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 USERRAthe 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
i
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
i
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.
P
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
nd
Page
Verify Information
Complete Electronic Signature
4) Click Continue
5) 3
rd
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
Or
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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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-LEHRS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]SYQIIXFSXLGSRHMXMSRW[VMXIw)\IQTXxLIVI
9RHIVTIREPXMIWSJTIVNYV]-HIGPEVIXLEX-LEZII\EQMRIHXLMWGIVXMJMGEXIERHXSXLIFIWXSJQ]ORS[PIHKIERHFIPMIJMXMWXVYI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[LMVIVITSVXMRK)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
% )RXIVwxJSV]SYVWIPJ %
& )RXIVwxMJ]SY[MPPJMPIEWQEVVMIHJMPMRKNSMRXP] &
' )RXIVwxMJ]SY[MPPJMPIEWLIEHSJLSYWILSPH '
( )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
(
)'LMPHXE\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MJQEVVMIHJMPMRKNSMRXP]IRXIVwx
)
* '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MJQEVVMIHJMPMRKNSMRXP]IRXIVwx *
+ 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* 
+
, %HHPMRIW%XLVSYKL+ERHIRXIVXLIXSXEPLIVI ,
*SVEGGYVEG]
GSQTPIXIEPP
[SVOWLIIXW
XLEXETTP]
y-J]SYTPERXSMXIQM^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[SVOWLIIXSRP]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MRI\GIWWSJSJ
]SYVMRGSQI7II4YFJSVHIXEMPW
)RXIV
MJ]SYvVIQEVVMIHJMPMRKNSMRXP]SVUYEPMJ]MRK[MHS[IV
MJ]SYvVILIEHSJLSYWILSPH
MJ]SYvVIWMRKPISVQEVVMIHJMPMRKWITEVEXIP]

7YFXVEGXPMRIJVSQPMRI-J^IVSSVPIWWIRXIVwx
 )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
%HHPMRIWERHERHIRXIVXLIXSXEP
)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
(VSTER]JVEGXMSR 
)RXIVXLIRYQFIVJVSQXLI4IVWSREP%PPS[ERGIW;SVOWLIIXPMRI,EFSZI
 %HHPMRIWERHERHIRXIVXLIXSXEPLIVI-J^IVSSVPIWWIRXIVw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
ERHIRXIVXLMWXSXEPSR*SVQ;PMRITEKI

*SVQ;
4EKI
8[S)EVRIVW1YPXMTPI.SFW;SVOWLIIX
2SXI9WIXLMW[SVOWLIIXSRP]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
(IHYGXMSRW%HNYWXQIRXWERH%HHMXMSREP-RGSQI;SVOWLIIXSRTEKIXLIRYQFIVJVSQPMRISJXLEX
[SVOWLIIX 

 -JPMRIMWQSVIXLERSVIUYEPXSPMRIWYFXVEGXPMRIJVSQPMRI)RXIVXLIVIWYPXLIVIMJ^IVSIRXIVwx
ERHSR*SVQ;PMRITEKI(SRSXYWIXLIVIWXSJXLMW[SVOWLIIX
2SXI-JPMRIMWPIWWXLER PMRIIRXIVwxSR*SVQ;PMRITEKI'SQTPIXIPMRIWXLVSYKLFIPS[XS
JMKYVIXLIEHHMXMSREP [MXLLSPHMRKEQSYRXRIGIWWEV]XSEZSMHE]IEVIRHXE\FMPP
)RXIVXLIRYQFIVJVSQPMRISJXLMW[SVOWLIIX
)RXIVXLIRYQFIVJVSQPMRISJXLMW[SVOWLIIX
7YFXVEGXPMRIJVSQPMRI
*MRHXLIEQSYRXMR8EFPIFIPS[XLEXETTPMIWXSXLI,-+,)78TE]MRKNSFERHIRXIVMXLIVI
1YPXMTP]PMRIF]PMRIERHIRXIVXLIVIWYPXLIVI8LMWMWXLIEHHMXMSREPERRYEP[MXLLSPHMRKRIIHIH
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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
Number:
Home/Cell Phone
Number:
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.
Employee Type:
Full-Time: Faculty,
Administrators, Classified Staff
Part-time Faculty Admin/Classified Hourly
PLEASE ATTACH VOIDED CHECK
OR
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
fo
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
c
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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1IQFIV-RJSVQEXMSR*SVQ{(IJMRIH&IRIJMX4PERW-RWXVYGXMSRW
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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
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-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&IRIJMXWFSSOPIX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
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-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
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
2EQI 6IPEXMSRWLMT 772 &MVXLHEXI
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
7XVIIX6SYXISV&S\2YQFIVERH%TX2YQFIV 'MX] 7XEXI >-4'SHI
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
2EQI 6IPEXMSRWLMT 772 &MVXLHEXI
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
7XVIIX6SYXISV&S\2YQFIVERH%TX2YQFIV 'MX] 7XEXI >-4'SHI
'SRXMRKIRX&IRIJMGMEV]MIW
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
2EQI 6IPEXMSRWLMT 772 &MVXLHEXI
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
7XVIIX6SYXISV&S\2YQFIVERH%TX2YQFIV 'MX] 7XEXI >-4'SHI
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
2EQI 6IPEXMSRWLMT 772 &MVXLHEXI
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
7XVIIX6SYXISV&S\2YQFIVERH%TX2YQFIV 'MX] 7XEXI >-4'SHI
1IQFIV7MKREXYVICCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC(EXICCCCCCCCCCCCCCCCCCCCCCCCC
83&)'3140)8)(&=)1403=)6*362);)1403=))7320=
)QTPS]IV2SCCCCCCC )QTPS]IV2EQICCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC (EXICCCCCCCCCCCCCCCCCCCCCCC
7XEVXMRK7EPEV] CCCCCCCCCCCCCCC .SF8MXPI CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC (EXI)QTPS]IHCCCCCCCCCCCCCCCCCC
QFVMRJS6):
1IQFIV-RJSVQEXMSR*SVQ{(IJMRIH&IRIJMX4PERW
'SPSVEHS4YFPMG)QTPS]IIWv6IXMVIQIRX%WWSGMEXMSR
43&S\(IRZIV'SPSVEHS
SV4)6%
*E\ [[[GSTIVESVK

6IEHXLIMRWXVYGXMSRWXSXLIPIJXFIJSVIGSQTPIXMRKXLMWJSVQ&IWYVIXSWMKRERHHEXIXLMWJSVQEW[IPPEWER]IRGPSWYVIW
772
 
130
Metropolitan State University of Denver
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PERA INFORMATION
As a result of Senate Bill 04-257, effective July 1, 2005, PERA employers are required to
begin paying employer contribution salaries paid to PERA retirees. To ensure that we have
correct information on our employee population, please complete this form and return it with
your contract to the Office of Human Resources. If you have questions, please contact the Office
of Human Resources at 6-3120.
I am not a retiree.
I am a PERA retiree and currently receiving a monthly benefit.
I am receiving a retirement benefit from another retirement plan other than PERA.
Plan Name:
Print Name Date
________________________________
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Metropolitan State University of
Denver
Confidentiality Agreement Federal Educational Rights and Privacy Act
Rev 01/01/2019
Federal Educational Rights and Privacy Act (FERPA)
FERPA is a federal law protecting the privacy of a student’s educational records and applies to any educational
institutions that receive funds under any program administered by the U.S. Department of Education. Violation to
FERPA would result to the University losing the ability to provide financial aid to our students.
FERPA rights belong to the student at a postsecondary institution regardless of age. Student applies to all
studentsincluding continuing education students, students auditing a class, distance education students, and
former students.
Metropolitan State University of Denver maintains educational records for each student who has enrolled at the
University. Under the Family Education Rights and Privacy Act of 1974, 20 USC 1232g, and the implementing
regulations published at 34 CFR part 99, each eligible student has the right to:
1. Inspect and review his/her educational records;
2. Request the amendment of the student’s education records to ensure that they are not inaccurate,
misleading or otherwise in violation of the student’s privacy or other rights;
3. Consent to the extent that FERPA authorizes disclosure without consent (see Nondisclosure and
Exceptions in the University catalog under Student’s Rights and Responsibilities.
4. File a complaint under 34 CFR 99.64, concerning alleged failures by the University to comply with the
requirements of FERPA, with the Family Compliance Office, U.S. Department of Education.
As a staff or faculty member at MSU Denver, it is your responsibility to oversee and uphold the rights of FERPA
grants to our students. Basic guidelines include:
Do not display any personally identifiable data or information which includes, but is not limited to
student’s name, the name of the student’s parent or other family members, the address of the student
or student’s family, a personal identifier such as SSN, student number or biometric record. Other
indirect identifiers such as the student’s date of birth, place of birth, mother’s maiden name, or other
information alone or in combination that is linked to a specific student.
Student educational records are considered confidential and cannot be released without the student’s
prior written consent.
As a student worker, staff, or faculty member, you are given access to student educational records for
the sole purpose of performing your job. It is your responsibility to protect educational records
whenever they are used and regardless of the medium in which they are accessed.
Do not use anyone else’s username or password or allow anyone to use yours. Log out of Banner when
not in use and lock your computer when you walk away.
When in doubt, do not give it out. Do not hesitate to call the Office of the Registrar at 303-556-3991 for
any FERPA guidance.
I have read and agree to the above responsibilities regarding FERPA regulations:
Name: _____________________________________________ 900#_________________________
Signature: __________________________________________ Date: _________________________
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Required Trainings:
Equal Opportunity & University Trainings and
Disability & Americans with Disabilities Act Awareness
EQUAL OPPORTUNITY & UNIVERSITY TRAININGS
One of our ongoing commitments to students, faculty, and staff is to ensure that the campus complies with
Federal regulations. One of the most important of these has to do with our commitment to a harassment-free
work environment. The recent compliance changes, require the preventing discrimination and sexual harassment
courses to be updated and expanded. Additionally, MSU Denver is committed to building and preserving a
community in which all of its members can work together and study in an environment free from all forms of
exploitation and intimidation. Therefore, we are requiring everyone to complete the “Bullying Prevention for
Higher Education” training course.
All employees need to complete the following trainings:
1. Preventing Discrimination and Sexual Violence: Title IX, VAWA and Clery Act for Faculty and Staff
2. Unlawful Harassment Prevention for Higher Education- Staff/Administrative/Students/Temporary
Employee
o Unlawful Harassment Prevention Supervisor Supplement-Faculty
o Unlawful Harassment Prevention Supervisor Supplement- Staff/Administrative/ Students/Temporary
3. Bullying Prevention for Higher Education"
Time Allotment: Plan on 30-45 minutes for each course.
You can start and stop your training at any time. Once you return to complete the training it will begin where you
left off.
DISABILITY AND AMERICANS WITH DISABILITIES ACT (ADA) AWARENESS
Metropolitan State University of Denver is committed to maintaining a work and learning environment free of
discrimination based on disabilities. In keeping with this commitment, the University has produced an interactive
online training video, designed to educate faculty, staff and student employees.
This program focuses on the following areas: ADA Law, University Policies and Procedures, Academic
Accommodations, Rights and Responsibilities of Faculty, Staff, and Students and Workplace Accommodations.
Time Allotment: Plan on 60-90 minutes for the course.
You can start and stop your training at any time. Once you return to complete the training it will begin where you
left off.
All trainings are now hosted in Blackboard Learn. Below are the steps to access the new training:
1. Go to http://www.msudenver.edu/facstaff
2. Click on the Blackboard Learn Link (under the Email & Collaboration heading)
3. Login with your MSU Denver NetID and Email/WINAD password. Your MSU Denver NetID is anything
before the @ in your email address. For example, if your email address
is astudent@msudenver.edu your MSU Denver NetID would be astudent.
4. Once Logged into Blackboard Learn you will find the course titles under the My Courses Section.
If you experience any difficulties taking these courses, please contact the IT Services Helpdesk at (303) 352-
7548. You can also submit a service ticket at www.msudenver.edu/gethelp.
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Mandatory
MSU Denver’s Emergency Notification System
For the safety of the entire campus community, all MSU Denver students, faculty and staff are asked to
sign up for the Emergency Notification System (ENS), provided by Rave Mobile Safety.
NOTE: All faculty and staff members MUST register for the Emergency Notification System (ENS)
The Auraria Campus, along with the CCD, MSU Denver, and UCDDowntown Denver Campus and
Anschutz Medical Campus, has partnered with Rave Wireless to provide a new and improved emergency
alert text and voice-message system capable of delivering messages directly to you should conditions
develop on or near our locations that pose a threat of imminent danger. This service will only be used to
notify you of an event of imminent danger on or around the Auraria Campus.
To start your registration process you will need to go to the registration website:
https://www.getrave.com/login/MSUDenver
Click on the Register button:
You will need to provide the following information:
First Name
Last Name
Registration email (the email you would like notifications sent to)
Create a system password
Provide your mobile phone number
Select and Confirm your mobile carrier (service provider)
You will be able to have test messages sent.
Once these have been completed, make sure to log out at the top right hand corner.