Fillable Central Connecticut State University Recommendation for University Assistant Fiscal Year 2014-15

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Central Connecticut State University Recommendation for University Assistant Fiscal Year 2014-15

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Central Connecticut State University
Recommendation for
University Assistant Appointment
Fiscal Year 2014 - 2015
Renewal _______ New Appointment_______
CCSU ID#
|___|___|___|___|___|___|___|___|
Name: _____________________________________________________________________________
Last First MI
Address: _____________________________________________________________________________
Street
_____________________________________________________________________________
City State Zip Code
Home #: (__________) __________- ___________ Cell #: (________) __________ - _____________
Department: _______________________________
Supervisor: __________________________________
Duties: ___________________________________________________________________________________
___________________________________________________________________________________
Please use either # 1 or 2 1. If working full fiscal year 2. If working partial fiscal year
Start Date 06/27/2014 Start Date ____/____/____
Position #: |___|___|___|___|___| End Date 06/25/2015 End Date ____/____/____
Banner Index: |___|___|___|___|___|___| Total Weeks: 52 Total Weeks: _________
Total Salary for 2014-15 Employment Period:
$_________ (rate/hour) x _________ (hours/week)* x __________ (total weeks) = $________________
*The number of hours assigned and worked by the University Assistant may not exceed an average
of 19 hours per week for the term of the employment. Hours worked may not exceed 40 hours per pay week.
Recommended by ___________________________________ (Supervisor) Date ___________
Print name / Signature
Approved by ________________________________________ (Dean, Director, etc.) Date ___________
Print name / Signature
Approved by ________________________________________ (Executive Officer) Date ___________
Print name / Signature
Approved by ________________________________________ (Grants-for ALL Grants) Date ___________
Print name / Signature
New appointments ONLY:
(To be filled in after appointment is approved) Date of Birth _____/______/______ Race ______ Sex M / F
For Human Resources Use Only
Citizen Y / N W-4 ____ CT W-4 ____ Ethics/Violence Prevention Policy _______
If No – VISA or PRA I-9 ______ BKGRD _______ Employee # _________
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Central Connecticut State University Recommendation for University Assistant Fiscal Year 2014-15

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Completed 4 December 2019

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