Form Information:
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UW-Platteville Employee Transaction Form
Employee ID
Appointment Number
Check one:
Classified (“X” if applicable)
Unclassified (“X” if applicable)
LTE (“X” if applicable)
Last Name
First Name
Middle Initial
Gender
– choose one:
Male (“X” if applicable)
Female (“X” if applicable)
Minority
– choose one:
Yes, a minority (“X” if applicable)
Not a minority (“X” if applicable)
If minority, check one:
– Place an “X” after one:
Black
Hispanic
Asian
Am. Indian/Alaskan Native
Date of Birth
Position Information
Percentage of work-time
Yes, part-time (“X” if applicable)
No, not part-time (“X” if applicable)
Department
Yes, split appointment (“X” if applicable)
No, split appointment (“X” if applicable)
Job Title Code
Job Title
Org. Code (UDDS)
Action – Place an “X” after one:
New Hire
If new hire, effective date:
Termination
If termination, effective date:
Promotion
If promoted, promoted from
If promoted, promoted to
If promoted, effective date:
Transfer
If transfered, promoted from
If transfered, promoted to
If transfered, effective date:
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