Academic Affairs - State Temporary Service Appointment Form
For Temporary Service Accounts
Please complete for all state funded positions that did NOT require a search
(except those with the title: Graduate Assistant, Student Assistant, or Visiting Faculty)
Unit/Department: ___________________________________ Title Requested (if known): _________________________________
Supervisor: ________________________________________
Salary Requested (if known): ________________ Check One: _____Hourly Rate _____Biweekly Rate _____Total Remuneration
Position Status (check one): ____ Temporary (from ____________________ to ____________________) OR _____ Term
Percent of Effort (check one): ____ Full Time or _____ Part Time non faculty(required, if selecting): _______% (specify %, ex: 25%, 50%, etc.)
Provide justification for position or attach (ex: backfill, new function, etc.): ________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
Provide brief job description or attach: ______________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
Last Name: ________________________________________________ First Name: _____________________________________
Salutation (check one): ____Dr. ____Mr. ____Ms. ____Mrs. ____Miss
Phone #: ___________________________________
Email (required): __________________________________________________
Academic Affairs Unit Head Temporary Service Accounts
____________________________________________________ _________________________________________
Department Chair/Unit Head Name—Print Name Account # if using Department Chair/Unit Head Account
____________________________________________________ ________________________________
Department Chair/Unit Head—Signature Date
____________________________________________________ _________________________________
Assistant VP for Academic Finance—Signature Date
____________________________________________________ __________________________________ ______________________
Provost—Signature (if using Provost account) Account # (provided by Provost Office) Date
Step 2: Employee Information
Step 3: Signatures for Approvals
Step 1: Complete for all Positions
Step 4: Upon Completion—Forward to The Office of Human Resources: 216 Bray Hall
Revised 3.6.19
Office of Human Resources 216 Bray Hall 1 Forestry Drive Syracuse, NY 13210 Phone: 315-470-6611 www.esf.edu
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome