VISITING (RESEARCHER, PROJECT SCIENTIST, or SPECIALIST) APPOINTMENT FORM

Department Contact Information

Department Contact:
Phone:
Email:
Business Officer:
Administrative Comments:

For All Appointments, Reappointments, or Modifications

Date:
To: Dana Mastro - Associate Vice Chancellor for Academic Personnel
From:
Department:
Re: New Appointment Reappointment Modification
Proposed Appointee:
Title: Visiting Assistant Researcher
Visiting Associate Researcher
Visiting Researcher Visiting Assistant Project Scientist
Visiting Associate Project Scientist
Visiting Project Scientist Visiting Junior Specialist
Visiting Assistant Specialist
Visiting Associate Specialist
Visiting Specialist
Salary Scale: Regular Salary Scale Engineering Salary Scale Without Salary
Annual Salary:
Source of Funding:
Percent of Time:
Begin Date:
End Date:
Reports To Position #:
Worksite ID: Choose One 8-162 (AASP - Asian American Studies) 8-218 (AFFA- Title IX Office) 8-114 (ANTH - Anthropology) 8-126 (ARTS - Arts Admin Support Center) 8-93 (ASTD - Associated Students) 8-102 (ATHL - Athletics) 91 (BFS) 8-133 (CARE - Career Services) 8-217 (CFTM - Carsey-Wolf Center) 8-94 (CHEM - Chemistry) 8-92 (CHLD - Childcare) 8-219 (CHNE-Chemical Engineering) 8-134 (CITO - ENTERPRISE TECHNOLOGY SERVICES) 8-136 (COMM - Communications) 8-175 (COMS - Computer Science) 8-210 (CONF - CONFERENCE) 8-130 (COUN - Counseling/CAPS) 8-135 (CRST - Creative Studies) 8-104 (CTRL - Controller) 8-109 (DEVL - Development) 8-105 (DFSS - Facilities) 8-128 (DOST - Student Life Cluster) 8-145 (DRAM - Dramatic Arts / Dance) 8-211 (DSRS - RESIDENTIAL & COMMUNITY LIVING) 8-116 (EAPQ - UC Education Abroad Program) 8-119 (ECON - Economics) 8-113 (EDUC - Gervirtz Graduate School of Education) 8-97 (EEMB - Ecology, Evolution & Marine Biology) 8-112 (ELEG - Electrical & Computer Engineering) 8-100 (ENGR - Engineering) 8-190 (ENMT - Materials) 8-152 (ENST - ENVIRONMENTAL STUDIES) 8-122 (EOPO - Educational Opportunity Program) 8-155 (ERII- Earth Science) 8-132 (ESMS - Bren Graduate School) 8-150 (FARM - Financial and Resource Management) 8-206 (FCHO - THE CLUB) 8-213 (FDCN - Concessions) 8-203 (FDFT - PORTOLA DINING COMMONS) 8-214 (FDRR- Tenaya Market) 8-204 (FDSC - CARRILLO DINING COMMONS) 8-201 (FDSD - DE LA GUERRA DINING COMMONS) 8-215 (FDSE- Catering) 8-202 (FDSO - ORTEGA DINING COMMONS) 8-200 (FDSR - CENTRAL DINING) 8-96 (FILM - Film Studies) 8-121 (GEOG - Geography) 8-120 (GISP - Global Studies) 8-138 (GRAD - Graduate Division) 8-207 (HDAE CENTRAL) 8-124 (HSSB - HSSB Administrative Support Center) 8-180 (ICBT - Institute for Collaborative Biotechnologies) 8-142 (IHUC - Interdisciplinary Humanities Center) 8-140 (INEE - Institute for Energy Efficiency) 8-123 (INST - Institutional Advancement) 8-216 (ISBE - Inst. Social Behaviour Econ Research) 8-185 (ISBE - Institute for Social, Behavioral and Economic Research) 8-165 (KITP - Kavli Institute for Theoretical Physics) 8-107 (LIBR - Library) 8-118 (LSAA - Letters and Science) 8-101 (LSIT - College of Letters & Science) 8-131 (MATH - Mathmatics) 8-172 (MATP - MEDIA ARTS & TECHNOLOGY PROGRM) 8-157 (MCDB - MOLECULAR BIOLOGY) 8-137 (MECE - Mechanical Engineering) 8-98 (MSII - Marine Science) 8-115 (NCEA - National Center for Ecological Analysis and Synthesis) 8-212 (OPERATIONS/TPS) 8-170 (PERS - Human Resources) 8-127 (PHYS - Physics) 8-103 (POLI - Police Dept) 8-129 (POLS - Political Science) 8-117 (PSYC - Psychological and Brain Sciences) 8-99 (REGR/FINA - Financial Aid) 8-110 (SASC - South Hall) 8-111 (SASC - South Hall - Students) 8-160 (SASS - Student Academic Support Services) 8-108 (STHL - Student Health) 8-106 (STSP - Disabled Students Program) 8-139 (SUMS - Summer Sessions) 8-220 (TECH) 8-209 (UCBS - CAMPUS STORE) 8-208 (UCEN & DLSS - University Center) 8-205 (UCFS - RETAIL DINING) 8-125 (WC - Wellness Cluster)

Position and Other Information

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Description of Duties:
Exception to Policy: Near Relative Other (If other, please explain in space provided)

For Initial Appointments Only

Misconduct Disclosure Form

Has the candidate submitted the Misconduct Disclosure Form?

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No

Education

Highest Degree Earned:
Date:
Institution:

Justification and Evaluation

Justification:
Analytical Evaluation:

(Last Revised 5/2025)