Department of Human Resources

Temporary Office Service (T.O.S.)

UMD Department Request Form for T.O.S.

*Contact Name
*Department Name
*Campus Telephone Number
*Complete E-mail Address (_____@d.umn.edu)

Supervisor's Name, if different than above
Supervisor's Telephone Number
Supervisor's Complete E-mai (_____@d.umn.edu)

*Specify dates of assignment from/to)
*Work Hours
*Campus address T.O.S employee will be reporting
If requesting for a specific T.O.S. employee, specify name
EFS String for Salary
EFS String for Administrative Charges

Job Duties (check all that apply):

General Office Duties
Word Processing
Data Entry

Peoplesoft
Employment System

EFS (Enterprise Financial System)

Work with or exposure to confidential health information or health billing (administrative, research, clinic) which will require additional HIPAA Privacy Training. Cathy Rackliffe, HIPAA Coordinator, (cracklif@d.umn.edu or 218-726-6827) will contact you for more information or as to what additional HIPAA training is required.

Other Job Duties

Additional Information or Comments

*REQUIRED FIELD---NEED TO BE FILLED OUT BEFORE SENDING

Reset form will delete all your entries

Contact for questions or assistance:

Tanisha C. Lee, Tanisha C. Lee, 218-726-7161
Lita C. Wallace, lwallace@d.umn.edu, 218-726-7822