Rrcc Appointment Form - Red Rocks Community College
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1RRCC APPOINTMENT FORM
PLEASE PRINT AND PRESS FIRMLY
EMPLOYEE’S LEGAL NAME (LAST, FIRST, MIDDLE INITIAL):
SOCIAL SECURITY #:
STREET OR P.O. BOX:
CITY:
STATE:
ZIP CODE:
HOME PHONE NUMBER:
WORK OR CELL PHONE #:
E-MAIL ADDRESS:
EMERGENCY CONTACT NAME:
EMERGENCY CONTACT PHONE NUMBER:
EQUAL OPPORTUNITY EMPLOYMENT
GENDER
DATE OF BIRTH:
ETHNICITY – CHECK ONE:
US CITIZEN
:
:
FEMALE
AFRICAN AMER
AMER INDIAN/
YES
MALE
ASIAN
ALASKAN NATIVE
NO - IF NO,
CAUCASIAN
HISPANIC/LATINO
ENTER
NATIVE HAWAIIAN/
OTHER
CATEGORY
MO
DAY
YR
PACIFIC ISLANDER
TYPE _________
EDUCATIONAL LEVEL:
1. NO ACADEMIC CREDENTIALS
2. HIGH SCHOOL DIPLOMA/GED
3. TRADE CERTIFICATE
4. SOME COLLEGE
5. ASSOCIATE DEGREE IN __________________
6. BACHELOR’S DEGREE IN _________________
7. MASTER’S DEGREE IN ___________________
8. PROFESSIONAL DEG/LICENSURE IN ________________ 9. OTHER DOCTORATE ____________________
10. Ph.D. IN _____________________
YEAR DEGREE CONFERRED ___/___/_____
HR DEPARTMENT USE ONLY BELOW THIS LINE
STATUS
:
NEW
RETURNING
REHIRE
ADDITIONAL JOB
(HAS WORKED IN THE LAST 120 DAYS)
(HAS NOT WORKED IN THE LAST 120 DAYS.)
BACKGROUND CHECK DONE _______________
DATE
SUMMER STUDENT WORKER ONLY:
TIAA-CREF ELIGIBLE?
YES
NO
(CIRCLE ONE)
ELIGIBLE FOR SHIFT DIFFERENTIAL?
YES
NO
2ND SHIFT
3RD SHIFT
(CIRCLE ONE)
CURRENT APPOINTMENT:
FT
PT
ADMINISTRATOR
CLASSIFIED
FACULTY
LIMITED FACULTY
NON-STUDENT HOURLY
PT INSTRUCTOR
STUDENT HOURLY
TECH PRO
TEMPORARY CLASSIFIED
WORK STUDY
RATE OF PAY:
ORG CODE & %:
START DATE:
END DATE:
JOB TITLE:
DEPT:
SUPERVISOR & PHONE EXT:
POSITION #:
APPT %:
S #:
SEMESTER EFFECTIVE:
TODAY’S DATE:
COMPLETED BY (PRINT NAME):
RRCC HR 5/31/11 PP ___ EMP ___ NBA ___ DED ___ COV ___ DIR ___ BEN ___ SIA ___ INI ________ DATE ____________
WHITE – HR COPY
YELLOW – PAYROLL COPY
PINK – SUPERVISOR COPY
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Parent category: Business