COVER SHEET: SECONDARY APPOINTMENT (for current NU Faculty)

Use this form to propose a secondary appointment in an FSM department for a faculty member whose primary appointment is in an NU school outside of FSM.

1. CANDIDATE INFORMATION
Last Name / First Name / Middle Initial / Degree(s) / Employee ID
2. APPOINTMENT INFORMATION
School / Department/
Division* / Rank / Tenure / Basis / Appt. Start Date / Appt. End Date***
Primary
Appt. / NTE
TE
Tenured / FT
PT >50%
PT <50%
Unpaid
Proposed
Secondary
Appt. / FSM / Same as above / NTE
only / Unpaid
only**
*Only FSM departments may grant secondary appointments; FSM institutes and centers can offer membership but not an appt.
**If the FSM department is providing salary, this is a JOINT appointment rather than a secondary. Please consult with FAO.
***If primary appointment is tenured, then the secondary appointment has indefinite end date. Otherwise, maximum appointment term
is 3 years, but end date of the secondary appointment cannot extend past the end date of the primary appointment.
3. DESCRIPTION OF CANDIDATE’S RESPONSIBILITIES WITH SECONDARY DEPARTMENT
4. CONSENT OF CANDIDATE AND DEPARTMENTS
Consent of Candidate
I request this secondary appointment with the responsibilities described above and will continue to fulfill my obligations to my primary department. / Signature of Candidate
Consent of Secondary Department
I recommend the candidate for a secondary appointment in my department with the responsibilities described above. / Signature of Secondary Department Chair
Consent of Primary Department
I support this recommendation for a secondary appointment and accept continued responsibility for the candidate’s primary appointment. / Signature of Primary Department Chair
5. SUBMISSION TO FAO (send paper copies in the order listed below)
The department recommending the secondary appointment should assemble the materials in the order listed below and submit a hard copy to the Faculty Affairs Office:
This form, completed
Prior correspondence with FAO regarding special circumstances (if applicable)
Current CV
Position Data/Appointment Forms
Prepared and signed by secondary department
Indicate employee ID on the appointment form
Personal Data Form (must include SSN for FAO to create database record) / Guidance: FASIS Codes
Form / Action Code / Reason Code
Appointment / HIR / ADD
Position / POS / NEW
Note: There is never salary on the FASIS record of the secondary appointment. If you wish to add an appointment that has salary on the FASIS record, this is a JOINT appointment. Consult FAO.

Version Date: 6/9/2015