Multiple Jobs: Yes No PERSONNEL AUTHORIZATION … will be performing an instructional assignment Yes...
Transcript of Multiple Jobs: Yes No PERSONNEL AUTHORIZATION … will be performing an instructional assignment Yes...
Multiple Jobs: Yes No Position Number: _________________ PERSONNEL AUTHORIZATION REQUEST FORM FISCAL YEAR 2017-2018 (Please remember to always attach a Scope of Work with each PARF)
PART I: COMPLETED BY EMPLOYEE
Legal Name: Last First Middle
DOB: Gender: M F
Banner #: Current employee at Cuesta?
No Yes
Dept. Name:
Current student at Cuesta? Yes No Federal Work Study CalWORKS
Mailing Address: City: State: Zip: Home/Cell Phone:
Email Address: This is the primary method of communication by Human Resources
I have verified my mailing address and understand this is where my paycheck will be sent. Please initial __________
Employee’s Signature: Date:
PART II: COMPLETED BY REQUESTING DEPARTMENT
Earliest Preferred Start Date: End Date:
Division:
Campus: SLO NC SSC
Employee Type: (Ed Code § 88003)
Employee will be performing an instructional assignment Yes No
Employee will need computer access Yes No
(Please submit computer access form to Computer Services)
Position is a categorically funded position. Yes No
Employee will be directly supervised by a member of the Employee’s immediate family Yes No
Employee is: Position Title:
Accounting/Clerical Series:
Range must be from Short-Term/Temporary & Student salary schedule:
Rate of Pay (x) Hrs./Week (x) Weeks Working (=) Estimated Cost
Account String(s): *Acct Code 2320=student, non-instructional 2332= hourly, non-instructional 2421= student, instructional 2431= hourly, instructional2422= student, instructional dept 2432= hourly, instructional dept
FN ORG ACCT* PROG ACT %
PART III: REQUIRED SIGNATURES
Department Contact:
Print Name: Ext:
Web/Dept. Time Entry Information (If Applicable) Approver: (approves the web based timesheet)
Print Name: Ext:
Proxy (approves the web based timesheet when approver is unavailable)
Print Name: Ext:
Supervisor Approval: Print Name:
Signature: __________________________ Date: __________
Director/Coordinator Approval:
Print Name: Date: _________
Signature: ____________________________________
Dean or Vice President Approval:
Print Name: Date: _________
Signature: _____________________________________
Vice President of Human Resources Approval:
Signature: ___________________ Date: _________
Payroll: Human Resources:
W-4 Status: Pay ID: EM MD
TS Org #: Job % BOT Date:
Deductions:
105 OASDI 110 MC 120 SUI 125 WC
Excluded Deductions:
Dues STRS PERS
PERS 6% PERS 7% PERS Retiree PERS Exempt STRS Retiree STRS Exempt None
Entered By: ____ Date: _____
Units ___ EMTC ___ WBTE DTE
Entered By:______ Date: _____ Termed By: ___ Date: ______
Entered By: ____ Date: _______
Support Series: Support Series II:Technical Series:
Special Series: