/ University of Puerto Rico Mayagüez / / PAPP #: ____ - ______

Research & Development Center
Personnel and Budget Action Proposal
Appointments

Renewal is contingent upon availability of funds. This appointment does not constitute a commitmentfor regular permanent employment.

Plase submit to the Human Resources Office at least 15days prior to the personnel action start date with all required documentation.

Name, Last name, Mother’sLast name / Social Security Number
- - / Weekly attendance schedule
LMMJV-am / -pm
KEY / DESCRIPTIÓN / MONTHLY COST / EFFECTIVE PERIOD
DAY/ MONTH/ YEAR / TOTAL NUM. OF MONTHS / WEEKLY HOUR TOTAL
Special Appointment / $ / From - -
To - -
Building name / Office number / Phone or ext.
EMPLOYMENT DATA / CURRENT DATA / PROPOSED DATA
Title:
College and Department: / Project Name
Classification and Scale: / Teaching Non-Teaching Scale: / Teaching Non-Teaching Scale:
Appointment type: / Perm. Sust. Temp. Conf.Esp. Ad.Hon. / Perm. Sust. Temp. Conf. Esp. AdHon
Obligated Salary: / $ / By period: $
AffectedAccounts(s)-Code: / - / Account: Code: 1030 1011

the tasks to be performed by the employee are on the back of the documentIt is audit requirement to comply with all of the firms below:

(1) Principal Investigator, Applicant / Date / (4) R&DC Director Recommendationeha / Date
(2) Department Chair P/C
Date / Date / (5) Chancellor, Approval / Date
(3) Dean’s Vo.Bo. / Date / (4) Employee signature accepting employment and acknowledgement of receipt of duties/document / Date
SWEARING FORM / Only required for new UPRM employees
1. Are you a citizen of the United States?  Yes  No / 2. On the contrary, indicate foreign citizenship :
3. Do you contribute to the Federal Social Security? / 4. Dateof Birth:
5. Academic Degree: / 6. Are you retired Retirement system? ______Which? ______
7. Have you worked before for a govenrment agency in Puerto Rico?  Yes  No If yes, specify: Department, Agency orMunicipality: ______
Monthly Salary: ______Date de resignation ordismiss: ______Reason: ______

I hereby certify that the information provided is correct and that,to the start date of providing services to the University of Puerto Rico, I do not receive any compensation for services rendered as a regular employee nor am I on paid leave for reasons of resignation from any dependency, corporation or municipality of Puerto Rico.

I, ______, _____ years old, named accept this appointment and do solemnly swear that to maintain and defend the Constitution of the United States of America, the laws and the Constitution of the Commonwealth of Puerto Rico against all internal and external enemies, to pay loyalty and adherence to the same,that I assume this obligation freely and without mental reservation or purpose of avoiding it; and that I will undertake the duties of the position that I am about to occupy.

______

Employee Signature

Sworn and signed before me, ______at and for the Commonwealth of Puerto Rico, today______of______of 200 .

AFFIDAVIT NUM. ______

Dean for Administration

For R&DC Exclusive Use

FULL TIME PART-TIME
MEDICAL INSURANCE BONUS
RETIREMENT
VACATION SICK LEAVE
PROPOSAL ALLOCATION
__
Verified by HR Date / HRS: # DE PUESTO: ______
JOB: SCHEDULE: ______
ROLL-OVER AMOUNT: $ ______
RATE QUNCENAL $ ______
ASN NO. TARJ. ACUM. ______
____- - ___
Entered at HRS Date / (2031)$ (2051) $______
(2032)$ (2053) $ ______
(2045) $ (2044) $ ______
( ) $ # OBLIGATION: ______
PROPOSAL ALLOCATION
By:______- _____ - ______
Budget Obligation Date

This document follows the dispositions of Law Num 1 of January 20, 1966 and the UPR Code of General Regulations.

Equal opportunity employer M/F/V/I. Form CID-RH/Rev. Feb/2013 -- Appointments.doc