Re-Hire Appointment Package Checklist

• PeopleSoft Form (VP Coordinator)
• State Employment Application (If separated over six (6) months)
• Curriculum Vitae (CV)
• Original copy of Acceptance Letter of Offer (with employee's signature)
• Demographics Form
• Federal and State/City Tax Withholding Forms
• Oath of Office card
• Form I-9: Immigration & Naturalization Service (original copy only) (If separated over one (1) year)
• Approved Form SUSB 68: Summary of Affirmative Action Recruiting Activity (copy 1 & 4 only) OR Waiver of Recruitment form
• Approved Form SUSB 37: Personnel Requisition or copy of PDAR

Other (if applicable):

• Form UP-211: Approval of Employment of Retired Public Employee earning over salary limitation.
• Extra Service/Dual Employment approval form.

All forms must include appropriate signatures.

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