Fillable CCSU Student Help Program Certification pdf

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CCSU Student Help Program Certification pdf

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Central Connecticut State University
Student Help Program Certification
Last First MI
Telephone Extension:_____________
Supervisor's Signature
_____/_____/_____
Grants Administration (GRANT-FUNDED ONLY)
2. I will not allow a student to begin working until their employment paperwork is processed,
completed and the student receives an e-mail with their Core-CT Username and password.
_____/_____/_____
Date
Supervisor's Certification
In hiring this student worker, I agree under penalty of law, to abide by all Federal Regulations, State Statutes,
Board of Trustees'/Regents' Resolutions, and University Policies regarding student employment, some of which are
outlined be
low:
4. I
will work no more than 40 hours per pay period when classes are in session and no more
than 40 hours per week during vacation periods and summer session.
5. I have read, understand, agree, and will comply with and abide by the State Code of Ethics, Violence
in the Workplace Prevention Policy, Records Retention and Disposition Policy, and the Board of
______/______/______
Date
Regents for Higher Education Acceptable and Responsible Use of Information Technology and
Resources Policy. If you wish to receive a copy of these policies, check here
Student's Certification
Student's Name
CCSU ID #:
l___l___l___l___l___l___l___l___l
Student's Signature
In accepting this position, I agree to abide by all State Statutes, Board of Trustees'/Regents' Resolutions and
University Policies regarding student employment, some of which are outlined below:
I must remain matriculated in order to continue student employment.
2. I am not employed by any other state agency.
3. I understand that I may not work for more than one supervisor in any given pay period.
1. I am a matriculated student at one of the Connecticut State Universities, and understand that
1. I will not all
ow the student to work more than 40 hours per pay period when classes are in
3. Banner Index: l___l___l___l___l___l___l
session and no more than 40 hours per week during vacation periods and summer sessions.
All lines below must be completed:
1. Effective date:
_____/_____/_____
(if switching department or status this date must be the 1st day of a pay period)
2. Position: l___l___l___l___l___l Department:
_____________________________________
Supervisor's Name (Print)
Alternate Approver's Name (Print) Date
New Employee Personal Data
All New Employees Must Complete This
Last First MI
4. Gender Female Male
American Indian/Alaskan Native Hispanic/Latino
Asian Native Hawaiian/Oth Pacific Islander
Black/African American White
Also, select one or more races to indicate what you consider yourself to be:
American Indian/Alaskan Native Native Hawaiian/Oth Pacific Islander
Asian
10. Emergency Contacts
Name:
Address:
Phone: ( ) ( ) ( )
Rev. 04/01/14
2. Permanent Address:
__________________________________________________________________________
__________________________________________________________________________
Street
8. Email Address: ___________________________________________
City State Zip
3. Telephone #'s (Home)
(___l___l___) l___l___l___l - l___l___l___l___l
(Cell) (___l___l___) l___l___l___l - l___l___l___l___l
5. Date of Birth: ____/____/____
7a. If yes, what agency and when were you last employed? ____________________________________________________
1. Name:
Last Name First Name Relationship
Street (Apt. No. if applicable)
City, State, Zip Code (Country if not US)
White
Black/African American
6. US Citizen?
Yes No
6a.
If
No
, are you a Resident Alien ____ International Student ____
7. Have you previously been employed by CCSU or another state agency? Yes No
9. Race/Ethnicity State coding (select one):
9a. Federal coding: Hispanic or Latino Not Hispanic or Latino
I-9 ____ W-4 ____ CT W-4 ____ Employee# ________
General Information
The official payroll title for students engaged in the Student Help Program is Student Laborer. This is a position in the "Unclassified" category
of state service. Wages earned as a Student Laborer are not covered by State Retirement or Unemployment Compensation Law. Social
Security contributions are not deducted while the student is attending classes. Wages are subject to Federal and State withholding tax.
Hours worked are reported through the Core-Ct Time Entry System. Payrolls are processed bi-weekly. You can expect a minimum four-week
delay before receipt of your first paycheck. Subsequent paychecks will be issued every two weeks. A pay period schedule may be obtained
from http://www.ccsu.edu/page.cfm?p=5037.
Newly hired students MAY NOT begin working until they are certified.
Home WorkCellular
*** Please bring this completed form in person to the Student Payroll Services Department where an I-9 form (Employment Elgibility
Verification), CT W-4 and a Federal W-4 must be completed. ***
For Student Payroll Services Use Only
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CCSU Student Help Program Certification pdf

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Completed 18 January 2020

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