Completing the Change or
Separation Form for Graduate Student Employees
The Change or Separation Form
(PER 39) (pdf) is designed
to simplify the processing of
employee data
changes and/or separations. This form may be used for graduate
student employees.
The form may be used to submit multiple changes with the same effective
date. The Graduate Student Appointment
Form (PER-41) (pdf) is used
for graduate student new
hires,
concurrent appointments and rehires.
The PER
39 (pdf) may be used to
process the following types
of
actions:
| Home Address Change | Pay Rate Change |
| Name Change | Reappointment |
| Citizenship Status Change | FTE Change |
| Visa Type Change | Resignation |
| Military Status Change | End of Temporary
Appointmetn |
| Marital Status Change | Death |
The following is specific information on how to complete the form for
graduate student employees. Refer to the Transaction
Guidelines found on the Division of
Human Resources web site for a list of documents to be included, the
graduate student checklist.
The information at the top of the form must be completed for
the change or separation.
This information represents the current information of the employee prior
to the new action.
The following fields are required when completing the PER 39 (pdf)
to help expedite processing time.
Name
- Enter the full name of the employee. Format should be mixed
case, [First Name] space [Middle Name or
Initial] space [Last Name] space [Suffix
- if
applicable].
Department ID
- Identify the 10-digit department to which the position belongs. The
first five digits are KSU Agency number "36700". The last five
digits are the FRS
department number.
- Examples:
- President's Office -- 3670001010
- Human Resources -- 3670005050
Department Name
- The department name (description) coinciding with the Department ID to
which the position belongs.
Employee ID
- An eleven-digit identification number assigned to the employee at the
time
of original hire.
RCD# (Employment Record #)
- The Employment Record Number employee is assigned for which the change
is being requested.
For example, if you are updating Employment Record Number "0"
indicate "0",
if updating Employment Record Number "1", indicate
"1."
Effective Date
- This is the date the action takes effect. All actions must have an
"Effective Date."
The effective date of a termination is the day following the last day
of employment.
Position No.
- The 8-digit position number that an employee is assigned to.
9 Month or 12 Month
- Put an "X" in the appropriate box to indicate if the
employee is 9 or 12 month.
Classifed, Unclassified or Graduate Student
- Put an "X" in the appropriate box for a graduate student
employee.
Job Code
- The 6-digit graduate student job code associated with the graduate
student job title of the position
number.:
- 030500-Graduate Teaching Assistant(GTA)
- 032000-Graduate Research Assistant(GRA)
- 031000-Graduate Assistant(GA)
Job Title
- Graduate student job title description for the graduate student job
code.
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Departments have access to update addresses in HRIS
during the second week of each pay period.
Instructions are available on address changes.
If you wish Human Resources to update an address change, please submit the
Change or Separation Form PER
39 (pdf).
Home address indicates the employee's current address. This is where
employees' paycheck, W-2 information, health insurance information will
be sent. If the employee wishes the "Check Address" to be
different than the
"Home Address" - please contact HR Payroll & Employee Data.
HR-Payroll & Employee Data staff will make this change on the
Paycheck page in HRIS; not the Address History page where
Home Address is stored. For example, a different address might be used
when an employee is on leave, away from the Manhattan area. The employee
maintains a "home address"
in the Manhattan area, but also maintains a temporary mailing address
while on leave.
Address 1 & Address 2, City, County, Zip Code & State
- Street address, apartment and/or box number, city, county, zip
code and state
of employee.
- Common address abbreviations are provided at address abbreviations.
- The county identifies the two-digit county code associated with the
city the of the Home Address
- The county codes may be found on the county abbreviations.
Home Phone
- Indicate the 10-digit home phone number of the employee.
Withhold Home Address/Phone in Campus Phone Book?
- Not applicable for Graduate Students
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This section of the form is used to indicate a change to the current
information on file. To process a change complete the top section of the
form (required fields) and indicate the "Type of
Action" that is to be made by placing an
"X" in the box by the appropriate action and
then indicate the new or correct information where applicable.
Multiple actions may be indicated if the effective date of the action is
the same. If there is other information not specifically indicated on the
PER 39 (pdf) you may
indicate the change under "Other.".
Name Change
- Place an "X" in the action box and indicate the new or
correct name. Use name format [First Name] space
[Middle Name or Initial] space [Last
Name] space [Suffix- if applicable].
Note: A copy of the Social Security Card with the new name
must be attached.
Personal Change
- Place an "X" in the box if any personal data is
changing.
Indicate the new information in the box provided.
Citizenship Status
- Identify the employee's citizenship. Place an "X" in the
action box and indicate the new or correct information.
If changing status from Alien Temp to Alien Perm please attach
appropriate documents, for example a permanent resident card. Valid
values are listed below:
- Alien Perm
- Native
- Alien Temp
- Naturalized
Visa Type
- Place an "X" in the action box and indicate the new or
correct information. An On-Campus Work
Permit is required for visa holders.
This is obtained through the International Student Center
for all employees. A change in Visa Type requires a new I-9 (pdf) to reverify
employment eligibility. Valid Visa types are listed below.
| Visa | Type |
|---|
| F1 | Student |
| J1 | Exchange Visitor/Research |
| J2 | Spouse/Child Exchange |
| H1B | Temporary Worker |
| TN | Nafta Agreement |
| O1 | Extraordinary Ability |
Military Status
- Identify the military status of the employee. Place an "X"
in the action box and indicate new or correct information.
- Not Indicated
- Other Vet
- Active Reserve
- Retired
- Inactive Reserve
- Vietnam Vet
- No Mil Svc
Marital Status
- Place an "X" in the box if personal data is changing.
Indicate the new information in the box provided. The following is a list
of Marital Status options.
| Marital
Status |
|---|
| Common Law | Married |
| Divorced | Single |
| Separated | Widowed |
| Head of Household | |
Pay Rate Change (Biweekly)
- Place an "X" in this action
box if you are changing salary for graduate research assistant or
graduate teaching assistant.
Indicate the current salary in the "From" block and the new
salary in the "To" block. Action/Reason is PAY/OTH.
Pay Rate Change (Hourly)
- Place an "X" in this action box if you are changing
hourly rate for graduate assistant. Indicate the current rate in the
"From" block and the new hourly rate in the "To"
block. Action/Reason is PAY/OTH.
Preferred
Name
- Not applicable for Graduate Students
Return From Leave
- Not applicable for Graduate Students
Reappointment
- Place an "X" in this box if you are reappointing a
graduate student employee at the same rank or job code and there
has not been a break in service. Blanket listings may be sent to
Human Resources versus individual forms for multiple reappointments
including rank changes if applicable.
End of Appointment Date
- This date is used to indicate end of appointment date. This date is
the first
day the employee will not be employed. To continue an appointment beyond
the end of appointment date, a PER-39 (pdf) must be submitted to
reappoint.
- Example: Last day at work is March 6--effective date for termination
is March 7 (first day employee is not at work).
FTE Change
- Place an "X" in this action box if you are changing the
tenths time (FTE) of an employee's position.
Indicate the current FTE in the "From" block and the new FTE in
the "To" block.
Show as 1.0, .50, .30 etc. NOTE: Total FTE cannot exceed .5
for all graduate positions.
Benefit Program
- Benefit Program for graduate positions will always be GEN
Other
- Use this action box for other types of action not listed in which a
change needs to be made. An example of this might be a social security
number correction.
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This section of the form is used to indicate a separation from the
graduate appointment prior to the End of Appointment Date indicated on
the initial hire, rehire or reappointment forms. Graduate student
employees are automatically terminated based on end of appointment date
and no paperwork is required unless they separate prior to that date.
To process a separation, complete the top section of the form
(required fields) and place an "X" under the appropriate
"separation" action. NOTE: The effective date of a
resignation is the day following the last day of employment.
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Use this section for additional comments that are relevant to the type
of action being processed.
Employee Signature: It is recommended that employee signatures be
obtained on all personnel transactions whenever possible to ensure that
the employee is aware of and understands the information that has been
completed.
Signature(s) of Unit or Department Head, Dean, and/or Vice President:
Contingent upon internal procedures, the Unit or Department Head, and/or
Dean, Vice-President, etc., signs and dates the PER 39 (pdf)
to signify approval of the appointment. For multiple appointments,
signatures must be obtained from all applicable departments.
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PER 39 Sample
A-Multiple Changes (pdf)
PER 39
Sample
B-Termination (pdf)
PER 39
Sample
C-Name Change (pdf)