONLY)
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  27. What is the Employee's Area (WebWork)
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  28. Where is the Employee's Primary Work Location (WebWork)
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  29. What is the Employee's Craft (WebWork)
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  30. Employee Identification/Assignment Number - Oracle number for employee that now takes the place of their Social Security Number (NOTE: IF THERE IS A -2 OR A -3 IN THE EMPLOYEES ASSIGNMENT NUMBER, YOU MUST INCLUDE THIS FOR THE GORRIE/REGAN TIME KEEPING SYSTEM!)
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  31. Pay Class and length of meal break: (Example: FT 60 Min. Meal) (FOR GORRIE/REGAN TIME KEEPING SYSTEM USERS ONLY)
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  32. Schedule Pattern: (Example: 10:00a/6:30p) (FOR GORRIE/REGAN TIME KEEPING SYSTEM ONLY!)
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  33. Physical Street Address:
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  34. Campus Delivery Address:
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  35. Supervisor / Reports To:
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  36. Room Number:
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  37. Building Name Abbrev:
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  38. Office Telephone #:
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  39. Fax Number (optional):
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  40. Other Notes:
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  41. Your Name(*)
    Please type your name.
  42. Your E-mail Address(*)
    Please type in the following format: info@info.com
  43. When you click on the SUBMIT button a copy of this form will be sent to the IT department and a copy will be sent to the address you listed in the YOUR E-MAIL ADDRESS field.
  44. Please enter the following characters:(*)
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