REV 02/19/19
3-in-1 Form
EmplID
PUBLIC
OFFICERS
A public or political office is defined as position that is held at the local, state, or national level and is the result of a public
election or appointment in mid-term to a position normally determined by a public election. Prior to any offer of appointment
as an employee or consultant, an appropriate review will be required to minimize the possibility of negative repercussions
based on a perception that a conflict of interest exists in making such an appointment. For additional information, please visit
the guidelin
es at: http://hr.ucf.edu/files/Guideline_Appt_Public_Office_09.05-21_BOTapproved1.pdf.
Please check one box:
I certify that I do currently hold, or have held in the past, a public or elected official position.
Please indicate the Public or Elected Position
Title:
I
certify that I do not currently hold, or have held in the past, a public or political office.
NOTIFICATION OF SOCIAL SECURITY NUMBER COLLECTION AND USAGE
Providing your Social Security number to the University of Central Florida is a required condition of employment. The
Human Resources Department collects and uses your social security number only for the following purposes in performance
of the University’s duties and responsibilities. To protect your identity the University of Central Florida will secure your SSN
from unauthorized access, will never release your SSN to unauthorized parties, and will assign you a unique employee
identificatio
n number. This unique ID number is used for all associated employment and educational purposes. To ensure
that you are properly linked to outside governmental entities such as the Internal Revenue Service, your social security
number is used for any or all of the following legitimate business purposes
:
•
For processing payroll and other human resource functions, including
benefits, credentialing, tax reporting, unemployment reporting,
workers compensation, direct deposit, and payroll deductions
(including for University gifts or services such as parking fees, etc.)
Required by the Internal Revenue Code (see
sections
3402(f)(2)(A) and 6109 and implementing
regulations). See also Florida Statute
119.071(5(a)6 (authorized)
•
For use in the proper identification and background
screening of employees, vendors and volunteers
Immigration and Control Act of 1986 – 8 USC
1324
(required)
•
For use in administering federal and state programs, including
verifying program eligibility and reporting data for accountability
measures
Higher Education Act (HEA) of 1965 (see
Sections
483 and 484) (required; authorized); Florida
Statute
1001.706(5)(d) and 1008.31(3) (authorized)
•
For use in processing employee health related benefits including
medical claims and identifying patients
See Florida Statute 119.071(5)(a) and(5)(a)6.f.
(authorized)
By checking this box, I certify that I have read and understand the Notification of Social Security Number Collection
and
Usage
UCF REGULATIONS AND P
OLICIES
By initialing here, I understand it is my responsibility to read and adhere to, as well as educate my subordinates
about, UCF Policies and Regulations, which are located at http://policies.ucf.edu and
http://regulations.ucf.edu/
.
EMPLOYEE SIGNATURE S
ECTION
Employee Signature Date
click to sign
signature
click to edit
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