University of Arkansas for Medical Sciences

 

NON - EMPLOYEE INFORMATION

 

Sponsoring departments are responsible for entering non-employee information into SAP.  This form may be helpful to the department.  Granting of UAMS privileges is contingent upon the entering of the following information into the SAP database.

 

 

Name of Non-employee: __________________      _____  ___________________________

                                                 First             MI      Last

 

Social Security Number:  _______ - ____- _______

 

Birth date ______________________

 

Sponsoring Department:  _____________________________      ____________         

                                      Name                                         Org Unit#

 

Name of Company who employs this person: ___________________________________

(Or home address of the non-employee)

 

Address                            _____________________________________

 

City, State, Zip Code          ____________________,     ___,    _______

 

Gender      Female  ______      Male  ______       Unknown  _______

 

Start Date on campus                   _____________        End Date on campus  ____________

 

UAMS phone number:          _____________                  Second work phone Number __________________

 

UAMS location:                  ______________ (building/number)

 

UAMS mail slot:                  ______________

 

UAMS fax number:              ______________

 

Services include Domain Access, On-line Telephone Listing, and ID Badge

 

Please call these departments for additional services:  

Parking (UAMS Parking)                 Yes     No

           Library Privileges                         Yes     No

          Other                                         _________________________________________________

           

 

Signature of Department Director/Chair, Sponsoring Department:

 

_____________________________________________     _________________________   ____________

Name                                                  Title                       Date

 

Please include a telephone number should we have any questions: _________________________________

                                                                         Telephone Number

 

 

OHR – 8/28/06 (rev).