FULL AND PART-TIME FACULTY ADDITIONAL PAY AUTHORIZATION FORM
ACADEMIC YEAR _________________ Instructor: Full-time ____ Part-time ____
Last Name: _______________________________________ First Name: __________________________________
Division: _______________________________ Dept: _________________Employee ID No.: _______________________
*PLEASE BE AWARE OF BEGIN AND END DATES OF EACH QUARTER. TOTAL AMOUNT MUST BE A ROUNDED NUMBER.
Job Title: ______________________________________________________________
*PLEASE DESCRIBE DUTIES BEING PERFORMED ON AN ADDITIONAL PAGE FOR EACH AUTHORIZATION FORM.
Index Code:____________ or Fund: ________________ Org: ______________ Acct: 1430 Prog: ______________
Faculty $ Rounded For Payroll Use Only
SUMMER Start:__________ End:___________ Total Amt: $__________ Bracket: ______________
FALL QTR Start:__________ End:___________ Total Amt: $__________ Step:_________________
WTR QTR Start:__________ End:___________ Total Amt: $__________ Position #: ____________
SPR QTR Start:__________ End:___________ Total Amt: $__________ Entered by:____________
Date: ________________
Please Note: Not withstanding Article 7.11 in the FA Agreement, additional pay for part-time faculty will create load if it is their primary
assignment and will be calculated by column and step. Please keep this in mind when awarding additional pay to part-time faculty.
Faculty/Non Instruction Hours Only
SUMMER Start: __________ End: ___________ Total Hours: __________ For Retro Pay/District Payroll Office
FALL QTR Start: __________ End: ___________ Total Hours: __________ Entered by: ___________________
WTR QTR Start: __________ End: ___________ Total Hours: __________ Date: ________________________
SPR QTR Start: __________ End: ___________ Total Hours: __________
Comments: _ _
SIGNATURE APPROVALS
_________________________________________ ____________________________________________
Originator's Name (Please Print) Ext./Date Faculty Member Date
________________________________________ ____________________________________________
Division Dean Date Vice President Date
________________________________________ ____________________________________________
Director, Budget & Personnel Date Associate V.P. of Instruction Date
Load Initialed by: _____ AVP0I)
COLA: Yes No
*All Additional Pay is presumed No Load unless initialed by the A. V.P. of Instruction.
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.
Revised 9/11 By Budget & Personnel, pj/oe
