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