Faculty Employment Authorization Form _____ - - %______ _____ [PDF]

Department: Position Code:______ Title_________________________________. Choose all the apply: □ Regular □ Full-Time

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Idea Transcript


Faculty Employment Authorization Form WC ID# _____________________ Name: _____________________________________________________________________________

(Proper Name Required – No Nicknames)

Address: ________________________________________________________________________________ ________________________________________________________________________________ New Employee’s New Employee’s Phone: ______________________________ Email : _____________________________________

Start Date: __________________

End Date: _______________________

Position Information: Department: __________________________ Position Code:_____________ Title_________________________________ Choose all the apply: □ Regular □ Full-Time □ Adjunct □ Visiting

□ Tenure Track □ Non-Tenure Track

Course Information: Course Number: Days: □

Course Title:

M□ T□ W□ T□ F

Course Number: Days: □

□ Team Teaching With:

Course Title:

M□ T□ W□ T□ F

Course Number: Days: □

Credits ________________

Credits ________________

□ Team Teaching With:

Course Title:

M□ T□ W□ T□ F

Position Funding: □ Overload □ Stipend

Credits ________________

□ Team Teaching With:

Payment Distribution: □ One time □ Other:___________

□ Semester

Stipend Hours: ________________

Travel Allowance:

________ X ________________ X ___________X ___________ = $____________ Miles From Home X 2

Number of Teaching Days

Weeks

Prevailing College Mileage Rate

Total Travel Allowance

Total Stipend Amount:

___________ + ________________ = $____________ Stipend Amount

Travel Amount

Total Stipend Amount

Funding Source(s): Funding Sources must equal 100%

_____ - ________________ - __________________ _____ - ________________ - __________________ _____ - ________________ - __________________

Funds to be paid in:

%________ %________ %________

□ FY16 (07.01.15 – 06.30.16) □ FY17 (07.01.16 – 06.30.17) Former 4-digit department code:

_______________________

Authorization Signatures: Department Head: ________________________________________ Provost & Dean: ________________________________________ Budget Director/VP Finance: ________________________________________ Office of Human Resources: _________________________________________ RATIONALE FOR POSITION:

Date: ____________ Date: ____________ Date: ____________ Date: ____________

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