Department of Human Resources

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

• are a new hire
• transferred to a 50-75 percent time appointment
• appointment is three months or longer

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

Please send as follows (check all that apply):

Orientation packet
Guide for UPlan Benefits Enrollment (check if employee is interested in benefits information)