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Faculty Information Sheet

Personal Information
Name:
Degree:
SAP Employee #:
SSN:
Date of Birth:
Ethnicity:
Gender: Male
Female
Patient Care: Yes
No


Department Information
Department:
Sub Department:
Appointment Date: (mm/dd/yyyy format)
Slot #:
Work location: (If other than Main Campus)


Salary Data
UAMS salary:
VA salary:
Incentive Pay:
% FTE:
Total Annual Salary:
Total Insurable Income for LTD:


Funding for FGP Fringe Benefits
Fund:
Cost Center:
Internal Order/WBS: