Student Employment Office - 60 W Olsen Road #1375 - Thousand Oaks, CA 91360 - P: 805.493.3115 - www.callutheran.edu/studentemployment
Expires 05/12/2017
Student Employment Personnel Action
The student must submit this form in-person to the Student Employment Office located
within the Office of Financial Aid.
CALIFORNIA LUTHERAN UNIVERSITY
FALL 2016-SPRING 2017
STUDENT: APPLICATION
LAST NAME
FIRST NAME
UNIVERSITY EMAIL
2016-17 CLASS YEAR: (choose one)
FRESHMAN SOPHOMORE JUNIOR SENIOR GRADUATE
PERMANENT ADDRESS:
STREET
CITY
STATE
ZIP
PERM PH:
CAMPUS / LOCAL ADDRESS:
STREET
CITY
STATE
ZIP
LOCAL PH:
1. Are you authorized to work in the U.S.? If “NO”, you must obtain a Social Security card before you are eligible to work.
YES
NO
2. Have you ever been a paid student employee at Cal Lutheran before?
YES
NO
3. Do you have another Cal Lutheran job during this Academic Year? If “YES” please review the Concurrent employment section under the “Terms and Conditions of Employment”.
YES
NO
4. I understand that any false information contained in this application may cause forfeiture of all my rights to any employment at California Lutheran University.
Initials
5. I have read and understand all of the “Terms and Conditions of Employment” listed on the second page of this form. I accept this assignment subject to all terms and conditions herein.
Initials
6. I understand that I CANNOT start working until I receive an authorization email indicating that my employment has been approved by the Student Employment Office.
Initials
STUDENT SIGNATURE
DATE
By signing above, you certify that all your answers and statements are true to the best of your knowledge.
SUPERVISOR: STUDENT PERSONNEL ACTION
ACTION: HIRE HOURLY STIPEND _________HOURS PER WEEK WAGE CHANGE
CONCURRENT EMPLOYMENT HOURS INCREASE/DECREASE TERMINATION/RESIGNATION EFFECTIVE DATE ______________________
COMMENTS:
DEPARTMENT NAME
STUDENT’S POSITION TITLE
MAIL CODE
WAGE
$ _____________________ PER HOUR
MAXIMUM HRS WORKING/WK
(Cannot exceed 15 hrs/wk)
PRIMARY SUPERVISOR:
SECONDARY SUPERVISOR:
EMAIL @PLTS.EDU
@CALLUTHERAN.EDU
EXT.
EMAIL @PLTS.EDU
@CALLUTHERAN.EDU
EXT.
SUPERVISOR SIGNATURE
SUPERVISOR SIGNATURE
By signing above, you are affirming that there are sufficient funds in the department budget to cover this student’s wages for the duration of their employment.
FOR S.E. OFFICE USE ONLY:
APP DEN
Payment Type:
SUM
FWS
CWS
SWS
DA
GA
Stipend
I-9
W-4
NRA
BNDS
DD
Semester Units
Payroll Initials:
SE Initials:
PLTS
Eligible Start/End Date:
Adj Payrate
Student Employment Office - 60 W Olsen Road #1375 - Thousand Oaks, CA 91360 - P: 805.493.3115 - www.callutheran.edu/studentemployment
STUDENT: TERMS OF EMPLOYMENT
Concurrent Employment: You may not have more than one on-campus job at California Lutheran University (CLU). If a department wants to hire you for a second job AND
you are only required to work a very limited number of hours with your first job (e.g. Events, Athletics, etc.), the second job’s supervisor must submit the Personnel Action
form with a thorough justification in the Comments section explaining why you should be hired for the additional position. Any request requires approval before you may
start working. Students who are approved for a concurrent position may not work more than 8 hours total in a day between the two jobs. The student is required to take a
½ hour meal break between jobs. Students are limited to a maximum of 15 hours per week during the academic year and 40 hours per week during breaks (ie. Winter,
Spring, Summer).
Performance: You are expected to provide punctual, efficient, and cooperative performance for any job you accept.
Attendance: If illness or some other unforeseen circumstances prevent your attendance at work, you must notify your supervisor at least one hour in advance of your
reporting time.
Exams or Special Class Situations: You are expected to remain on the job during Examination Periods. When your schedule conflicts with an exam, you will notify your
employer and you must agree on schedule changes. Additionally, you will have the opportunity to attend Chapel every Thursday from 11:25am to 11:55am.
Confidentiality: As an employee of California Lutheran University, some of your work will involve access to information/records that may be considered confidential. You
must acknowledge your responsibility as a student employee to respect the confidentiality of student and/or department records, to follow office procedures in order to
protect privacy, and to act in a professional manner to the public, both in person and over the phone. Any violation of this agreement will result in immediate termination of
your employment.
Tax Exemptions: An automatic exemption from FICA taxes (Social Security and Medicare) is applied to all eligible full and part-time students who are also employees of CLU.
The exemption from paying FICA taxes will remain in effect during breaks that are five weeks or less, and is applicable during the summer break if the student is enrolled at
least half-time. In addition, students are not subject to Unemployment Insurance (UI), Employment Training Tax (ETT), and State Disability Insurance (SDI).
Harassment: Harassment refers to unwelcome behavior that is offensive, fails to respect the rights of others and interferes with work effectiveness. California Lutheran
University seeks to create and maintain an academic and working environment in which all members of the community are free of harassment based on race, color,
religion, age, natural origin, disability, marital status, sexual orientation, or gender.
Forms of harassment include, but are not limited to the following:
Verbal: Sexual innuendoes; suggestive comments; racial or derogatory slurs; off-color jokes; propositions; threats; suggestive or insulting sounds; repeated unwanted sexual
advances; threats of reproach or promises of rewards contingent upon the obtainment of sexual favors.
Visual/Nonverbal: Derogatory posters, cartoons or drawings; suggestive objects or pictures; graphic commentaries; leering obscene gestures.
Physical: Unwanted physical contact including touching; interference with an individual's normal work or movement; assault.
Be advised that no form of harassment will be tolerated at California Lutheran University. Anyone who engages in harassment and is in violation of this policy will be subject
to immediate disciplinary action, up to and including termination.
Termination: Typically a part-time job at CLU will be terminated at the end of the academic year, or at the end of the semester, if applicable. Students who are graduating
or separating from the university may not continue to work beyond the period of enrollment. You have the right to terminate your employment at any time. You should
give two weeks notice if you find it necessary to leave your job before the end of the year (or semester). In the event of severe academic difficulty or prolonged illness, you
may ask permission to leave your job before the end of your commitment. You further understand that you may be involuntarily terminated if your work performance is
continually unsatisfactory for reasons, such as, but not limited to: violating any of the applicable policies identified in the Student Handbook/Standards of Conduct;
continued poor work performance or attitude; continued excessive tardiness or absence; falsification of employment or University records (including reporting hours
worked); disobedience, insubordination, or harassment of other individuals.
By signing the first page of this form, you are agreeing to strive to meet the duties, responsibilities, and standards required by the position and defined by your
Supervisor.