Faculty Enrollment Form

FACULTY ENROLLMENT FORM

This Faculty Enrollment Form establishes the official record of proposed appointment, assignment, and administrative information for faculty members. Submission of this form certifies that the information provided is accurate and that the faculty member agrees to comply with institutional policies, applicable laws, and conditions of appointment as set forth by the appointing unit.

Faculty Information

Preferred Name:    Date of Birth:    Personnel ID:

Phone:    Email:

Emergency Contact

Relationship:    Phone:

Appointment Details

Rank / Title: Professor Associate Professor Assistant Professor Lecturer Adjunct

Tenure Status: Tenure-track Tenured Non-tenure-track

Appointment Type: Full-time Part-time Visiting Fixed-term

Full-Time Equivalent (FTE) Percentage:    Appointment Start Date:    Expected End Date (if applicable):

Academic Qualifications

Awarding Institution:    Year Awarded:

Teaching, Research & Service Assignment

Compliance, Certifications & Disclosures

By submitting this form, the faculty member certifies under penalty of disciplinary action that all information provided is true and complete. The faculty member acknowledges and agrees to the following mandatory conditions:

1. Compliance: The faculty member will comply with institutional bylaws, academic and conduct policies, conflict-of-interest and research integrity requirements, and all applicable federal and state laws governing employment, teaching, and research.

2. Intellectual Property and Works: Unless otherwise provided by separate agreement, works created in the scope of employment or under institutional funds are governed by institutional intellectual property policy, which may assign certain rights to the institution.

3. Background Check and Eligibility: Appointment is conditioned upon satisfactory completion of required background checks and verification of employment eligibility; the faculty member consents to such checks where permitted by law.

4. Mandatory Reporting: The faculty member shall comply with mandatory reporting obligations for student safety, research misconduct, and other matters as required by policy and law.

5. Privacy and Directory Information: The faculty member authorizes inclusion of name, title, department, official email, and professional biography in institutional directories unless otherwise restricted by applicable law.

Conflict of Interest Disclosure: No known conflicts to disclose    Conflicts exist; explanation attached

Has the faculty member ever been subject to disciplinary action, investigation, or termination by an academic or professional employer? No    Yes

Required Documents Checklist

The following documents must be provided and retained in the personnel file (check all that apply):

Curriculum Vitae    Official Transcripts    Licenses / Certifications

Teaching Evaluations    References    Other (specify below)

Consent and Final Certification

I certify that the information provided in this Faculty Enrollment Form and the attached documents is true, correct and complete to the best of my knowledge. I understand that any material misrepresentation or omission may result in withdrawal of the appointment or disciplinary action. I authorize the institution to verify the information provided and to obtain employment, education, and background information as permitted by law.

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