AdditionalPay_FT_AssignmentCover_2014_v3.docx Revised 12/14 kp/pg
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FULL-TIME FACULTY ADDITIONAL PAY AUTHORIZATION FORM
(Do not use this form for Part-Time Faculty)
ACADEMIC YEAR _______________
Last Name:
____________________________________ First Name: _______________________________________________
Division:
_____________________________________ Dept: ________________________ CWID No:_____________________
Job Title*: ________________________________________________________________________________________________
* Describe duties being performed on an additional page for each assignment
Index Code ________________ or Fund
_______________________!
Org
___________________!!
Acct 1430 Program
___________________
Please Be Aware Of Begin And End Dates Of Each Quarter. Total Amount Must Be A Rounded Number
Faculty – Instructional Rounded For Payroll Use Only
SUMMER Start: _________ End: __________ Total Amt: $___________ Pos#_________ Entr’d By:_____ Date:______
FALL QTR Start: _________ End: __________ Total Amt: $___________ Pos#_________ Entr’d By:_____ Date:______
WTR QTR Start: _________ End: __________ Total Amt: $___________ Pos#_________ Entr’d By:_____ Date:______
SPR QTR Start: _________ End: __________ Total Amt: $___________ Pos#_________ Entr’d By:_____ Date:______
Faculty – Non-Instructional Hours Only
SUMMER Start: _________ End: __________ Total Hrs: ___________ Pos#_________ Entr’d By:_____ Date:______
FALL QTR Start: _________ End: __________ Total Hrs: ___________ Pos#_________ Entr’d By:_____ Date:______
WTR QTR Start: _________ End: __________ Total Hrs: ___________ Pos#_________ Entr’d By:_____ Date:______
SPR QTR Start: _________ End: __________ Total Hrs: ___________ Pos#_________ Entr’d By:_____ Date:______
Comments: ________________________________________________________ Bracket:______________ Step: _____________
_________________________________________________________________ Retro/District Payroll: Entr’d By: _____Date:____
SIGNATURE APPROVALS
Originator's Name (Please Print)
Ext./Date
Faculty Member Date
Division Dean Date Area Vice President Date
Director, Budget & Personnel Date Associate V.P. of Instruction Date
*All Additional Pay is presumed No Load unless initialed by the A. V.P. of Instruction. Load Initialed by: ___AVPI COLA: Yes No
Note: All required signatures submitted must be forwarded to the Director of Budget & Personnel for final approval. Original to be
processed and kept on file in Campus Payroll with appropriate copy to District Payroll for processing.
