EMPLOYEE ASSIGNMENT FORM

Hire Date: (dd/mmm/yy) Rehire? Previously Vested in Retirement? If Yes to Service Credit, indicate:
___Y ___N ___ SUNY
____Y ____N If no, Prior Service Credit? ___ Other College/University
___Yes ___No ____N/A ___ Research Organization

PEOPLE DATA
Last Name: First Name: Middle Name:
Title: ___Dr. ___Miss ___Mr. ___Mrs. ___Ms. ___Mx. Sex: ___M ___ F Gender: ___M ___F ___X
Social Security #: Birth Date: (dd/mmm/yy) Type: Internal
Nationality: ___US Citizen ___ Non-Citizen in US on VISA ___Non-Citizen Not in US ___Perm. Resident
Ethnic Origin: (select all that apply) ___American Indian or Alaskan Native ___Asian ___Black or African American ___Hispanic
or Latino ___Native Hawaiian or Other Pacific ___White ___Two or More Races
Chosen or Preferred First Name:
I-9 Status: __Yes __No __Pending Visa Type: I-9 Expiration Date:
Vets 100 Status: Vets 100A Status: New Hire: Include in New Hire Report
Mail Stop (Check Delivery Drop): Correspondence Language:
E-Verify Status: Date Authorized: Case Verification #:
SPECIAL INFO
Education Level: Degree Expected: Date Degree Expected:(dd/mmm/yy)
Other Special Info: ___Y ___N Specify:
ADDRESS
US Address (Primary Address in United States):
City: State: Zip Code:
County: Country:
Type: Primary: Y (this should be checked on the US address)
Telephone: ( )
E-Mail Address:
Address 2: ___US ___Foreign

City: State: Zip Code:

County: Country:
Type: Primary: N Telephone: ( )
ASSIGNMENT
Organization: Op. Location: Group:
Effort Reporting Status: N/A = Not Applicable Assignment Category:
Job: Grade: Payroll: Biweekly
Location: Status: ____ Active Assignment ____SUNY Extra Service
Supervisor: Employee Category:
Work Week Basis: ___37 ½ hours ___40 hours | Hourly-Benefits Eligible? ___Y ___N
Salary Basis: FTE: Work Region: Appointment Type:
SALARY
Proposal (Effective) Date:(dd/mmm/yy) New /Change Value:
Approved: X Reason:
Retro Required? ___No ___Yes: Begin Date: (dd/mmm/yy) Retro End Date:(dd/mmm/yy)

Input by: Date:

August 2022 1
 EMPLOYEE ASSIGNMENT FORM
NAME: Employee #:
LABOR DISTRIBUTION
Schedule Hierarchy ___Assignment ___Element
Schedule Line Changes
LD LD
Project Task Award Organization Expenditure Type %
Start Date End Date

Input by: Date:

DECLARATION AND AUTHORIZATION

I accept the position offered as an employee of The Research Foundation for The State University of New York (“RFSUNY”). I understand this position is subject to final
approval by RFSUNY and is terminable at will. I also agree to abide by all policies and regulations of RFSUNY.

Intellectual Property Assignment

I have read The State University of New York’s Patents, Inventions and Copyright Policy (“SUNY Policy”) and RFSUNY’s Intellectual Property Policy (“RF Policy”). I agree
to abide by the SUNY Policy and the RF Policy, and by any additional terms and conditions imposed by any sponsor from which I accept support through RFSUNY, including
but not limited to the Patent and Trademark Amendments Act (i.e., Bayh-Dole Act) and its implementing regulations found in 37 CFR 401. I will promptly disclose to
RFSUNY or its designee any Intellectual Property (as defined in the SUNY Policy) subject to the SUNY Policy or sponsor requirements, and will cooperate with RFSUNY, the
sponsor, and the State University of New York, and execute any such documents as may be necessary to protect the subject Intellectual Property. I understand that the prompt
disclosure of Intellectual Property developed within the scope of my employment is required to enable its protection prior to U.S. or foreign statutory bars and to establish the
government’s rights, where applicable. I hereby assign to RFSUNY all rights in Intellectual Property subject to the SUNY Policy, and will execute any documents required to
effectuate such assignment to or as directed by RFSUNY.

As an Equal Opportunity/Affirmative Action Employer, the RFSUNY will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex,
pregnancy-related conditions, reproductive health decisions, childbirth or related medical conditions, sexual orientation, gender identity or expression, transgender status, age,
national origin or ancestry, marital status, familial status, citizenship, physical and mental disability, prior arrest or conviction record, genetic characteristics/genetic
information, predisposition or carrier status, domestic violence victim status, military status or service, veteran status, or any other characteristics protected under federal, state
or local law. The RFSUNY will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed
their own pay or the pay of another employee or applicant. The RFSUNY will not discharge or in any other manner discriminate against employees or applicants because they
have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.

Employee Signature:___________________________________________________________ Date:___________________________________

APPROVALS
This assignment is consistent with sponsored program terms and conditions and with Research Foundation policies.
Project Director/Co-Project Director:

(Signature) (Date)
Funds are in the account for this assignment.
Operations Manager:

(Signature) (Date)
Additional Campus Signatures as Required:

(Signature) (Date)

(Signature) (Date)

June 2024 2