Miami University
Personnel Data Sheet
About Miami
Academics
Admission
Living at Miami
University Offices
Academic Affairs Personnel Data Sheet
*
Indicates a required field
Appointment Type (
*
must select one)
Faculty Full-time
Faculty Part-time
Faculty Summer Only
Staff
Aramark Employee
Intermittent/Consultant
Other
Check here if tenure-track or appointment with tenure
For tenure-track or appointment with tenure, please note your research interests here (max length 2000 characters)
2000
Characters Remaining
If Other, please comment
Name (as it appears on your Social Security Card or your full legal name)
Last
*
First
*
Middle
Maiden
Home Address:
Street 1
*
Street 2
City
*
U.S. State & Canada
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
Armed Forces, Americas
Armed Forces, Europe
Armed Forces, Pacific
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Foreign State
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northern Mariana Islands
Northwest Territories
Nova Scotia
Ohio
Oklahoma
Ontario
Oregon
Palau
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Unknown
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon Territory
Zip/Postal Code
Province
Nation
United States of America
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Terr
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burma (NO LONGER EXISTS)
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Czechoslovakia(NO LONGER EXIST
Democratic Yemen (NO LONGER EX
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
FrenchSouthern&AntarcticLands
Gabon
Georgia
German Dem Rep (NO LONGER EXIS
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island & McDonald Isl.
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Neutral Zone(NO LONGER EXISTS)
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia&S.Sandwich Islnd
South Korea
Spain
Sri Lanka
St. Helena
St. Lucia
St. Pierre & Miquelon
St. Vincent & The Grenadines
St.Kitts & Nevis
Sudan
Suriname
Svalbard & JanMayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
The Gambia
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
UNKNOWN
US Minor Outlying Islands
USSR (NO LONGER EXISTS)
Uganda
Ukraine
United Arab Emirates
United Kingdom
Unknown or Unspecified Country
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Wallis & Futuna Islands
West Bank
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Phone number(s):
Primary Contact Phone
*
Secondary Contact Phone
Email Address (strongly suggested)
U.S. Citizen
*
Yes
No
Citizenship, if not U.S. citizen
*
Visa Status
*
F1/OPT
CPT
H1
IM (Immigrant)
J1
O1
PR (Permanent Resident)
RA (Resident Alien)
TN
EAD
Asylum status
Pending
Visa Expiration(MM/DD/YYYY) (Select today's date if your visa is pending)
*
Date of Birth(MM/DD/YYYY)
*
Social Security #
Gender
*
Male
Female
Marital Satus
Married
Single
Divorced
Widowed
Separated
Name of Spouse or Partner
I confirm I do not yet have a social security number.
Hiring Department or Program
Hiring Campus or Learning Center
Are you currently receiving retirement benefits from the State of Ohio?
*
Yes
No
Race/Ethnicity
Required for Federal reporting purposes.
Are you Hispanic?
*
Yes
No
If Hispanic, select your Hispanic origins
Mexico
Puerto Rico
Other
If non-Hispanic, select race (check all that apply)
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Emergency Contact (Atleast One Emergency Contact is Required)
Contact Name
Relationship
Aunt
Brother
Child
Daughter
Father
Fiance
GrandParent
Guardian
Mother
Other
Partner/Significant Other
Sister
Son
Spouse
Uncle
Address
City
State/Province
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
Armed Forces, Americas
Armed Forces, Europe
Armed Forces, Pacific
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Foreign State
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northern Mariana Islands
Northwest Territories
Nova Scotia
Ohio
Oklahoma
Ontario
Oregon
Palau
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Unknown
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon Territory
Nation
United States of America
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Terr
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burma (NO LONGER EXISTS)
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Czechoslovakia(NO LONGER EXIST
Democratic Yemen (NO LONGER EX
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
FrenchSouthern&AntarcticLands
Gabon
Georgia
German Dem Rep (NO LONGER EXIS
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island & McDonald Isl.
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Neutral Zone(NO LONGER EXISTS)
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia&S.Sandwich Islnd
South Korea
Spain
Sri Lanka
St. Helena
St. Lucia
St. Pierre & Miquelon
St. Vincent & The Grenadines
St.Kitts & Nevis
Sudan
Suriname
Svalbard & JanMayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
The Gambia
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
UNKNOWN
US Minor Outlying Islands
USSR (NO LONGER EXISTS)
Uganda
Ukraine
United Arab Emirates
United Kingdom
Unknown or Unspecified Country
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Wallis & Futuna Islands
West Bank
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Zip/Postal Code
Phone
Alternate Phone
Contact Name
Relationship
Aunt
Brother
Child
Daughter
Father
Fiance
GrandParent
Guardian
Mother
Other
Partner/Significant Other
Sister
Son
Spouse
Uncle
Address
City
State/Province
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
Armed Forces, Americas
Armed Forces, Europe
Armed Forces, Pacific
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Foreign State
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northern Mariana Islands
Northwest Territories
Nova Scotia
Ohio
Oklahoma
Ontario
Oregon
Palau
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Unknown
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon Territory
Nation
United States of America
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Terr
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burma (NO LONGER EXISTS)
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Czechoslovakia(NO LONGER EXIST
Democratic Yemen (NO LONGER EX
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
FrenchSouthern&AntarcticLands
Gabon
Georgia
German Dem Rep (NO LONGER EXIS
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island & McDonald Isl.
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Neutral Zone(NO LONGER EXISTS)
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia&S.Sandwich Islnd
South Korea
Spain
Sri Lanka
St. Helena
St. Lucia
St. Pierre & Miquelon
St. Vincent & The Grenadines
St.Kitts & Nevis
Sudan
Suriname
Svalbard & JanMayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
The Gambia
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
UNKNOWN
US Minor Outlying Islands
USSR (NO LONGER EXISTS)
Uganda
Ukraine
United Arab Emirates
United Kingdom
Unknown or Unspecified Country
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Wallis & Futuna Islands
West Bank
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Zip/Postal Code
Phone
Alternate Phone
The following two sections are required only if a cv or resume has not been submitted as part of an application packet.
Education
College or University
City/State
Degree Type
Date Earned(MM/DD/YYYY) or # Years Attended
Professional Experience - Academic/Non Academic (3 most recent)
Employer
Position/Rank/Title
Start Date(MM/DD/YYYY)
End Date(MM/DD/YYYY)
Your appointment is predicated upon representations made by you regarding education and experience which if subsequently proven to be incorrect, shall cause this appointment to be void.
For Faculty Appointments:
Full-time faculty appointments
are for a 9-month term. The default pay schedule is:
August
~1/2 month salary;
September through April
full-month salary;
May
~1/2 month salary;
Pay dates are the last working day of the month.
Faculty may receive salary over twelve months. A portion of each month's salary during the term (academic year) is "deferred" and reserved so that salary is distributed over the summer months, allowing an equal month's salary for 12 consecutive months. Please note: By selecting a 12-month pay plan, your first pay for the academic year will be
September 30
. If you wish to be paid over twelve months, you must sign and submit the
Deferred Pay Authorization
. Return it to the Academic Personnel Office one month before you begin employment, or sign it in Academic Personnel Services no later than August 10. This pay plan cannot be implemented after the August payroll is completed and is not available for one-semester or part-time faculty appointments.
Academic Personnel Services
academicpersonnel@miamioh.edu
Fax - 513-529-1720
Rm 1, Roudebush Hall, 513-529-6724
Do you wish to submit the form at this time? (Click OK to submit, click Cancel to return to the form)