1. ACADEMIC PERSONNEL TRANSACTION FORM
2. FACULTY CONTRACTS:
This Notice of Appointment must accompany all new appointments. For detailed procedures for completing the contract, refer to the Notice of Appointments section. No contracts are required for paid appointments on Academic OPS or non-salaried college appointments. Include in "qualifying remarks," specific dates of employment if appointment is temporary or to be renewed on a year by year basis. These contracts should also include the statement, "Your employment under this contract will cease on the date indicated. No further notice of cessation of employment is required."
3. Medicaid Credit Balance Letter: In addition to these statements in the letter of offer, include the Medicaid Credit Balance letter with the letter of offer.
4. Privacy Policies and Procedures & Confidentiality Statement should be included as an attachement to all letters of offer , regardless of title or job duties, the confidentiality statement should be signed by the signed amployee and returned with the letter of offer to the department.
5. CURRICULUM VITAE WITH ATTACHED BIBLIOGRAPHY (2 copies).
6. AAMC FACULTY ROSTER. This form must be signed by the appointee. If the faculty member gives consent, his data will be included in a pool of women and minorities for recruitment to faculty positions in the U.S. Form must be submitted for all full-time positions (Instructor and above). Not required for temporary or part-time positions. (original only)
7. IDENTIFICATION BADGE - Do not forward to Dean's Office.
8. SEXUAL HARASSMENT WORKSHOPS - Mandatory attendance by all employees. Schedule available at Training and Development website.10.FACULTY ASSIGNMENT FORM - These forms are submitted each semester for continuing faculty. (One copy.)
11. PROFESSIONAL LIABILITY QUESTIONNAIRE - Forward application for malpractice coverage to Dean's Office.
12. FLORIDA LICENSURE INFORMATION - All appointees who have practice privileges must either have a Florida License or a Medical Faculty Certificate. The appointee's paperwork may not be forwarded to the Office of Academic Affairs without a copy of his/her Florida License or Medical Faculty Certificate.
13. FOREIGN MEDICAL SCHOOL GRADUATE - If appointee is graduate of foreign medical school an ECFMG number, date issued, status (standard or interim) and copy of ECFMG certificate must be provided.
14a. ALACHUA COUNTY MEDICAL SOCIETY: Submit application to Immigration and Licensure, PO Box 100005.
14b. FRINGE BENEFIT REVIEW: Make an appointment with Fringe Benefits, Office of the Dean, for review of benefits and completion of benefit enrollment forms.
15. NEW HIRE CHECKLIST:
a. LETTER OF OFFER - The following information should be included in letters offering employment. (2 copies) ***Letter of offer must be reviewed by the Dean's Office, Personnel Section, prior to forwarding to a prospective faculty member.Date
Title and Job Code: Title is the professional rank (Professor, Associate Professor, Assistant Professor, etc.) plus any administrative position (Dean, Chairman, Director, etc.) being offered.
FTE The percent of full-time effort (F.T.E.) assigned.
Department, Program, College or Employment Unit where primary appointment is held.
Salary and administrative salary supplement when appropriate. This must not exceed the advertised range. All faculty except OPS faculty, Postdoctoral Associates, Research Associates,faculty appointed with visiting modifier, and faculty appointed at Pensacola, Leesburg, North Broward and Melbourne are included as part of the College of Medicine Compensation Plan. The Core and Performance salary must be designated as follows: "You will receive an annual salary of $___ ($___ core and $___ performance)." (See Compensation Plan in order to determine the core salary.) **For part-time employees, core rate should be prorated based on FTE.
Employment Period List both contractual beginning and ending dates. The begin date will be the effective date of employment with the University, and end date will be June 30 for 12 month employees. For tenure-accruing titles, include the statement: "contracts are renewable annually based on your effectiveness in the performance of your assigned duties and responsibilities, the needs of the department and financial consideration". For non-tenure accruing titles you may use the preceding statement OR "Your employment under this contract will cease on the date indicated. No further notice of cessation of employment is required" **If this statement is utilized in the initial letter of offer, subsequent letters of offer must be completed on an annual basis for continued employment
Duties & Responsibilities: This area should be used to describe the assigned duties and responsibilities of the employee. Effort percentages should be listed for each of the following categories: clinical, research, administration and teaching.
Contract Statement THE FOLLOWING STATEMENT SHOULD BE INCLUDED IN ALL LETTERS OF OFFER, "IN PERFORMANCE OF THE CONTRACT, BOTH PARTIES ARE SUBJECT TO THE CONSTITUTION AND LAWS OF THE STATE OF FLORIDA, THE RULES, REGULATIONS AND POLICIES OF THE FLORIDA BOARD OF GOVERNORS AND THE UNIVERSITY OF FLORIDA BOARD OF TRUSTEES, INCLUDING THE COLLEGE OF MEDICINE FACULTY COMPENSATION PLAN, A COPY OF WHICH IS ATTACHED." FOR THOSE FACULTY NOT APPOINTED AS PART OF THE COMPENSATION PLAN (I.E. OPS FACULTY, POSTDOCTORAL ASSOCIATES, RESEARCH ASSOCIATES,FACULTY WITH A VISITING MODIFIER AND PENSACOLA, LEESBURG, NORTH BROWARD AND MELBOURNE FACULTY), PLEASE OMIT THE LAST PART OF THE STATEMENT, "INCLUDING THE COLLEGE OF MEDICINE FACULTY COMPENSATION PLAN, A COPY OF WHICH IS ATTACHED."
Position number should be listed if known at the time of offer.
Tenure Status* All letters of offer for full-time and part-time faculty must first have a tenure statement indicating the status of the position (tenured, non-tenure earning or tenure earning).
For tenure track faculty, include the following statements: "No tenure earning time shall be accrued during a leave of absence without pay or a reduced FTE appointment, except as agreed to in writing by the Office of Academic Affairs and the faculty member at the time of approval of the leave or FTE reduction."AND "College of Medicine faculty members are granted tenure and are promoted pursuant to the College of Medicine's tenure and promotion guidelines, which may be accessed at: http://medinfo.ufl.edu/faculty/faculty_programs/tenure_promototion_guidelines/ Please be aware the probationary period for granting tenure in the College of Medicine is seven years; therefore, a tenure-accruing faculty member must be a U.S. citizen or have obtained permanent residency status by the end of his/her sixth year of employment in order to be considered for tenure."
If requesting approval to hire a faculty member with tenure, the request must first have the approval of the Dean, the Senior Vice President for Health Affairs and the President of UF before being offered to the prospective employee. Complete the Request for Tenure upon Appointment form; attach curriculum vitae, three letters of recommendation, and any recent teaching evaluation to the letter. Prior to receiving Board of Trustee’s approval, please preface any reference to tenure in the letter of offer with the introductory clause, "Upon your acceptance you will be recommended for tenure, and if approved by the University of Florida Board of Trustees, you will be awarded tenure."
Patient Records Statement: "The University of Florida will be the owner of all medical or patient records generated by the practitioner." If the faculty member is to be assigned to the VA, please include "except those generated by the VA".
License and Privileges Statement: "Your effective date of employment is contingent upon your receipt of a valid Florida Medical License or Medical Faculty Certificate and Shands HealthCare Credentials. It is your individual and sole responsibility to obtain and maintain an unrestricted license to practice medicine in the state of Florida and to obtain and maintain unrestricted clinical privileges at the institution(s) to which you are or may be assigned. Your failure to obtain and maintain appropriate licensure or clinical privileges will be considered just cause for revocation of this offer or immediate termination of your employment."
Medicaid Statement: "Your signature also affirms that you have diligently inquired and to your knowledge have no outstanding Florida Medicaid credit balances that you incurred before your employment with the University and that would in any way bar or delay Florida Medicaid reimbursement for your services rendered with the University. Please be aware that, if any such credit balances are revealed at any time and result in the University being unable to collect from Florida Medicaid reimbursement for services you render with the University, then you have failed to effectively maintain eligibility with that program which is a condition of your employment. In such an event, if you do not promptly resolve the credit balance issue to the satisfaction of the University, then your employment may be terminated immediately."The Medicaid Claims Department (800-289-7799) can verify any credit balances by provider's medicaid number.
Health Assessment Statement:Outside Employment Statement: The following statement must be included in all letters of offer, "If you propose to engage in any outside activity or have a potential conflict of interest you shall notify your supervisor in writing (using the proper University of Florida forms) and obtain written approval from your supervisor before engaging in outside activity. Such notification must be done annually on July 1st for each subsequent year for as long as you continue to engage in such activity or have such conflict of interest."
Compliance Statement: The following statement must be included in all letters of offer (per General Counsel's Office), "Your signature on this letter affirms you are not currently excluded,debarred or otherwise ineligible to participate in the Federal health care programs or in Federal procurement or non-procurement programs and that you have not been convicted of a criminal offense related to the provision of health care items or services. Your eligibility to participate in Federal health care programs is a condition of your employment with the University. If you are at any time excluded, debarred or otherwise declared ineligible to participate in Federal health care programs (other than through a College of Medicine-approved "private contracting" arrangement) or in Federal procurement or non-procurement programs or are convicted of a criminal offense related to the provision of Health care items or services, your employment may be terminated immediately."
HIPAA Privacy Statement: All University of Florida Health Science Center employees are required to sign a statement agreeing to maintain the confidentiality of protected health information. Enclosed is a copy of the University of Florida's confidentiality statement. Please read, sign and return the confidentiality statement to me. All university of Florida Health Science Center employees also are required to complete specialized training regarding privacy and security that involves HIPPA general awareness and Principal Investigator training, as applicable. Arrangements will be made to assist you with accessing this on-line training following your arrival at the university. Please be aware that all Health Science Center employees are required annually to re-sign the confidentiality statement and to complete the on-line privacy and security training.
Retirement Contribution Statement: THE FOLLOWING STATEMENT SHOULD BE INCLUDED IN ALL LETTERS OF OFFER FOR FACULTY. "FOR ALL NEW EMPLOYEES HIRED AFTER JULY 1, 1996, NO RETIREMENT CONTRIBUTIONS WILL BE MADE ON ANNUAL COMPENSATION THAT EXCEEDS LIMITS ESTABLISHED BY FEDERAL LAW, CURRENTLY $245,000."
Immigration Statement: If the employee is not a U.S. citizen, the following statement should be included in their letter of offer. "This offer and your employment is contingent upon your eligibility to work under the provisions of all applicable immigration laws and regulations including the Immigration Reform and Control Act of 1986, as amended, and your providing the necessary documents to establish identity and employment eligibility to satisfactorily complete Form I-9 of the U.S. Citizenship and Immigration Services"
If the appointee will be on an H-1 visa, a separate addendum to the letter of offer must be issued for immigration purposes which states:"As you know, you will be employed pursuant to an H-1B visa being authorized. Although your University employment contract is renewable on an annual basis, and is subject to all the University's regulations, the University is requesting H-1B status sponsorship for a period of __ years, mm/dd/yyyyy to mm/dd/yyyy, because at present, we have a reasonable expectation that your employment period will continue on a year to year basis."
VA Faculty: Letters of offer for faculty members with any portion of their salary paid from the VA may include the following statement: "Since you are a VA employee, if awarded tenure, it will remain in effect as long as the Gainesville VA Medical Center is a Dean's Committee Hospital of the University of Florida, College of Medicine." However, if this statement is included in the letter of offer, it must also be included on the notice of appointment form. The letter must include the following statement, "You are being appointed as part of the VA Dean's Agreement."
Signature Line: Letter must be signed by employee. Include the following statement at the bottom of the letter. "I understand and accept the conditions of this letter of offer." Include a line for employee to sign on.
b. CONFIRMATION OF HIGHEST DEGREE As of July 1988, on all new appointments, the highest degree must be verified. The highest degree shall be confirmed independently (the employee may not provide the confirmation) in one of the following ways:
Verbal confirmation of the degree by the Graduate School or the Registrar's Office (at the degree-granting institution). The documentation must include the date, time, institution, office called, and the name and title of the person making the telephone call and of the person providing the confirmation, the phone number called, and any other pertinent information (Download Degree Confirmation Form here).
In the case of confirmation for an M.D., the campus-wide Registrar's Office must be called for confirmation. If the campus-wide Registrar's Office will not confirm the degree and refers the confirmation request to the medical school, this must be noted on the degree confirmation form as well as an explanation as to why.
Written confirmation of the degree by an appropriate official, the Graduate School or Registrar's Office at the degree-granting institution. Please note the above concerning confirmation of M.D. degree. An official copy of a transcript from the degree-granting institution which confirms the degree which has been sent directly to the employing unit. Reproduced copies of the diploma and/or transcript will not be accepted.
Should unusual circumstances preclude a direct confirmation of educational credentials such as with an institution which is no longer in operation or with a foreign institution, the hiring administrator may obtain confirmation by direct contact with colleagues, professors or other persons which would have first hand knowledge of the educational credentials obtained by the applicant. If there is difficulty in contacting persons with a first hand knowledge of educational credentials, the administrator should then attempt to obtain confirmation from individuals who personally knew someone who could attest to the credentials. These "here say" confirmations will only be accepted in the most extreme instances.
c. VISA INFORMATAION - This data must be completed prior to the starting date of an employee who is not a citizen of the United States. Federal law prohibits employment of aliens in undefined status. For personnel processing purposes, submit two copies of the I-94 card (front and back) or the green card. If a new faculty member is a permanent resident, he/she will have a green card (2 copies) even if employment authorization card is provided. In addition, for employees with a J-1 status, a copy of the DS2019 Form must be attached. For F1, a copy of I-20 must be attached, and for employees with an H1 status, a copy of I-797A Form must be attached.
d. WINDSTAR FORMS (Original and one copy.) These forms are required for all non-resident aliens. You must first submit a completed Foreign National Tax Information Form with copy of both sides of the I-94 card and IAP-66 or I-20, whichever is applicable, to University Tax Services, 104 Tigert Hall for review. Their office will forward the appropriate Winstar forms to the department for completion by the employee.
e. DIRECT DEPOSIT Forward Direct Deposit form(s) to faculty member - required for all UF employees.
f. SELECTIVE SERVICE All male employees between the ages of 18 and 26 are required to register with the Selective Service System under the Military Selective Service Act, 50 U.S.C. App. 453. Without proof of such registration, no such male may be offered employment with the University of Florida or may be promoted to a higher authorized position. In order to ensure compliance with Section 110.1128 of the Florida Statutes, a screen-print from the Selective Service web page must accompany new hire paperwork for any male between the ages of 18 and 26 who is being employed.
g. W-4 CARD If a request for a duplicate social security card {Form SS-5 (10-80)} is being submitted, another form of identification other than "original social security number card" must be used for employment eligibility on the Form I-9, List C (i.e. Birth Certificate). However, if the employee has applied for a duplicate card through the social security office, he/she will receive a computerized print-out from the social security office. This print-out may be used for W-4 purposes.
If an out of state address it utilized on a W-4 card, the Comptroller's office will deduct appropriate state income tax. Therefore, all new employees should use his/her departmental addres until a home address is established in Florida. As soon as a local residence is known, submit a revised W-4 to the Dean's Office.
h. Retirement Plan Acknowledgement Form
i. Benefits Acknowledgement Form
j. I-9 Form
k. Four In One Form Employees are required to take an oath in the presence of a notary public. Proper identification must be produced and the type of identification so indicated on the form if the notary public does not have personal knowledge of the employee.
1. VA Salary - The VA salary must be included in the "Remarks" Section of the APT form.
Faculty Contract - Include the VA salary in the total annual salary, for the 12 month salary figure requested on the contract form.
2. VA DEAN'S COMMITTEE APPROVAL - A letter from the respective department chair must be submitted to the Dean, College of Medicine, requesting approval to appoint a College of Medicine faculty member to the Medical Education Affiliation agreement between the North Florida/South Georgia Veterans Health System and the University of Florida College of Medicine. The request must include the proposed effective date of the appointment. When appointing a Consultant or Attending, the letter should state whether the physician will be appointed with or without compensation. (See sample)
3. APPLICATION FOR PHYSICIANS AND DENTISTS All Staff Physicians, Consultants, and Attendings must complete an "Application for Physicians and Dentists", VA Form 10-2850, in triplicate. All three copies of the application should be forwarded to the Chief of Staff's Office at the VA Hospital. A supply of application forms can be requested from the Chief of Staff's Office.
4. DECLARATION OF HEALTH FORM A physical examination is required for (salaried) Staff Physicians and may be given by any physician other than the applicant. A supply of forms can be requested from the Chief of Staff's Office at the VA Medical Center. (Physical examinations are not required for Consultants and Attendings).
5. INITIAL CLINICAL PRIVILEGES APPLICATION Form with appropriate specialty attachment should be submitted to the VA Chief of Staff's Office. Forms may be requested from the VA.
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Updated on 5/6/08