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Summary: Staff Number S.I.N. S.I.N. Expiry Date
Title Surname Given names Initial Gender Date of Birth
Home Address Line 1 Line 2
City Prov Country Postal Code
Pay Address Line 1 Line 2
Country of Residence prior of Appointment Citizenship Immigration Status Effective Date
0 Canadian 2 Working 3 Permanent Pending
Visa Resident
Position # (if not new) QUFA Position (check if yes)
Appointment Dates Start End
Appointment Types (check one)
Check if appointment is
Adjunct Group 1(term) Continuing Adjunct (continuing) Overload appointment
Adjunct Group 2 (term) Academic Related (term) * Cross appointment
Adjunct Group 3 (term) Academic Assistant (term) Joint appointment
Rank Professor Emeritus 1 Professor 2 Associate Professor 3 Assistant Professor 4 Lecturer
Appointment Title
Faculty Department
Method of Payment
Requisition Paid (* Not to be used for Academic Assistants)
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