Employee Request for Prior Service Credit

Office of Human Resources
585-395-2126

Requestor is

Requestor is Professional staff Faculty
SUNY Policies of the Board of Trustees [XI, Title B.335.4 (d)(1)]:
In determining eligibility for continuing appointment..., satisfactory full-time prior service in academic rank at any other accredited institution of higher education may, at the request of the appointee and in the discretion of the Chancellor, or designee, be credited as service, up to a maximum of three years, at the time of appointment at a college. Waiver of all or part of this service credit shall be granted upon written request of the employee to the chief administrative officer not later than six months after the date of initial appointment.
● Waiver of Prior Service is not applicable to SUNY service. This service is not discretionary, but mandatory.
● Prior service earned at SUNY Brockport is not eligible.
● Read more details in the College Prior Service Policy.
SUNY Policies of the Board of Trustees [XI, Title B.335.8 (c)]:
(1) In determining eligibility for permanent appointment..., satisfactory full-time prior service in a professional title at any one college of the university may, at the request of the professional employee and in the discretion of the chancellor or designee, be credited as service, up to a maximum of three years, at the time of appointment at another college. Waiver of all or part of this service credit shall be granted upon written request of the employee to the chief administrative officer not later than six months after the date of appointment at that college.

(2) In computing consecutive years of service for the purposes of appointment or reappointment of professional employees, periods of leave of absence at full salary and periods of full-time service in probationary and temporary appointments granted pursuant to this Title shall be included; periods of leave of absence at partial salary or without salary and periods of part-time service shall not be included, but shall not be deemed an interruption of consecutive service for other purposes.
● Waiver of Prior Service is not applicable to SUNY service. This service is not discretionary, but mandatory.
● Prior service earned at SUNY Brockport is not eligible.
● Read more details in the College Prior Service Policy.
After reviewing the sections of the above referenced policies, and after reviewing tenure requirements with my unit head and/or dean, I hereby request approval of credit for the following service:
Name of Requestor Name of Requestor First Middle Last
Budget Title
Local Title
Academic Title/Rank at SUNY Brockport

If your title is not listed, contact the Office of Human Resources, x2126.
Email - Requestor
Department
Division
School
Name of your Supervisor/Department Chair Name of your Supervisor/Department Chair First Last
Email - Supervisor/Department Chair
Is your new position at SUNY Brockport a tenure track title?

Is your new position at SUNY Brockport a tenure track title? Yes No
You indicated your new position at SUNY Brockport is NOT a tenure track title. Therefore, you are not eligible for prior service credit. If you should transition to a tenure track title, reapply.
Indicate which institution type you have prior service with

Indicate which institution type you have prior service with Non-SUNY accredited academic institution of higher education SUNY institution (other than SUNY Brockport)

Choose as many as apply.
Record of Full-Time Academic Service at accredited institutions of higher education, other than SUNY
Name of Non-SUNY Institution
Academic Title/Rank at Institution

If your title is not listed, contact the Office of Human Resources, x2126.
Full-time employment at this Non-SUNY Institution?

Full-time employment at this Non-SUNY Institution? Yes No
Periods of part-time service are not eligible.

Only complete this form if you have prior full-time service in an academic rank at any other accredited academic institution of higher education.
Start Employment at Institution Start Employment at Institution / MM / DD YYYY
End Employment at Institution End Employment at Institution / MM / DD YYYY
Years of Service Credit requested for Institution
Name of Human Resources Contact at Institution Name of Human Resources Contact at Institution First Last
This person will be asked to verify your employment and years of service.
Email - HR Contact at Institution
Do you have another record of Full-Time Academic Service at an accredited institution of higher education, other than SUNY?

Do you have another record of Full-Time Academic Service at an accredited institution of higher education, other than SUNY? Yes No
Institution 2 (non-SUNY)
Academic Title/Rank at Institution 2

If your title is not listed, contact the Office of Human Resources, x2126.
Full-time employment at Institution 2?

Full-time employment at Institution 2? Yes No
Periods of part-time service are not eligible.

Only complete this form if you have prior full-time service in an academic rank at any other accredited academic institution of higher education.
Start Employment at Institution 2 Start Employment at Institution 2 / MM / DD YYYY
End Employment at Institution 2 End Employment at Institution 2 / MM / DD YYYY
Years of Service Credit requested for Institution 2
Name of Human Resources Contact at Institution 2 Name of Human Resources Contact at Institution 2 First Last
This person will be asked to verify your employment and years of service.
Email - Contact at Institution 2
Record of Full-Time Academic or Professional Service at SUNY
SUNY Institution

You cannot request prior service earned at SUNY Brockport or any SUNY community college.
Budget Title
Academic Title/Rank at SUNY Institution

If your title is not listed, contact the Office of Human Resources, x2126.
Employment was full-time at the named SUNY?

Employment was full-time at the named SUNY? Yes No
Periods of part-time service are not eligible.

Only complete this form if you have prior full-time service in an academic rank at any other accredited academic institution of higher education.
Periods of part-time service are not eligible. Only complete this form if you have prior full-time service.
Years of Service Credit requested for other SUNY Institution
Another Record of Full-Time Academic or Professional Service - SUNY?

Another Record of Full-Time Academic or Professional Service - SUNY? Yes No
SUNY Institution 2

You cannot request prior service earned at SUNY Brockport or any SUNY community college.
Budget Title - SUNY Institution 2
Academic Title/Rank - SUNY Institution 2

If your title is not listed, contact the Office of Human Resources, x2126.
Employment was full-time at SUNY Institution 2?

Employment was full-time at SUNY Institution 2? Yes No
Periods of part-time service are not eligible.
Years of Service Credit requested - SUNY Institution 2
Waiver of Prior Service is not applicable to SUNY service. This service is not discretionary, but mandatory.
VERIFICATION AUTHORIZATION
To Whom It May Concern:
The undersigned hereby authorizes the accredited institutions aforementioned to verify my employment information as necessary. Please accept this authorization or reproductions of it as authorization for your response.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Click on the below "Submit" button to forward your request to the Office of Human Resources. A copy of this submission will be sent to your email.

Employee Request for Prior Service Credit

After reviewing the sections of the above referenced policies, and after reviewing tenure requirements with my unit head and/or dean, I hereby request approval of credit for the following service:

You indicated your new position at SUNY Brockport is NOT a tenure track title. Therefore, you are not eligible for prior service credit. If you should transition to a tenure track title, reapply.

Record of Full-Time Academic Service at accredited institutions of higher education, other than SUNY

Periods of part-time service are not eligible. Only complete this form if you have prior full-time service in an academic rank at any other accredited academic institution of higher education.

Periods of part-time service are not eligible. Only complete this form if you have prior full-time service in an academic rank at any other accredited academic institution of higher education.

Record of Full-Time Academic or Professional Service at SUNY

Periods of part-time service are not eligible. Only complete this form if you have prior full-time service in an academic rank at any other accredited academic institution of higher education.

Periods of part-time service are not eligible. Only complete this form if you have prior full-time service.

Periods of part-time service are not eligible.

Waiver of Prior Service is not applicable to SUNY service. This service is not discretionary, but mandatory.

VERIFICATION AUTHORIZATION

Click on the below "Submit" button to forward your request to the Office of Human Resources. A copy of this submission will be sent to your email.

Periods of part-time service are not eligible.

Only complete this form if you have prior full-time service in an academic rank at any other accredited academic institution of higher education.

Periods of part-time service are not eligible.

Only complete this form if you have prior full-time service in an academic rank at any other accredited academic institution of higher education.

Periods of part-time service are not eligible.

Only complete this form if you have prior full-time service in an academic rank at any other accredited academic institution of higher education.