LPL Information Form First Name * Last Name * LPL Building, Office and/or Lab Space Assigned * If you require access to additional rooms (labs, additional office space, etc.) your supervisor must email a list of required rooms to Office Phone Number What employee type are you? * - Select -LPL New EmployeeLPL VisitorUA Employee, Non-LPLSpace Grant Intern LPL New Employee Start Date * Year Year20142015201620172018 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Choose employee title * - Select -Adjunct AppointmentAssistant ProfessorAssistant Research ScientistAssociate ProfessorAssociate Research ScientistAssociate Staff ScientistPostdoctoral Research AssociateProfessorPTYS Graduate StudentRetiredSpace Grant InternSR Research AssociateSR Research ScientistStaff ScientistUndergraduate StudentVisiting ScientistOther Appointed PersonnelOther Graduate StudentOther... Choose employee title Other... Supervisor's Name * Home Address * Contact Number * (Home/Cell Phone) Print home/cell phone number in LPL online directory? * - Select -YesNo Current/personal/non-LPL email address * Suggested LPL email address (no more than 8 characters) or assigned LPL email address, if known (for LPL faculty, staff, and LPL graduate students) * @lpl.arizona.edu Have you Reviewed the New Employee Resources Info and FAQ? If "no," please do so ASAP. * - Select -YesNo LPL New Employee Resources | LPL FAQ Upload your Harassment Prevention Education completion document here in order to complete and submit this form. You can complete the training using the link below. * Harassment Prevention EducationFiles must be less than 2 MB.Allowed file types: jpg jpeg png psd pdf doc docx. Complete the UA Security Awareness Training using the link below in order to complete and submit this form. * I have completed the UA Security Awareness Training. All-employee Security Awareness Training Complete the Conflict of Interest Disclosure Training using the link below in order to complete and submit this form. * I have completed the Conflict of Interest Disclosure Training. Conflict of Interest Disclosure Training. (Instructions for the disclosure system can be found here.) LPL Visitor Visit Start Date * Year Year20142015201620172018 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Visit End Date * Year Year20142015201620172018 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Title * - Select -Visiting ScientistVisiting Research AssistantVisiting StudentVisiting Scholar Country of Citizenship * Dual Citizenship? * No If Yes, Country Dual Citizenship? If Yes, Country U.S. Green Card Holder * No Yes Visa Classification * Reason for Visit * (describe in detail) Name of Faculty Sponsor * Will the visitor be collaborating on sponsored research projects * No Yes Which projects? * (Include FRS #'s) *Department Export Control Administrator (Glinda Davidson) approval is required prior to allowing a visitor to participate or have access to a sponsored project that is not identifed above. Name of LPL employee you report to * UA Employee, Non-LPL Title Group * - Select -FIB-SEM UserOther... Title Group Other... Title * Home Department * Name of LPL employee you work with * Complete the Emergency Contact Information form at the URL below in order to complete and submit this form. * I have completed the LPL Emergency Contact Information form. Emergency Contact Information Form CAPTCHAPlease check the box below to verify your submission
First Name * Last Name * LPL Building, Office and/or Lab Space Assigned * If you require access to additional rooms (labs, additional office space, etc.) your supervisor must email a list of required rooms to Office Phone Number What employee type are you? * - Select -LPL New EmployeeLPL VisitorUA Employee, Non-LPLSpace Grant Intern LPL New Employee Start Date * Year Year20142015201620172018 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Choose employee title * - Select -Adjunct AppointmentAssistant ProfessorAssistant Research ScientistAssociate ProfessorAssociate Research ScientistAssociate Staff ScientistPostdoctoral Research AssociateProfessorPTYS Graduate StudentRetiredSpace Grant InternSR Research AssociateSR Research ScientistStaff ScientistUndergraduate StudentVisiting ScientistOther Appointed PersonnelOther Graduate StudentOther... Choose employee title Other... Supervisor's Name * Home Address * Contact Number * (Home/Cell Phone) Print home/cell phone number in LPL online directory? * - Select -YesNo Current/personal/non-LPL email address * Suggested LPL email address (no more than 8 characters) or assigned LPL email address, if known (for LPL faculty, staff, and LPL graduate students) * @lpl.arizona.edu Have you Reviewed the New Employee Resources Info and FAQ? If "no," please do so ASAP. * - Select -YesNo LPL New Employee Resources | LPL FAQ Upload your Harassment Prevention Education completion document here in order to complete and submit this form. You can complete the training using the link below. * Harassment Prevention EducationFiles must be less than 2 MB.Allowed file types: jpg jpeg png psd pdf doc docx. Complete the UA Security Awareness Training using the link below in order to complete and submit this form. * I have completed the UA Security Awareness Training. All-employee Security Awareness Training Complete the Conflict of Interest Disclosure Training using the link below in order to complete and submit this form. * I have completed the Conflict of Interest Disclosure Training. Conflict of Interest Disclosure Training. (Instructions for the disclosure system can be found here.) LPL Visitor Visit Start Date * Year Year20142015201620172018 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Visit End Date * Year Year20142015201620172018 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Title * - Select -Visiting ScientistVisiting Research AssistantVisiting StudentVisiting Scholar Country of Citizenship * Dual Citizenship? * No If Yes, Country Dual Citizenship? If Yes, Country U.S. Green Card Holder * No Yes Visa Classification * Reason for Visit * (describe in detail) Name of Faculty Sponsor * Will the visitor be collaborating on sponsored research projects * No Yes Which projects? * (Include FRS #'s) *Department Export Control Administrator (Glinda Davidson) approval is required prior to allowing a visitor to participate or have access to a sponsored project that is not identifed above. Name of LPL employee you report to * UA Employee, Non-LPL Title Group * - Select -FIB-SEM UserOther... Title Group Other... Title * Home Department * Name of LPL employee you work with * Complete the Emergency Contact Information form at the URL below in order to complete and submit this form. * I have completed the LPL Emergency Contact Information form. Emergency Contact Information Form CAPTCHAPlease check the box below to verify your submission
