CALIFORNIA STATE UNIVERSITY DOMINGUEZ HILLS FOUNDATION
NEW HIRE/POSITION CHANGE FORM
Employee Name __
______________________
Effective Date ___
Home Address ________________________________________
________________________________________
Home Phone
Department
Work Phone
SS Number _______________________
Fdn Account #__
_____________
________________________________________
Work Location__________________________________
__
_________________
__________________________________
_________
Foundation
State
CSUDH Student
(
)
(
)
CSUDH Faculty
(
)
(
)
CSUDH Staff
Student/Off Campus
(
(
)
)
(
(
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)
( ) NEW HIRE ( ) RE-HIRE ( ) CONTINUING (Must Include Job Description)
Hire Date _________________________
Position Title __
___________________
Appointment: Start Date __
_________ Project End Date ____
___ _____
__
Rate of Pay: $ _
Appointment Effort %: ____
Annual Salary:$ ___
__________
__________
_______________
Budgeted Amount: $ _
Budgeted Object Code: __
Check One: ( ) Full Time
Check One: ( ) Regular
Benefits:
_____________
_______________
( ) Yes
( ) Part Time
( ) Temporary
( ) No
# of Hours/Week _________________________
Supervisor’s Name & Title ___
________________________________
ATTENTION: This appointment, reappointment or change of status is not valid, and is not approved until so indicated
in writing on this form by the Foundation Executive Director.
(
(
) POSITION CHANGE (Position Description Must be attached indicating New Job Duties)
) SALARY CHANGE (Must provide justification in writing for change in salary)
( ) Merit
( ) Promotion
( ) Reclassification
( ) Other (specify) ___________________________
Current Job Title ________________________________
New Job Title _______________________________
Current Project # ________________________________
New Project # ______________________________
Current Rate $___________________ Proposed New Rate $__________________
% Change _________
ATTENTION: This appointment, reappointment or change of status is not valid, and is not approved until so indicated
in writing on this form by the Foundation Executive Director.
APPROVAL (The signature of Grants Administrator certifies that funds are available.)
______________________________________________ _______________________________________________
Supervisor
Date
Foundation H/R Administrator
Date
______________________________________________ _______________________________________________
Project Director
Date
Grants Administrator
Date
___________________________________________________
Academic Resource Manager
Date
___________________________________________________
College Dean
Date
___________________________________________________
Director, Grants & Contracts
Date
___________________________________________________
Director, Business & Finance
Date
___________________________________________________
___________________________________________________
Provost/Vice President
Executive Director
Date
Date
FDN #101 01/11
California State University
Dominguez Hills Foundation
Position Description
Employee:
Position Title:
Department/School:
Supervisor & Title:
1.
Purpose of Position:
2.
Primary Position Responsibilities:
3.
4.
Minimum Qualifications:
Physical Requirements and other Condition of Employment:
Foundation Position Description Template
(Revised June 2011)
Instructions
New Hire/Position Change Form
California State University Dominguez Hills Foundation
(310) 243-3306
The form is used to hire or change an employee’s term of employment, compensation and percent of effort. There
are four Sections in the form as follows:
1) Employee Information Section: Complete the employee’s information as to name, home address, home phone
number, Work location, Department and Work Phone. The effective date of employment will be determined
upon notification from Foundation HR. Social Security Number; Foundation account No. where the employee will
be working must be indicated.
Primary Employer:
Foundation – Check the applicable box underneath if the employee will be employed by the Foundation as the
primary employer.
State – Check the applicable box underneath if the employee has a primary employer other than the Foundation.
2) Appointment Section:
New Hire – Check this box if this is a new appointment.
Re-Hire – Check this box if this is a renewal of an existing employment term.
Continuing – Check this box if this is a continuation of an existing employment, example: working on a multiple
year project.
Start Date – Indicate the first working day of employment.
End Date – Indicate the end of assignment date, or funding year, if applicable.
Position Title – Indicate working title.
Appointment Effort – Define the percentage of effort that the employee will be working for this assignment (i.e.
full time is 100%, part time 20 hours is 50%)
Annual Salary – Indicate annual rate of pay
Rate of Pay – If hourly, indicate hourly rate of pay, Semi-monthly , divide annual pay by 24 payments to show
payments per pay period.
Budgeted Amount – Indicate amount shown in the approved budget.
Budgeted Object Code – Indicate the appropriate code (to be supplied by the Foundation).
Supervisor’s Name and Title – Name and Title of Supervisor if other than the Principal Investigator.
Status: Check all boxes that apply to the employee’s employment terms.
Full Time – Check this if the employee will be working 100%.
Part Time – Check this if the employee will be working less than 40 hours per week.
Regular – Check this if the employee will be working a minimum of 6 months.
Temporary – Check this if the employee will be appointed for 6 months or less – regardless of number of
hours per week.
Benefits: (Yes) for full time and (No) for part time/temporary.
Undergraduate Student – limited to 20 hours per week during fall and spring semesters.
Graduate Student – limited to 20 hours per week during fall and spring semesters.
# of Hours/Week – Indicate the number of hours work per week (e.g. 20 hours per week).
3) Position/Salary Change Section:
Position Change - Check this box if there is a change of Position Title and attach the old Position description and
new Position description indicating new job duties.
Salary Change – Check this box if there is a change in salary on the old position, providing justification in writing
for the change in salary.
Check the appropriate box to indicate the cause for the change (Merit, Promotion, Reclassification or Other as
specified).
Indicate the Current Rate, Proposed Rate and Percentage of Change.
4) Approval Section: The Signatures of the Supervisors, Project Director, Academic Resource Manager, College
Dean and Provost/Vice President must be completed before the form is send to the Foundation for appropriate
action.
NOTE: This appointment, re-appointment or change of status is not valid and is not approved until so indicated in
writing on the form by the Foundation Executive Director. Under no circumstances should an applicant be sent to the
Foundation HR for Orientation without an approved appointment.
If you need assistance in completing this form, please call the Foundation HR Administrator at (310) 243-3028 or for
Grants and Contracts; call Rita Darcy at extension 3059 or Lauren Ansorge at extension 2373.