Fillable New Hire Checklist Classified Staff (Metropolitan State College of Denver)

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New Hire Checklist Classified Staff (Metropolitan State College of Denver)

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New Hire Checklist – Classified Staff

Last Name: __________________________ First Name: ___________________________

Employee ID: ________________________ Title: _________________________________

Department: _________________________ Start Date: ___________________________

Background Check Authorization

Background Completion Date: ________ Entered in Banner: PPAIDEN

PEAEMPL

NBAJOBS

NBAPOSN

HR Forms

Employment Data Sheet

Voluntary Disability Form

I-9 & Forms of ID

PRWORA

SSA Form

Oath of Allegiance

Outside Employment

Compensatory Time Agreement

Payroll Forms

Direct Deposit

W-4

PERA Member Information

PERA Bill 04-257

o Date submitted to payroll __________________________

Metropolitan State University of Denver

Employee Data Sheet

(2pages)

EMPLOYEE CONTACT INFORMATION AS OF:

(DATE)

First Name: MI: Last Name:

Social Security Number: Date of Birth:

Street Address: City, State, Zip:

Personal Email: Telephone Number: Cell Home

(Please circle)

EMERGENCY CONTACT INFORMATION:

Name of Contact Telephone Number:

If different from above:

Street Address: City, State, Zip:

VOLUNTARY INFORMATION SELF IDENTIFICATION:

Disclosure of self-identification information is voluntary and responses will not be used in a discriminatory

manner.

Gender: Citizenship Status: If Other than a United States Citizen

Female Male

Visa Type Country Visa Exp. Date

Ethnicity (select one):

Hispanic/Latino, Chicano, Cuban, Puerto Rican, Mexican American

Non-Hispanic/Latino

Race (regardless of answer above, select all that apply):

American Indian or Alaskan Native – A person having origins in any of the original peoples of North and South America

(including Central America), and who maintain cultural identification through tribal affiliation or community recognition.

Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent,

including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and

Vietnam.

Black or African-American – A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or

other Pacific Islands.

White, Anglo, Caucasian – A person having origins in any of the original peoples of Europe, Middle East, or North Africa.

Voluntary Self-Identification – Protected Veteran Status:

This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as

amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take

affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active

duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the

appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the

effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

These classifications are defined as follows:

I am not a Veteran.

I am not a protected veteran.

A “disabled veteran” is one of the following:

 A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but

for the receipt of military retired pay would be entitled to compensation) under laws administered by the

Secretary of Veterans Affairs; or

 A person who was discharged or released from active duty because of a service-connected disability.

A “recently separated veteran” means any veteran during the three-year period beginning on the date of such

veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

 Date of Separation:

An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S.

military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has

been authorized under the laws administered by the Department of Defense.

An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military,

ground, naval or air service, participated in a United States military operation for which an Armed Forces service

medal was awarded pursuant to Executive Order 12985.

Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment

Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may

be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for

the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training

Service (VETS), toll-free, at 1-866-4-USA-DOL.

EMPLOYEE SIGNATURE: DATE:

click to sign

signature

click to edit

__________________________ __________________

Voluntary Self-Identification of Disability

Form CC-305

OMB Control Number 1250-0005

Expires 1/31/2020

Page 1 of 2

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to

qualified people with disabilities

To help us measure how well we are doing, we are asking you to tell us if you

have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will

choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used

against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may

become disabled at any time, we are required to ask all of our employees to update their information every five

years. You may voluntarily self-identify as having a disability on this form without fear of any punishment

because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that

substantially limits a major life activity, or if you have a history or record of such an impairment or medical

condition.

Disabilities include, but ar

e not limited to:

Blindness

Deafness

Cancer

Diabetes

Epilepsy

Autism

Cerebral palsy

HIV/AIDS

Schizophrenia

Muscular

dystrophy

Bipolar disorder

Major depression

Multiple sclerosis (MS)

Missing limbs or

partially missing limbs

Post-traumatic stress disorder (PTSD)

Obsessive compulsive disorder

Impairments requiring the use of a wheelchair

Intellectual disability (previously called mental

retardation)

Please check one of the boxes below:

☐

YES, I HAVE A DISABILITY (or previously had a disability)

☐

NO, I DON’T HAVE A DISABILITY

☐

I DON’T WISH TO ANSWER

Your

Name

Tod

ay’s Date

Voluntary Self-Identification of Disability

Form CC-305

OMB Control Number 1250-0005

Expires 1/31/2020

Page 2 of 2

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.

lease tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples

of reasonable accommodation include making a change to the application process or work procedures,

providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal

employ

ment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract

Compliance Programs (OFCCP) website at

www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required

to respond to a collection of information unless such collection displays a valid OMB control number. This

survey should take about 5 minutes to complete.

I-9 EMPLOYMENT ELIGIBILITY VERIFICATION FORM

ELECTRONIC PROCESS

Employee Portion: Link to Equifax Secured website:

https://secure.i9.talx.com/FormI9/Section1/LoginCaptcha.ascx?Employer=17682

1) Complete Section 1

 Name (if no middle name enter “n/a”)

 Address

 Date of Birth

 Social Security Number

 Email Address

 Telephone Number

 Location – MSU Denver Main Campus

 Employment Date

 Citizenship Status

 Preparer

2) Click Continue

3) 2

Page

 Verify Information

 Complete Electronic Signature

4) Click Continue

5) 3

Page

 Email Copy – Optional

 Click “LOGOUT” to save

6) Bring in the acceptable Forms of Identification to your orientation session (see next page)

 One item from List A

 One item from List B plus one item from List C

Page 9 of 9Form I-9 03/08/13 N

LISTS OF ACCEPTABLE DOCUMENTS

Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274).

For persons under age 18 who are

unable to present a document

listed above:

LIST A LIST B LIST C

2. Permanent Resident Card or Alien

Registration Receipt Card (Form I-551)

8. Employment authorization

document issued by the

Department of Homeland Security

1. Driver's license or ID card issued by a

State or outlying possession of the

United States provided it contains a

photograph or information such as

name, date of birth, gender, height, eye

color, and address

1. A Social Security Account Number

card, unless the card

9. Driver's license issued by a Canadian

government authority

1. U.S. Passport or U.S. Passport Card

2. Certification of Birth Abroad issued

by the Department of State (Form

FS-545)

3. Foreign passport that contains a

temporary I-551 stamp or temporary

I-551 printed notation on a machine-

readable immigrant visa

4. Employment Authorization Document

that contains a photograph (Form

I-766)

3. Certification of Report of Birth

issued by the Department of State

(Form DS-1350)

3. School ID card with a photograph

5. For a nonimmigrant alien authorized

to work for a specific employer

because of his or her status:

6. Military dependent's ID card

4. Original or certified copy of birth

certificate issued by a State,

county, municipal authority, or

territory of the United States

bearing an official seal

7. U.S. Coast Guard Merchant Mariner

Card

5. Native American tribal document

8. Native American tribal document

7. Identification Card for Use of

Resident Citizen in the United

States (Form I-179)

10. School record or report card

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

2. ID card issued by federal, state or local

government agencies or entities,

provided it contains a photograph or

information such as name, date of birth,

gender, height, eye color, and address

4. Voter's registration card

5. U.S. Military card or draft record

Documents that Establish

Both Identity and

Employment Authorization

Documents that Establish

Identity

Documents that Establish

Employment Authorization

OR AND

All documents must be UNEXPIRED

6. Passport from the Federated States of

Micronesia (FSM) or the Republic of

the Marshall Islands (RMI) with Form

I-94 or Form I-94A indicating

nonimmigrant admission under the

Compact of Free Association Between

the United States and the FSM or RMI

6. U.S. Citizen ID Card (Form I-197)

b. Form I-94 or Form I-94A that has

the following:

(1) The same name as the passport;

and

(2) An endorsement of the alien's

nonimmigrant status as long as

that period of endorsement has

not yet expired and the

proposed employment is not in

conflict with any restrictions or

limitations identified on the form.

a. Foreign passport; and

Refer to Section 2 of the instructions, titled "Employer or Authorized Representative Review

and Verification," for more information about acceptable receipts.

Employees may present one selection from List A

or a combination of one selection from List B and one selection from List C.

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GVIHMXWII4YF'LMPH8E\'VIHMX8S

VIHYGIXLIXE\[MXLLIPHJVSQ]SYVTE]F]

XEOMRKXLMWGVIHMXMRXSEGGSYRXJSPPS[XLI

MRWXVYGXMSRWSRPMRI)SJXLI[SVOWLIIX3R

XLI[SVOWLIIX]SY[MPPFIEWOIHEFSYX]SYV

XSXEPMRGSQI*SVXLMWTYVTSWIXSXEPMRGSQI

MRGPYHIWEPPSJ]SYV[EKIWERHSXLIV

MRGSQIMRGPYHMRKMRGSQIIEVRIHF]E

WTSYWIMJ]SYEVIJMPMRKENSMRXVIXYVR

0MRI*'VIHMXJSVSXLIVHITIRHIRXW

;LIR]SYJMPI]SYVXE\VIXYVR]SYQE]FI

IPMKMFPIXSGPEMQEGVIHMXJSVSXLIV

HITIRHIRXWJSV[LSQEGLMPHXE\GVIHMX

GERvXFIGPEMQIHWYGLEWEUYEPMJ]MRKGLMPH

[LSHSIWRvXQIIXXLIEKISVWSGMEP

WIGYVMX]RYQFIVVIUYMVIQIRXJSVXLIGLMPH

XE\GVIHMXSVEUYEPMJ]MRKVIPEXMZI8SPIEVR

QSVIEFSYXXLMWGVIHMXWII4YF8S

VIHYGIXLIXE\[MXLLIPHJVSQ]SYVTE]F]

XEOMRKXLMWGVIHMXMRXSEGGSYRXJSPPS[XLI

MRWXVYGXMSRWSRPMRI*SJXLI[SVOWLIIX3R

XLI[SVOWLIIX]SY[MPPFIEWOIHEFSYX

]SYVXSXEPMRGSQI*SVXLMWTYVTSWIXSXEP

7ITEVEXILIVIERHKMZI*SVQ;XS]SYVIQTPS]IV/IITXLI[SVOWLIIXWJSV]SYVVIGSVHW

*SVQ

(ITEVXQIRXSJXLI8VIEWYV]

-RXIVREP6IZIRYI7IVZMGI

)QTPS]IIvW;MXLLSPHMRK%PPS[ERGI'IVXMJMGEXI

;LIXLIV]SYvVIIRXMXPIHXSGPEMQEGIVXEMRRYQFIVSJEPPS[ERGIWSVI\IQTXMSRJVSQ[MXLLSPHMRKMW

WYFNIGXXSVIZMI[F]XLI-67=SYVIQTPS]IVQE]FIVIUYMVIHXSWIRHEGST]SJXLMWJSVQXSXLI-67

31&2S

=SYVJMVWXREQIERHQMHHPIMRMXMEP 0EWXREQI

,SQIEHHVIWWRYQFIVERHWXVIIXSVVYVEPVSYXI

'MX]SVXS[RWXEXIERH>-4GSHI

=SYVWSGMEPWIGYVMX]RYQFIV



7MRKPI 1EVVMIH 1EVVMIHFYX[MXLLSPHEXLMKLIV7MRKPIVEXI



-J]SYVPEWXREQIHMJJIVWJVSQXLEXWLS[RSR]SYVWSGMEPWIGYVMX]GEVH

 8SXEPRYQFIVSJEPPS[ERGIW]SYvVIGPEMQMRKJVSQXLIETTPMGEFPI[SVOWLIIXSRXLIJSPPS[MRKTEKIW     

 %HHMXMSREPEQSYRXMJER]]SY[ERX[MXLLIPHJVSQIEGLTE]GLIGO 



 -GPEMQI\IQTXMSRJVSQ[MXLLSPHMRKJSVERH-GIVXMJ]XLEX-QIIXFSXLSJXLIJSPPS[MRKGSRHMXMSRWJSVI\IQTXMSR

y0EWX]IEV-LEHEVMKLXXSEVIJYRHSJEPPJIHIVEPMRGSQIXE\[MXLLIPHFIGEYWI-LEHRSXE\PMEFMPMX]ERH

y8LMW]IEV-I\TIGXEVIJYRHSJEPPJIHIVEPMRGSQIXE\[MXLLIPHFIGEYWI-I\TIGXXSLEZIRSXE\PMEFMPMX]

-J]SYQIIXFSXLGSRHMXMSRW[VMXIw)\IQTXxLIVI



9RHIVTIREPXMIWSJTIVNYV]-HIGPEVIXLEX-LEZII\EQMRIHXLMWGIVXMJMGEXIERHXSXLIFIWXSJQ]ORS[PIHKIERHFIPMIJMXMWXVYIGSVVIGXERHGSQTPIXI

)QTPS]IIvWWMKREXYVI

8LMWJSVQMWRSXZEPMHYRPIWW]SYWMKRMX

(EXI

)QTPS]IVvWREQIERHEHHVIWW)QTPS]IV'SQTPIXIFS\IWERHMJWIRHMRKXS-67ERHGSQTPIXI

FS\IWERHMJWIRHMRKXS7XEXI(MVIGXSV]SJ2I[,MVIW

*MVWXHEXISJ

IQTPS]QIRX

)QTPS]IVMHIRXMJMGEXMSR

RYQFIV)-2

*SV4VMZEG]%GXERH4ETIV[SVO6IHYGXMSR%GX2SXMGIWIITEKI

'EX2S5

*SVQ;

Metropolitan State University of Denver, 890 Auraria Parkway, Denver, CO 80204

84-0559160

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*SVQ;

4EKI

MRGSQIMRGPYHIWEPPSJ]SYV[EKIWERH

SXLIVMRGSQIMRGPYHMRKMRGSQIIEVRIHF]

EWTSYWIMJ]SYEVIJMPMRKENSMRXVIXYVR

0MRI+3XLIVGVIHMXW=SYQE]FIEFPIXS

VIHYGIXLIXE\[MXLLIPHJVSQ]SYV

TE]GLIGOMJ]SYI\TIGXXSGPEMQSXLIVXE\

GVIHMXWWYGLEWXE\GVIHMXWJSVIHYGEXMSR

WII4YF-J]SYHSWS]SYVTE]GLIGO

[MPPFIPEVKIVFYXXLIEQSYRXSJER]VIJYRH

XLEX]SYVIGIMZI[LIR]SYJMPI]SYVXE\

VIXYVR[MPPFIWQEPPIV*SPPS[XLI

MRWXVYGXMSRWJSV;SVOWLIIXMR4YF

MJ]SY[ERXXSVIHYGI]SYV[MXLLSPHMRKXS

XEOIXLIWIGVIHMXWMRXSEGGSYRX)RXIVwx

SRPMRIW)ERH*MJ]SYYWI;SVOWLIIX

(IHYGXMSRW%HNYWXQIRXWERH

%HHMXMSREP-RGSQI;SVOWLIIX

'SQTPIXIXLMW[SVOWLIIXXSHIXIVQMRIMJ

]SYvVIEFPIXSVIHYGIXLIXE\[MXLLIPHJVSQ

]SYVTE]GLIGOXSEGGSYRXJSV]SYVMXIQM^IH

HIHYGXMSRWERHSXLIVEHNYWXQIRXWXS

MRGSQIWYGLEW-6%GSRXVMFYXMSRW-J]SY

HSWS]SYVVIJYRHEXXLIIRHSJXLI]IEV

[MPPFIWQEPPIVFYX]SYVTE]GLIGO[MPPFI

PEVKIV=SYvVIRSXVIUYMVIHXSGSQTPIXIXLMW

[SVOWLIIXSVVIHYGI]SYV[MXLLSPHMRKMJ

]SYHSRvX[MWLXSHSWS

=SYGEREPWSYWIXLMW[SVOWLIIXXSJMKYVI

SYXLS[QYGLXSMRGVIEWIXLIXE\[MXLLIPH

JVSQ]SYVTE]GLIGOMJ]SYLEZIEPEVKI

EQSYRXSJRSR[EKIMRGSQIRSXWYFNIGXXS

[MXLLSPHMRKWYGLEWMRXIVIWXSVHMZMHIRHW

%RSXLIVSTXMSRMWXSXEOIXLIWIMXIQWMRXS

EGGSYRXERHQEOI]SYV[MXLLSPHMRKQSVI

EGGYVEXIF]YWMRKXLIGEPGYPEXSVEX

[[[MVWKSZ;%TT-J]SYYWIXLI

GEPGYPEXSV]SYHSRvXRIIHXSGSQTPIXIER]

SJXLI[SVOWLIIXWJSV*SVQ;

8[S)EVRIVW1YPXMTPI.SFW

;SVOWLIIX

'SQTPIXIXLMW[SVOWLIIXMJ]SYLEZIQSVI

XLERSRINSFEXEXMQISVEVIQEVVMIHJMPMRK

NSMRXP]ERHLEZIE[SVOMRKWTSYWI-J]SY

HSRvXGSQTPIXIXLMW[SVOWLIIX]SYQMKLX

LEZIXSSPMXXPIXE\[MXLLIPH-JWS]SY[MPP

S[IXE\[LIR]SYJMPI]SYVXE\VIXYVRERH

QMKLXFIWYFNIGXXSETIREPX]

*MKYVIXLIXSXEPRYQFIVSJEPPS[ERGIW

]SYvVIIRXMXPIHXSGPEMQERHER]EHHMXMSREP

EQSYRXSJXE\XS[MXLLSPHSREPPNSFWYWMRK

[SVOWLIIXWJVSQSRP]SRI*SVQ;'PEMQ

EPPEPPS[ERGIWSRXLI;XLEX]SYSV]SYV

WTSYWIJMPIJSVXLILMKLIWXTE]MRKNSFMR

]SYVJEQMP]ERHGPEMQ^IVSEPPS[ERGIWSR

*SVQW;JMPIHJSVEPPSXLIVNSFW*SV

I\EQTPIMJ]SYIEVRTIV]IEVERH

]SYVWTSYWIIEVRW]SYWLSYPH

GSQTPIXIXLI[SVOWLIIXWXSHIXIVQMRI

[LEXXSIRXIVSRPMRIWERHSJ]SYV*SVQ

;ERH]SYVWTSYWIWLSYPHIRXIV^IVS

wxSRPMRIWERHSJLMWSVLIV*SVQ

;7II4YFJSVHIXEMPW

%RSXLIVSTXMSRMWXSYWIXLIGEPGYPEXSVEX

[[[MVWKSZ;%TTXSQEOI]SYV

[MXLLSPHMRKQSVIEGGYVEXI

8MT-J]SYLEZIE[SVOMRKWTSYWIERH]SYV

MRGSQIWEVIWMQMPEV]SYGERGLIGOXLI

w1EVVMIHFYX[MXLLSPHEXLMKLIV7MRKPI

VEXIxFS\MRWXIEHSJYWMRKXLMW[SVOWLIIX-J

]SYGLSSWIXLMWSTXMSRXLIRIEGLWTSYWI

WLSYPHJMPPSYXXLI4IVWSREP%PPS[ERGIW

;SVOWLIIXERHGLIGOXLIw1EVVMIHFYX

[MXLLSPHEXLMKLIV7MRKPIVEXIxFS\SR*SVQ

;FYXSRP]SRIWTSYWIWLSYPHGPEMQER]

EPPS[ERGIWJSVGVIHMXWSVJMPPSYXXLI

(IHYGXMSRW%HNYWXQIRXWERH%HHMXMSREP

-RGSQI;SVOWLIIX

-RWXVYGXMSRWJSV)QTPS]IV

)QTPS]IIWHSRSXGSQTPIXIFS\SV

=SYVIQTPS]IV[MPPGSQTPIXIXLIWI

FS\IWMJRIGIWWEV]

2I[LMVIVITSVXMRK)QTPS]IVWEVI

VIUYMVIHF]PE[XSVITSVXRI[IQTPS]IIWXS

EHIWMKREXIH7XEXI(MVIGXSV]SJ2I[,MVIW

)QTPS]IVWQE]YWI*SVQ;FS\IW

ERHXSGSQTP][MXLXLIRI[LMVI

VITSVXMRKVIUYMVIQIRXJSVERI[P]LMVIH

IQTPS]II%RI[P]LMVIHIQTPS]IIMWER

IQTPS]II[LSLEWRvXTVIZMSYWP]FIIR

IQTPS]IHF]XLIIQTPS]IVSV[LS[EW

TVIZMSYWP]IQTPS]IHF]XLIIQTPS]IVFYX

LEWFIIRWITEVEXIHJVSQWYGLTVMSV

IQTPS]QIRXJSVEXPIEWXGSRWIGYXMZI

HE]W)QTPS]IVWWLSYPHGSRXEGXXLI

ETTVSTVMEXI7XEXI(MVIGXSV]SJ2I[,MVIWXS

JMRHSYXLS[XSWYFQMXEGST]SJXLI

GSQTPIXIH*SVQ;*SVMRJSVQEXMSRERH

PMROWXSIEGLHIWMKREXIH7XEXI(MVIGXSV]SJ

2I[,MVIWMRGPYHMRKJSV97XIVVMXSVMIWKS

XS [[[EGJLLWKSZGWWIQTPS]IVW

-JERIQTPS]IVMWWIRHMRKEGST]SJ*SVQ

;XSEHIWMKREXIH7XEXI(MVIGXSV]SJ

2I[,MVIWXSGSQTP][MXLXLIRI[LMVI

VITSVXMRKVIUYMVIQIRXJSVERI[P]LMVIH

IQTPS]IIGSQTPIXIFS\IWERHEW

JSPPS[W

&S\)RXIVXLIIQTPS]IVvWREQIERH

EHHVIWW-JXLIIQTPS]IVMWWIRHMRKEGST]

SJXLMWJSVQXSE7XEXI(MVIGXSV]SJ2I[

,MVIWIRXIVXLIEHHVIWW[LIVIGLMPH

WYTTSVXEKIRGMIWWLSYPHWIRHMRGSQI

[MXLLSPHMRKSVHIVW

&S\-JXLIIQTPS]IVMWWIRHMRKEGST]SJ

XLMWJSVQXSE7XEXI(MVIGXSV]SJ2I[,MVIW

IRXIVXLIIQTPS]IIvWJMVWXHEXISJ

IQTPS]QIRX[LMGLMWXLIHEXIWIVZMGIWJSV

TE]QIRX[IVIJMVWXTIVJSVQIHF]XLI

IQTPS]II-JXLIIQTPS]IVVILMVIHXLI

IQTPS]IIEJXIVXLIIQTPS]IILEHFIIR

WITEVEXIHJVSQXLIIQTPS]IVvWWIVZMGIJSV

EXPIEWXHE]WIRXIVXLIVILMVIHEXI

&S\)RXIVXLIIQTPS]IVvWIQTPS]IV

MHIRXMJMGEXMSRRYQFIV)-2

*SVQ;

4EKI

4IVWSREP%PPS[ERGIW;SVOWLIIX/IITJSV]SYVVIGSVHW

% )RXIVwxJSV]SYVWIPJ %

& )RXIVwxMJ]SY[MPPJMPIEWQEVVMIHJMPMRKNSMRXP] &

' )RXIVwxMJ]SY[MPPJMPIEWLIEHSJLSYWILSPH '

( )RXIVwxMJ

y=SYvVIWMRKPISVQEVVMIHJMPMRKWITEVEXIP]ERHLEZISRP]SRINSFSV

y=SYvVIQEVVMIHJMPMRKNSMRXP]LEZISRP]SRINSFERH]SYVWTSYWIHSIWRvX[SVOSV

y=SYV[EKIWJVSQEWIGSRHNSFSV]SYVWTSYWIvW[EKIWSVXLIXSXEPSJFSXLEVISVPIWW

(

)'LMPHXE\GVIHMX7II4YF'LMPH8E\'VIHMXJSVQSVIMRJSVQEXMSR

y-J]SYVXSXEPMRGSQI[MPPFIPIWWXLERMJQEVVMIHJMPMRKNSMRXP]IRXIVwxJSVIEGLIPMKMFPIGLMPH

y-J]SYVXSXEPMRGSQI[MPPFIJVSQXSXSMJQEVVMIHJMPMRKNSMRXP]IRXIVwxJSVIEGL

IPMKMFPIGLMPH

y-J]SYVXSXEPMRGSQI[MPPFIJVSQXSXSMJQEVVMIHJMPMRKNSMRXP]IRXIVwxJSV

IEGLIPMKMFPIGLMPH

y-J]SYVXSXEPMRGSQI[MPPFILMKLIVXLERMJQEVVMIHJMPMRKNSMRXP]IRXIVwx

)

* 'VIHMXJSVSXLIVHITIRHIRXW7II4YF'LMPH8E\'VIHMXJSVQSVIMRJSVQEXMSR

y-J]SYVXSXEPMRGSQI[MPPFIPIWWXLERMJQEVVMIHJMPMRKNSMRXP]IRXIVwxJSVIEGLIPMKMFPIHITIRHIRX

y-J]SYVXSXEPMRGSQI[MPPFIJVSQXSXSMJQEVVMIHJMPMRKNSMRXP]IRXIVwxJSVIZIV]

X[SHITIRHIRXWJSVI\EQTPIwxJSVSRIHITIRHIRXwxMJ]SYLEZIX[SSVXLVIIHITIRHIRXWERHwxMJ]SYLEZI

JSYVHITIRHIRXW

y-J]SYVXSXEPMRGSQI[MPPFILMKLIVXLERMJQEVVMIHJMPMRKNSMRXP]IRXIVwx *

+ 3XLIV GVIHMXW -J ]SYLEZI SXLIV GVIHMXW WII;SVOWLIIX  SJ 4YF  ERH IRXIV XLIEQSYRXJVSQXLEX[SVOWLIIX

LIVI-J]SYYWI;SVOWLIIXIRXIVwxSRPMRIW)ERH*    

, %HHPMRIW%XLVSYKL+ERHIRXIVXLIXSXEPLIVI ,

*SVEGGYVEG]

GSQTPIXIEPP

[SVOWLIIXW

XLEXETTP]

y-J]SYTPERXSMXIQM^ISVGPEMQEHNYWXQIRXWXSMRGSQIERH[ERXXSVIHYGI]SYV[MXLLSPHMRKSVMJ]SY

LEZIEPEVKIEQSYRXSJRSR[EKIMRGSQIRSXWYFNIGXXS[MXLLSPHMRKERH[ERXXSMRGVIEWI]SYV[MXLLSPHMRK

WIIXLI(IHYGXMSRW%HNYWXQIRXWERH%HHMXMSREP-RGSQI;SVOWLIIXFIPS[

y-J]SYLEZI QSVIXLERSRINSFEXEXMQISVEVIQEVVMIHJMPMRKNSMRXP]ERH]SYERH]SYVWTSYWIFSXL

[SVOERHXLIGSQFMRIHIEVRMRKWJVSQEPPNSFWI\GIIHMJQEVVMIHJMPMRKNSMRXP]WIIXLI

8[S)EVRIVW1YPXMTPI.SFW;SVOWLIIXSRTEKIXSEZSMHLEZMRKXSSPMXXPIXE\[MXLLIPH

y-JRIMXLIVSJXLIEFSZIWMXYEXMSRWETTPMIWWXSTLIVIERHIRXIVXLIRYQFIVJVSQPMRI,SRPMRISJ*SVQ

;EFSZI

(IHYGXMSRW%HNYWXQIRXWERH%HHMXMSREP-RGSQI;SVOWLIIX

2SXI9WIXLMW[SVOWLIIXSRP]MJ]SYTPERXSMXIQM^IHIHYGXMSRWGPEMQGIVXEMREHNYWXQIRXWXSMRGSQISVLEZIEPEVKIEQSYRXSJRSR[EKI

MRGSQIRSXWYFNIGXXS[MXLLSPHMRK

 )RXIV ER IWXMQEXI SJ ]SYV  MXIQM^IH HIHYGXMSRW 8LIWI MRGPYHI UYEPMJ]MRK LSQI QSVXKEKI MRXIVIWX

GLEVMXEFPIGSRXVMFYXMSRWWXEXIERHPSGEPXE\IWYTXSERHQIHMGEPI\TIRWIWMRI\GIWWSJSJ

]SYVMRGSQI7II4YFJSVHIXEMPW 



 )RXIV

MJ]SYvVIQEVVMIHJMPMRKNSMRXP]SVUYEPMJ]MRK[MHS[IV

MJ]SYvVILIEHSJLSYWILSPH

MJ]SYvVIWMRKPISVQEVVMIHJMPMRKWITEVEXIP]

 



 7YFXVEGXPMRIJVSQPMRI-J^IVSSVPIWWIRXIVwx 



 )RXIV ER IWXMQEXI SJ ]SYV  EHNYWXQIRXW XS MRGSQI UYEPMJMIH FYWMRIWW MRGSQI HIHYGXMSR ERH ER]

EHHMXMSREPWXERHEVHHIHYGXMSRJSVEKISVFPMRHRIWWWII4YFJSVMRJSVQEXMSREFSYXXLIWIMXIQW   





%HHPMRIWERHERHIRXIVXLIXSXEP 



 )RXIVERIWXMQEXISJ]SYVRSR[EKIMRGSQIRSXWYFNIGXXS[MXLLSPHMRKWYGLEWHMZMHIRHWSVMRXIVIWX  



 7YFXVEGXPMRIJVSQPMRI-J^IVSIRXIVwx-JPIWWXLER^IVSIRXIVXLIEQSYRXMRTEVIRXLIWIW    



 (MZMHIXLIEQSYRXSRPMRIF]ERHIRXIVXLIVIWYPXLIVI-JERIKEXMZIEQSYRXIRXIVMRTEVIRXLIWIW

(VSTER]JVEGXMSR 



 )RXIVXLIRYQFIVJVSQXLI4IVWSREP%PPS[ERGIW;SVOWLIIXPMRI,EFSZI 

 %HHPMRIWERHERHIRXIVXLIXSXEPLIVI-J^IVSSVPIWWIRXIVwx-J]SYTPERXSYWIXLI8[S)EVRIVW

1YPXMTPI.SFW;SVOWLIIXEPWSIRXIVXLMWXSXEPSRPMRISJXLEX[SVOWLIIXSRTEKI3XLIV[MWIWXSTLIVI

ERHIRXIVXLMWXSXEPSR*SVQ;PMRITEKI



*SVQ;

4EKI

8[S)EVRIVW1YPXMTPI.SFW;SVOWLIIX

2SXI9WIXLMW[SVOWLIIXSRP]MJXLIMRWXVYGXMSRWYRHIVPMRI,JVSQXLI4IVWSREP%PPS[ERGIW;SVOWLIIXHMVIGX]SYLIVI

 )RXIV XLI RYQFIV JVSQ XLI 4IVWSREP %PPS[ERGIW ;SVOWLIIX PMRI , TEKI  SV MJ ]SY YWIH XLI

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Direct Deposit Authorization Agreement

COMPANY

NAME: Metropolitan State University of Denver COMPANY ID: 84-0559160

I hereby authorize MSU Denver, hereinafter called COMPANY, to initiate credit entries and to

initiate, if necessary, debit entries and adjustments for any credit entries in error to my

Checking Savings account (select one) indicated below at the depository named below,

hereinafter called DEPOSITORY, to credit and/or debit the same to such account.

BANK DEPOSITORY

NAME:

ROUTING

NUMBER:

ACCOUNT

NUMBER:

This authorization is to remain in full force and effect until COMPANY has received written

notification from me of its termination in such time and such manner as to afford COMPANY

and DEPOSITORY a reasonable opportunity to act on it.

NAME: 900#:

(PLEASE PRINT)

Work Telephone

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DATE: SIGNED:

NOTE: ALL WRITTEN CREDIT AUTHORIZATIONS SHOULD PROVIDE THAT THE RECEIVER

MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE

MANNER SPECIFIED IN THE AUTHORIZATION.

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PLEASE ATTACH VOIDED CHECK

BANKING INSTITUTION

LETTER

PRWORA Form

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, known as

welfare reform, require all employers to report certain information on their newly hired employees to a

designated state agency within time parameters.

For additional information, visit the U.S. Department of Health and Human Services, Administration for Children

and Families website:

http://www.acf.hhs.gov/programs/css/resource/new-hire-reporting-answers-to-employer-questions

PLEASE PRINT LEGIBLY IN BLACK OR BLUE INK:

Name:

Social Security Number:

Address:

City, State, Zip:

For Human Resources:

Hire Date:

TO: Colorado Department of Human Services

FROM: Metropolitan State University of Denver

P.O. Box 173362, Campus Box 47

Denver, CO 80217-3362

Federal Employer I.D. Number: 84-0559160

Form SSA-1945 (01-2013)

Destroy Prior Editions

Social Security Administration

Statement Concerning Your Employment in a Job

Not Covered by Social Security

Employee Name

Employee ID#

Employer Name

Employer ID#

Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled,

you may receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit

from Social Security based on either your own work or the work of your husband or wife, or former husband or

wife, your pension may affect the amount of the Social Security benefit you receive. Your Medicare benefits,

however, will not be affected. Under the Social Security law, there are two ways your Social Security benefit

amount may be affected.

Windfall Elimination Provision

Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figured using a

modified formula when you are also entitled to a pension from a job where you did not pay Social Security tax.

As a result, you will receive a lower Social Security benefit than if you were not entitled to a pension from this

job. For example, if you are age 62 in 2013, the maximum monthly reduction in your Social Security benefit as

a result of this provision is $395.50. This amount is updated annually. This provision reduces, but does not

totally eliminate, your Social Security benefit. For additional information, please refer to Social Security

Publication, “Windfall Elimination Provision.”

Government Pension Offset Provision

Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you

become entitled will be offset if you also receive a Federal, State or local government pension based on work

where you did not pay Social Security tax. The offset reduces the amount of your Social Security spouse or

widow(er) benefit by two-thirds of the amount of your pension.

For example, if you get a monthly pension of $600 based on earnings that are not covered under Social

Security, two-thirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If

you are eligible for a $500 widow(er) benefit, you will receive $100 per month from Social Security ($500 -

$400=$100). Even if your pension is high enough to totally offset your spouse or widow(er) Social Security

benefit, you are still eligible for Medicare at age 65. For additional information, please refer to Social Security

Publication, “Government Pension Offset.”

For More Information

Social Security publications and additional information, including information about exceptions to each

provision, are available at www.socialsecurity.gov. You may also call toll free 1-800-772-1213, or for the deaf

or hard of hearing call the TTY number 1-800-325-0778, or contact your local Social Security office.

I certify that I have received Form SSA-1945 that contains information about the possible effects of the

Windfall Elimination Provision and the Government Pension Offset Provision on my potential future

Social Security Benefits.

Signature of Employee

Date

Metropolitan State University of Denver

84-0559160

Name

OATH OF ALLEGIANCE

State of Colorado

County of Denver } ss

“I solemnly (swear/affirm) that I will uphold the constitution of the United States

and the constitution of the state of Colorado, and I will faithfully perform the

duties of the position upon which I am about to enter.”

Signed

Subscribed and sworn to before me this _______________ day of _______________ A.D. 20_________

Notary Public _________________________________________________________________________

My commissions expires ________________________________________________, 20

Outside Employment Policies

Revised ͸/1ͻ/ͳ͵ Page 1

Outside Employment Policies for Employees

Of Metropolitan State University of Denver

The8QLYHUVLW\ defines Personal Activity as any private practice, private consulting, teaching or research for

another organization, or similar services to third parties, whether compensated or uncompensated, which are

not a part of the employee’s assigned duties for which the 8QLYHUVLW\ ha

s provided no compensation. The

llowing are 8QLYHUVLW\ policies for Outside Personal Activities:

♦ Outside employment or business ownership shall not interfere with the performance of contractual

responsibilities.

♦ Employees should be aware of their obligations and responsibilities as public employees of the

8QLYHUVLW\. An employee is bound to observe, in all official acts, the highest standards of ethics

onsistent with the code of ethics of the State of Colorado (Part 18, Article 24, Colorado Revised

Statutes), the advisory opinions rendered with respect thereto, and 8QLYHUVLW\ policies.

♦ Nothing in this Article is intended to discourage an employee from engaging in personal activity in

order to increase the employee’s professional reputation, service to the community, or income,

subject to the conditions stated therein.

Employees are responsible for disclosing and resolving conflicts of interest, working with their supervisors

and other 8QLYHUVLW\ officials. A conflict of interest includes:

♦ Any conflict between the personal activities of the employee and the public interests of the 8QLYHUVLW\,

the Board of Trustees, or the State of Colorado, including conflicts of interests specified under

Colorado Statutes;

♦ Any conflict between a personal activity and the full and effective performance of the employee’s

duties and obligations to the 8QLYHUVLW\; or

♦ Any conflict or appearance of conflict between a personal relationship and the exercise of unbiased

professional judgment in performance of the employee’s institutional responsibilities or obligations.

Any employee who proposes to engage in any compensated personal activity, or any other personal activity

which the employee should reasonably conclude may create a conflict of interest, shall report to the

employee’s supervisor, in writing, the details of such proposed activity prior to engaging therein. The report

shall include, where applicable, the name of the employer or other receipt of services; the funding source; the

location where the activity will be performed; the nature and extent of the activity; and the intended use of

8QLYHUVLW\

facilities, equipment or services. This report shall be submitted every semester that the outside activity

continues and if there is a significant change in the outside activity such as the nature of the activity, the extent

of appointment, funding, etc. An employee engaging in any personal activity shall not use the facilities,

equipment, or services of the 8QLYHUVLW\ in connection with such outside activity without prior approval of the

President or a representative. Approval for the use of 8QLYHUVLW\ facilities, equipment, or services may be

conditioned upon reimbursement for the use thereof.

Any employee engaging in personal activity shall take reasonable precautions to ensure that the outside

employer or other recipient of services understands that the employee is engaging in such outside activity as a

private citizen and not as an employee, agent, or spokesperson of the 8QLYHUVLW\.

Print Name: ____________________________________ Date:_________________________

Signature: ______________________________________

COMPENSATORY TIME AGREEMENT

Revised 12/06

I understand Metropolitan State University of Denver has a policy related to

overtime. And, as a condition of my employment with the State of Colorado,

Metropolitan State University of Denver, I understand that my supervisor must

provide compensatory time off in lieu of cash payment for overtime worked

performed by me for the University. I understand that the rate of compensatory

time off will be one-and-one half (1 ½) times all actual overtime work hours. I

also understand that by signing this agreement, my supervisor has the option to

use either cash (budget permitting) or compensatory time to pay the overtime

work performed by me.

I have reached this agreement with Metropolitan State University of Denver freely

and without coercion or pressure. This agreement stays in effect until it is voided

by mutual agreement from both Metropolitan State University of Denver and me.

Please complete the following legibly.

________________________________________

Employee Name Printed

________________________________________

Employee Signature

________________________________________

Date

________________________________________

Human Resource Representative or Supervisor

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REQIWVIPEXMSRWLMTW7SGMEP7IGYVMX]RYQFIVWFMVXLHEXIWEHHVIWWIWERH]SYVWMKREXYVI8LMWTEKIQYWXFIWMKRIHSV]SYV

FIRIJMGMEVMIW[MPPRSXFIEHHIHGLERKIH

-J]SYGSQTPIXIER]FIRIJMGMEV]MRJSVQEXMSRSRXLMWJSVQERHWYFQMXXLMWJSVQXS'SPSVEHS4)6%]SYEVIGERGIPMRKERH

VITPEGMRKEPPSJ]SYVTVIZMSYWP]REQIHFIRIJMGMEVMIW-J]SY[ERXXSGSRXMRYIER]TVIZMSYWHIWMKREXMSRW]SYQYWXJYPP]REQIEPP

REQIHFIRIJMGMEVMIWSRXLMWJSVQSVSREWITEVEXIPMWXWYFQMXXIH[MXLXLMWJSVQ

-J]SY[SYPHPMOIXSGLERKI]SYVEHHVIWWSRP]KSXS'SPSVEHS4)6%vW;IFWMXI[[[GSTIVESVKERHPSKMRXS]SYV%GGSYRX

%GGIWWYWMRK]SYV4)6%4-2=SYQE]GLERKI]SYVEHHVIWWYWMRKw9THEXI'SRXEGX-RJSx=SYQE]EPWSGEPP'SPSVEHS4)6%vW

'YWXSQIV7IVZMGI'IRXIVEXSVERHWTIEOXSE'YWXSQIV7IVZMGI6ITVIWIRXEXMZI

-J]SYRIIHXSGLERKIMRJSVQEXMSRSR]SYV'SPSVEHS4)6%WTSRWSVIHPMJIMRWYVERGISV4)6%4PYWOSV4PERSV4)6%

('4PERWIIXLIMRJSVQEXMSRFIPS[

2EQIH&IRIJMGMEV]-RJSVQEXMSR

-J]SYLEZIEREGGSYRXMRFSXLXLI4)6%ERH(47FIRIJMXWXVYGXYVIWYWIXLIGLIGOFS\IWSRXLIJSVQXSMRHMGEXIMJ]SYVVIUYIWXIH

FIRIJMGMEV]GLERKIWETTP]XSSRISVFSXLSJ]SYVEGGSYRXW-J]SYHSRSXGLIGOEFS\XLIFIRIJMGMEV]GLERKIW[MPPFIQEHIXSFSXL

EGGSYRXWMJETTPMGEFPI

&IRIJMGMEV]HIJMRMXMSRW

4VMQEV]&IRIJMGMEV]{FIRIJMGMEV]XSVIGIMZITE]QIRX-J]SYLEZIQSVIXLERSRITVMQEV]FIRIJMGMEV]TE]QIRX[MPPFIHMZMHIH

IUYEPP]EQSRKEPPTVMQEV]FIRIJMGMEVMIW

'SRXMRKIRX&IRIJMGMEV]{TIVWSRXSVIGIMZITE]QIRXMJ]SYVTVMQEV]FIRIJMGMEV]MIWMWHIGIEWIH-J]SYPMWXQSVIXLERSRI

GSRXMRKIRXFIRIJMGMEV]TE]QIRX[MPPFIHMZMHIHIUYEPP]EQSRKXLIQ

7YVZMZSV&IRIJMX-RJSVQEXMSR

-J]SYLEZIQSVIXLERSRI]IEVSJWIVZMGIYRHIVXLI4)6%FIRIJMXWXVYGXYVISVQSVIXLERJMZI]IEVWYRHIVXLI(47FIRIJMXWXVYGXYVI

7XEXIPE[WTIGMJMIW[LSVIGIMZIWQSRXLP]FIRIJMXWEJXIV]SYHMI7YVZMZSVFIRIJMXWEVIHMJJIVIRXMJ]SYLEZIE4)6%SV(47FIRIJMX

WXVYGXYVIEGGSYRXWIIXLI7YVZMZSV&IRIJMXWFSSOPIXJSVHIXEMPIHMRJSVQEXMSR2SPE[WLEPPETTP]XSEYXSQEXMGEPP]VIZSOIEWTSYWIvW

HIWMKREXMSREWEREQIHFIRIJMGMEV]YTSR]SYVHMZSVGIERRYPQIRXSVER]HMWWSPYXMSRSVHIGPEVEXMSRSJMRZEPMHMX]SJ]SYVQEVVMEKI

'LERKMRK'SPSVEHS4)6%0MJI-RWYVERGI4)6%4PYWOERH4PERWSV4)6%('4PER-RJSVQEXMSR

-J]SYEVIIRVSPPIHMR'SPSVEHS4)6%WTSRWSVIHPMJIMRWYVERGIERHLEZIGLERKIHIQTPS]IVWRSXMJ]]SYVRI[IQTPS]IVXSHIHYGX

]SYVPMJIMRWYVERGITVIQMYQ-J]SY[ERXXSGLERKI]SYVPMJIMRWYVERGIFIRIJMGMEV]MIWGEPP9RYQXSPPJVIIEX

SVKSXS'SPSVEHS4)6%vW;IFWMXI[[[GSTIVESVKERHPSKMRXS]SYV%GGSYRX%GGIWWYWMRK]SYV4)6%4-2ERHWIPIGXw0MJI

-RWYVERGIxYRHIVXLI-RUYMV]QIRY

-J]SYLEZIE4)6%4PYWOSV4PERSV4)6%('4PERERHRIIHXSGLERKI]SYVREQIEHHVIWWSVTLSRIRYQFIV

GSQTPIXIXLI4)6%%GGSYRXW%HHVIWW'LERKI*SVQ-J]SYRIIHXSQEOIFIRIJMGMEV]GLERKIWXS]SYV4)6%4PYWOSV

4PERSV4)6%('4PERGSQTPIXIXLIVIWTIGXMZIOSV4)6%('4PER&IRIJMGMEV](IWMKREXMSR*SVQ=SYGERSFXEMR

XLIJSVQWSRPMRIEX[[[GSTIVESVKSVF]GEPPMRKERHWIPIGXMRKXLI4)6%4PYWOSV4PERSVXLI4)6%

('4PERSTXMSR

-J]SYLEZIE4)6%4PYWO4PEREGGSYRXERHEVIXVERWJIVVMRKJVSQSVEVIGYVVIRXP]IQTPS]IHF]ERSXLIV'SPSVEHS4)6%

IQTPS]IVERHEGXMZIP]GSRXVMFYXMRKRSXMJ]]SYVRI[IQTPS]IVvWTE]VSPPSJJMGIWSXLEXGSRXVMFYXMSRWQE]GSRXMRYIXLVSYKL]SYV

RI[IQTPS]IV-J]SYLEZIE4)6%4PYW4PERERHRIIHXSEHHSVGLERKIIQTPS]IVWPSKSRXSXLI4)6%;IFWMXIERHWIPIGX

XLI4PERSTXMSR

1IQFIV-RJSVQEXMSR{XSFIGSQTPIXIHF]]SY

-EQ

%2I[1IQFIV 'LERKMRK'SPSVEHS4)6%-RJSVQEXMSR*MPPMRREQIERHER]MRJSVQEXMSR]SYEVIGLERKMRKERHWMKR

1IQFIVCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC

 0EWX2EQI *MVWX2EQI 1MHHPI2EQI *SVQIV2EQI

1EPI ,SQI  ;SVO

&MVXLHEXI CCCCCCCCCCCCCCCC  7I\

*IQEPI 8IPITLSRI CCCCCCCCCCCCCCCCCCCC  8IPITLSRICCCCCCCCCCCCCCCCCCCC

 1SRXL(E]=IEV

1EMPMRK%HHVIWWCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC

 7XVIIX6SYXISV&S\2YQFIVERH%TX2YQFIV 'MX] 7XEXI >-4'SHI

7TSYWICCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC 7TSYWIvW&MVXLHEXI CCCCCCCCCCCCCCCCCCCC

 0EWX2EQI *MVWX2EQI 1MHHPI2EQI 1SRXL(E]=IEV

2EQIH&IRIJMGMEV]MIW{4VMQEV]ERH'SRXMRKIRXSJ=SYV'SPSVEHS4)6%%GGSYRXW

'LERKIWETTP]XS

4)6%&IRIJMX7XVYGXYVI%GGSYRX (47(IRZIV4YFPMG7GLSSPW&IRIJMX7XVYGXYVI%GGSYRX

%TTP]XS&SXL%GGSYRXW

2SXI-J]SYHSRSXGLIGOEFS\XLIFIRIJMGMEV]GLERKIW[MPPFIQEHIXSFSXLHIJMRIHFIRIJMXEGGSYRXWMJETTPMGEFPI

4VMQEV]&IRIJMGMEV]MIW