Types of Actions
Completing the PER 39
Samples of Completed PER 39
Related Resources
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The Change or Separation Form (PER 39) is designed to simplify the processing of employee data changes and/or separations. This form may be used for graduate student employees. The form may be used to submit multiple changes with the same effective date. The Graduate Student Appointment Form (PER-41) is used for graduate student new hires, concurrent appointments and rehires.

Completing the Change or Separation Form (PER-39)

General Information

The following is specific information on how to complete the form for graduate student employees. Refer to the Transaction Guidelines found on the Division of Human Resources web site for a list of documents to be included, http://www.ksu.edu/hr/infomgmt/imgradstud.htm.

The information at the top of the form must be completed for the change or separation. This information represents the current information of the employee prior to the new action.

The following fields are required when completing the PER 39 to help expedite processing time.

Name

• Enter the full name of the employee. Format should be mixed case, [First Name] space [Middle Name or Initial] space [Last Name] space [Suffix - if applicable].

Department ID

• Identify the 10-digit department to which the position belongs. The first five digits are KSU Agency number "36700". The last five digits are the FRS department number.
• Examples:
• President's Office -- 3670001010
• Human Resources -- 3670005050

Department Name

• The department name (description) coinciding with the Department ID to which the position belongs.

Employee ID

• An eleven-digit identification number assigned to the employee at the time of original hire.

RCD# (Employment Record #)

• The Employment Record Number employee is assigned for which the change is being requested. For example, if you are updating Employment Record Number "0" indicate "0", if updating Employment Record Number "1", indicate "1."

Effective Date

• This is the date the action takes effect. All actions must have an "Effective Date." The effective date of a termination is the day following the last day of employment.

Position No.

• The 8-digit position number that an employee is assigned to.

9 Month or 12 Month

• Put an "X" in the appropriate box to indicate if the employee is 9 or 12 month.

Classifed, Unclassified or Graduate Student

• Put an "X" in the appropriate box for a graduate student employee.

Job Code

• The 6-digit graduate student job code associated with the graduate student job title of the position number.:
• 030500-Graduate Teaching Assistant(GTA)
• 032000-Graduate Research Assistant(GRA)
• 031000-Graduate Assistant(GA)

Job Title

• Graduate student job title description for the graduate student job code.

HOME ADDRESS CHANGE

Departments have access to update addresses in HRIS during the second week of each pay period. Instructions are available on http://www.ksu.edu/hr/infomgmt/imaddress.htm. If you wish Human Resources to update an address change, please submit the Change or Separation Form PER 39.

Home address indicates the employee's current address. This is where employees' paycheck, W-2 information, health insurance information will be sent. If the employee wishes the "Check Address" to be different than the "Home Address" - please contact HR Payroll & Employee Data. HR-Payroll & Employee Data staff will make this change on the Paycheck page in HRIS; not the Address History page where Home Address is stored. For example, a different address might be used when an employee is on leave, away from the Manhattan area. The employee maintains a "home address" in the Manhattan area, but also maintains a temporary mailing address while on leave.

Address 1 & Address 2, City, County, Zip Code & State

• Street address, apartment and/or box number, city, county, zip code and state of employee.
• Common address abbreviations are provided at www.ksu.edu/hr/abbrev.pdf.
• The county identifies the two-digit county code associated with the city the of the Home Address
• The county codes may be found on the county table.

Home Phone

• Indicate the 10-digit home phone number of the employee.

Withhold Home Address/Phone in Campus Phone Book?

• Not applicable for Graduate Students

CHANGE

This section of the form is used to indicate a change to the current information on file. To process a change complete the top section of the form (required fields) and indicate the "Type of Action" that is to be made by placing an "X" in the box by the appropriate action and then indicate the new or correct information where applicable. Multiple actions may be indicated if the effective date of the action is the same. If there is other information not specifically indicated on the PER 39 you may indicate the change under "Other.".

Name Change

• Place an "X" in the action box and indicate the new or correct name. Use name format [First Name] space [Middle Name or Initial] space [Last Name] space [Suffix- if applicable]. Note: A copy of the Social Security Card with the new name must be attached.

Personal Change

• Place an "X" in the box if any personal data is changing. Indicate the new information in the box provided.

Citizenship Status

• Identify the employee's citizenship. Place an "X" in the action box and indicate the new or correct information. If changing status from Alien Temp to Alien Perm please attach appropriate documents, for example a permanent resident card. Valid values are listed below:
• Alien Perm
• Native
• Alien Temp
• Naturalized

Visa Type

• Place an "X" in the action box and indicate the new or correct information. An On-Campus Work Permit is required for visa holders. This is obtained through the International Student Center for all employees. A change in Visa Type requires a new I-9 to reverify employment eligibility. Valid Visa types are listed below.

Visa	Type
F1	Student
J1	Exchange Visitor/Research
J2	Spouse/Child Exchange
H1B	Temporary Worker
TN	Nafta Agreement
O1	Extraordinary Ability

Military Status

• Identify the military status of the employee. Place an "X" in the action box and indicate new or correct information.
• Not Indicated
• Other Vet
• Active Reserve
• Retired
• Inactive Reserve
• Vietnam Vet
• No Mil Svc

Marital Status

• Place an "X" in the box if personal data is changing. Indicate the new information in the box provided. The following is a list of Marital Status options.
  
  

  Marital Status
  Common Law	Married
  Divorced	Single
  Separated	Widowed
  Head of Household

Pay Rate Change (Biweekly)

• Place an "X" in this action box if you are changing salary for graduate research assistant or graduate teaching assistant. Indicate the current salary in the "From" block and the new salary in the "To" block. Action/Reason is PAY/OTH.

Pay Rate Change (Hourly)

• Place an "X" in this action box if you are changing hourly rate for graduate assistant. Indicate the current rate in the "From" block and the new hourly rate in the "To" block. Action/Reason is PAY/OTH.

Preferred Name

• Not applicable for Graduate Students

Return From Leave

• Not applicable for Graduate Students

Reappointment

• Place an "X" in this box if you are reappointing a graduate student employee at the same rank or job code and there has not been a break in service. Blanket listings may be sent to Human Resources versus individual forms for multiple reappointments including rank changes if applicable.

End of Appointment Date

• This date is used to indicate end of appointment date. This date is the first day the employee will not be employed. To continue an appointment beyond the end of appointment date, a PER-39 must be submitted to reappoint.
• Example: Last day at work is March 6--effective date for termination is March 7 (first day employee is not at work).

FTE Change

• Place an "X" in this action box if you are changing the tenths time (FTE) of an employee's position. Indicate the current FTE in the "From" block and the new FTE in the "To" block. Show as 1.0, .50, .30 etc. NOTE: Total FTE cannot exceed .5 for all graduate positions.

Benefit Program

• Benefit Program for graduate positions will always be GEN

Other

• Use this action box for other types of action not listed in which a change needs to be made. An example of this might be a social security number correction.

SEPARATION

This section of the form is used to indicate a separation from the graduate appointment prior to the End of Appointment Date indicated on the initial hire, rehire or reappointment forms. Graduate student employees are automatically terminated based on end of appointment date and no paperwork is required unless they separate prior to that date. To process a separation, complete the top section of the form (required fields) and place an "X" under the appropriate "separation" action. NOTE: The effective date of a resignation is the day following the last day of employment.

ADDITIONAL COMMENTS

Use this section for additional comments that are relevant to the type of action being processed.

SIGNATURES/DATES

Employee Signature: It is recommended that employee signatures be obtained on all personnel transactions whenever possible to ensure that the employee is aware of and understands the information that has been completed.

Signature(s) of Unit or Department Head, Dean, and/or Vice President: Contingent upon internal procedures, the Unit or Department Head, and/or Dean, Vice-President, etc., signs and dates the PER 39 to signify approval of the appointment. For multiple appointments, signatures must be obtained from all applicable departments.

Samples of Completed PER 39

PER 39 Sample A-Multiple Changes
PER 39 Sample B-Termination
PER 39 Sample C-Name Change

Related Resources

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Text versions of most Forms are available on the HR Forms page

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Kansas State University
June 25, 2008