Department of Human Resources & Equal Opportunity

Orientation/Benefits Request for employees with appointments of 50-74%

This form must be filled out by a hiring department (or department's payroll representative) for civil service employees who have an appointment of 50-74%:

• are a new hire
• transferred to a 50-74 percent time appointment
• temporary appointment lasts three months or longer

Name of employee
Empl ID
Department Name
Campus Address
Employee's Campus Phone #
Job Requisition Number
Job Code
Percentage of appointment
Start Date
Supervisor's Name
What is Your Name?
What is Yor Email?
What is your Phone #?

Check all that apply:

Employee would like to meet with HR&EO for an Orientation
Please send Orientation packet
Please send Guide for UPlan Benefits Enrollment