Form D-4 - Personnel Action Form - Rcuh
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1
2Research Corporation
of the University of Hawai‘i
Human Resources Department
Personnel Action Form
Name: Last
First
MI
1
New Hire
Rehire- date last employment
Change in Present Employment
Type of Action:
2
(skip to line 9)
NEW-HIRES/REHIRES
Employment Category
Regular
Temporary
Student
Intermittent
3
Relief
Relief Probation
Non-Regular
Other:
Recommended Appointment Period:
4
From:
To:
Project(s):
Project A
Project B
Project C
Project D
5
Project # (use 6 digit proj. #):
Budget Category (use 4 digit B.C.):
% of Charge (must total 100%):
%
%
%
%
Program Name or Department:
Base Pay Rate (select one type):
6
$
per month at
%FTE
Work Location:
City/Island:
State:
$
per hour at
%FTE
Country (if not in the USA):
$
total lump sum
Payroll Distribution Code:
List payment schedule for multiple payments:
Position Title (& Position # for Regular Hires)
7
A. Is Selectee currently an RCUH employee?
Yes*
No
8
B. Is Selectee currently an employee of a governmental agency?
Yes*
No
C. Does the Selectee currently have relatives employed with RCUH, UH
or the State of Hawai’i that have a direct relationship with your project?
Yes*
No
* If you answered yes to any question, please explain:
CHANGES
X
EFFECTIVE DATE
CHANGE
CURRENT
TO
9
Purchase Order/ Project
Proj #
BC
% Charge
Proj #
BC
% Charge
Number(s) (use 6 digit
A.
%
A.
%
proj. #), Budget
Category (ies) (use 4
B.
%
B.
%
digit B.C.) & % of
C.
%
C.
%
Charge
(must total 100%)
D.
%
D.
%
X
EFFECTIVE DATE
CHANGE
CURRENT
TO
10
FTE%
11
Pay Rate
12
Pay Range
13
Position Title
14
Other
INCOMPLETE/INCORRECT FORMS WILL BE RETURNED FOR COMPLETION/CORRECTION
RCUH Form D-4
revised 03/04/98, 3/28/16, 11/07/16
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