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University of California Santa Barbara

Forms

ACADEMIC RECALL APPOINTMENT FORM

Department Contact Information









Recall Appointment

Status at Time of Retirement






Proposed Recall Appointment












Other Recall Appointments:













Attach an up to date UC Biography form if there have been changes since the last appointment or time of retirement.

Note: A minimum 30-day break in service after the date of retirement is required prior to any recall to active duty. Recall appointments are limited to a maximum of 43% time per month (or a dollar amount that translates to that equivalent). Departments should advise any academic retiree to consult with the Benefits Office prior to accepting any post-retirement appointment to determine any possible impact on their retirement benefits.



_____________________________________________________________________ __________________

Department Chair Signature

Date

 
_____________________________________________________________________ __________________

Dean Signature (for teaching appointments)

Date

 
_____________________________________________________________________ __________________

Associate Vice Chancellor Signature (For research and administrative appointments)

Date

(Last Revised 8/2016)