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 #:
C
urrent 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:
Account String(s): *Acct Code
2320=student, non-instructional 2332= hourly, non-instructional
2421= student, instructional 2431= hourly, instructional
2422= student, instructional dept 2432= hourly, instructional dept
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: _________
W-4 Status:
Pay ID:
EM
MD
TS Org #: Job % BOT Date:
105 OASDI 110 MC
120 SUI 125 WC
Excluded Deductions:
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:
(Please Select One of the Options)
