Shawnee State University Employee Data Form
Welcome to Shawnee State University! We are a growing family who together dream great dreams, work hard, share problems and successes, and take time occasionally to enjoy an extra-curricular good time . . . while we carry on the business of education.
Kindly assist us by printing the information below. Are you a student? Yes No
Personal Information
Full Name SSU ID Citizenship
Last, First Middle Initial Country
Title Suffix Ethnicity/Race
Mr/Mrs/Ms/Miss/Dr/Prof, etc. Sr/Jr/II/III, etc. Hispanic/Latino Ethnicity Non-resident alien
American Indian/Alaska Native Race Unknown Race
Soc Sec # Black/African American Race Asian Race
Native Hawaiian/Pacific Islander Race White Race
Marital Divorced Married Single Parent Visa Code Visa #
Single Separated Widowed Visa Date
Birth Date Gender Male Female Veteran: Y / N
Social Security Name Degree(s) possessed
(as shown on card) Last, First Middle Suffix
College/Univ(s) attended
Address Information
Permanent Local
City, St Zip
Country Phone Country Phone
Birthplace City State Email address where you want to receive HR/Payroll communications (W2, Pay, etc.)
Res State Res County Res Country EMAIL:
Emergency Contacts
Name Phone Ext
Address Email
City, St Zip Relationship
Job/Position Information
Job/Position title Scheduled Hire Date
Supervisor Department
ST0P - HR/PAYROLL USE ONLY
Other Information EEO
Home Position Primary Occupation EEO Sort
Direct Deposit 01 Executive/Administrative Blank
02 Other Professionals A 9 – 10 months
03 Technical/Paraprofessional B less than 9 months
04 Clerical/Secretarial C 11 – 12 months
ADA Disability Y / N Code 05 Skilled Crafts D Executive/Administrative
06 Service/Maintenance E Other Professional
Accommodation(s) requested 07 Professor F Technical/Paraprofessional
08 Assoc Professor G Clerical/Secretarial
09 Asst Professor H Skilled Crafts
10 Instructor (incl Sr) I Service/Maintenance
11 Lecturers P Professional Degree
12 Faculty – no academic rank
SSU Data
Pension HEI Highest Degree STU/PTF/COA/OTH Hire Date Group/Union Affiliation
A Associate Degree
B Bachelor’s Degree Regular Hire Date Group/Seniority Date
C Certificate
D Doctoral Degree Rehire Date Termination Date
E Education Specialist Reason . . .
M Master’s Degree FTE No reason Layoff
N None of the above Deceased Resigned
P Professional Degree Service Pin Date Invol discharge Retired
Work Experience
Employer Position Held Start date End date Comments
SSU
Payroll - Benefits
Selection – Retirement System EE – OPERS ER – OPERS EE – STRS ER - STRS
AIG Valic APPV APRV APSV ASRV STRU – unfunded liab
AIG Aetna APPA APRA APSA ASRA STRU – unfunded liab
AXA Equitable APPE APRE APSE ASRE STRU – unfunded liab
Great Amer APPG APRG APSG ASRG STRU – unfunded liab
TIAA-Cref APPT APRT APST ASRT STRU – unfunded liab
OPERS & STRS PERS PERR STRS STRR
LAW Enforcement LAWE LAWR
Selection – Insurances EE ER EE ER
Family policy – Staff INEF INHF faculty INFF INHF Life Insurances INLI INAL INVL
Single policy - Staff INES INHS faculty INFS INHS SSUFlex & LongTerm Disability INFX INDP INLT
Waiver (HPPW) Universal Life & Cancer UNLI INCA
Selection – Time & Track benefits SCK Track Effective Date PSLD Track Effective Date
COMP PSLD Adm-FT SAFT Hrly PRS4 PRS5
PRS6 PRS7 PRS8
SCK VAC
Adm-PT SAPT
Hrly-FT SHFT Hrly -PT SHPT
Faculty SFFS
VAC Track Effective Date COMP Track Effective Date
Adm-FT VAFT VA75 VA80 VA83 Hrly COMP
Adm-PT VA50 VAP7 VAP8
Hrly-FT VHFT VHGF Hrly-PT VHPT
Payroll –Deductions/Allowances/Fringes Allowances-
Instructions: Code(s) Period Type Begin Date End Date Primary/Add’l Pctg Flat Amt
Health Ins INFF INFS (faculty contrib) Twice monthly $
INEF INES (staff contrib) Twice monthly $
INHF INHS (ER expense) Second Period $
COBF COBS (ER expense) Second Period $
COB1 (EE +1 dep) Second Period $
HPPW (Health Insur waiver) Second Period $
Life Ins INLI (ER expense) Second Period $
Retirement
LAWR LAWE Every period $
PERR PERS Every period $
STRR STRS Every period $
Taxes CTNB CTPO SD27 Use tax table $
FITM FITS FITA Use tax table $
TXOH TXKY TXWV Use tax table $
Union CWAD CWAFS CWAC Twice monthly $
SEAU SEAF Twice monthly $
Pre-taX INFX INDP Twice monthly $
SRAA SRAE SRAM Twice monthly $
SRAR SRAT SRAV Twice monthly $
OPED V457 Twice monthly $
After-tax INVL Guardian INLT Humana Twice monthly $
SODX UNIT TICK Twice monthly $
XGTL Twice monthly $
Payroll –Direct Deposit
requested - record set up check set on Emp Info - other info screen not requested - no record set up