Fillable Form 2: 4 3 1 PERSONNEL ACTION FORM (Research Corporation of University of Hawaii)

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Form 2: 4 3 1 PERSONNEL ACTION FORM (Research Corporation of University of Hawaii)

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  • 24 check-boxes
  • 94 other fields

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File type: PDF

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Page 1 of 2
Research Corporation
of the University of Hawai‘i
PERSONNEL ACTION FORM (PAF)
1
NAME: (Last, First, Middle Initial)
RCUH Employee 6-digit ID Number:
2
Type of Action: select
New Hire
Rehire - date of last employment
(mm/dd/yyyy)
Change Action during employment
(skip to line 9)
NEW-HIRES/REHIRES ACTIONS (complete 3, 4, 5, 6, 7, 8 and 15)
3
Employment Category Regular Temporary Student Intermittent Relief Crew
Select Non-Regular (category) Other
4
Appointment Period(mm/dd/yyyy):
From:
To:
5
Project Number(s): Project A Project B Project C Project D
Project # (use 7 digit proj. #):
Budget Category (use 4 digit B.C.):
% of Charge (must total 100%): % % % %
6
Location Code:
Project/Program Name
Work Location:
City/Island: State:
Payroll Distribution Code: Sub-Group:
Requested Base Pay Rate (select monthly or hourly):
$ per month
$ per hour
7
Position Title (& Position # for Regular Hires)
8
A. Is Selectee currently an RCUH employee? Yes* No
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 in box 15:
POST NEW HIRE CHANGE ACTIONS (complete applicable fields 9-15)
A
B
D
E
Place “X” in
applicable action
rows below in
column A
EFFECTIVE
DATE
(mm/dd/yyyy)
CHANGE ACTION CURRENT TO
9
Project No. & Allocation
Project Number(s) (use 7
digit proj. #)
Budget Category (ies)
(use 4 digit B.C.)
% of Charge (Total
allocations must = 100%)
Proj # BC % Charge
A. %
B. %
C. %
D. %
Proj # BC % Charge
A. %
B. %
C. %
D. %
10
FTE%
11
Pay Rate
12
Pay Range
13
Position Title
14
Other:
RCUH Form D-4
revised 03/04/98, 10/16/2020
Page 2 of 2
Research Corporation
of the University of Hawai‘i
15
COMMENT- Explanation of personnel action (include details of this personnel action):
(a) Include name/email/phone number of project’s contact person for this action.
(b) Attach applicable supporting documentation.
16
Certification: I certify the information contained in this personnel action is accurate and meets all terms and conditions of the
applicable awards being charged, (for federal awards) compliant with 2 CFR 200.430 and all applicable RCUH Policies.
17
Signature of Principal Investigator and/or Authorized Designee
Date (mm/dd/yyyy)
18
Name/Title (please print)
Email/Phone Number
19
Signature of University of Hawai`i Fiscal Administrator
Date (mm/dd/yyyy)
20
Name/Title (please print)
Email/Phone Number
21 & 22 for RCUH Human Resources Department Use Only
21
RCUH Human Resources Department Authorization:
Date (mm/dd/yyyy)
Director of Human Resources or RCUH Human Resources Staff with Delegated Authority
22
RCUH Data Entry Coding Section
Coding/Input/Audit Check:
Coded by: Date: Input by: Date: Checked by: Date:
(Print Initials)
RCUH Form D-4
revised 03/04/98, 10/16/2020
Plan Type: 10 / 15 11 / 16 18 / 19 / 1A
Cov Beg/End Date: ________
Ded Beg/End Date: ________
Plan Type: 40 (SRA)
Cov Beg/End Date: ________
Create Gen Ded: GRA
Ded Beg/End Date:
Plan Type: 60 / 61 / 6X / 6Y
Cov Beg/End Date: ________
Ded Beg/End Date: ________
Create Gen Ded: FSAEXP / PRKEXP
Ded Beg/End Date: ________
Create Gen Ded: LTCARE
Ded Beg/End Date: ________
Plan Type: 23 (Life)
Cov/Ded Beg/End Date: ________
Plan Type: 31 (LTD)
Cov/Ded Beg/End Date: ________
LVA Payout: Yes / No
LSK Payout: Yes / No
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Form 2: 4 3 1 PERSONNEL ACTION FORM (Research Corporation of University of Hawaii)

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Completed 2 November 2020

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