AdditionalPay_PT_AssignmentCover_2014_v5.docx Updated 12/14 kp/pg
ACADEMIC YEAR _______________
Last Name: _______________________________________ First Name: ______________________________________
Division: _______________________________ Dept: _________________Employee CWID: ____________________________
Assignment Title*: ______________________________________________________________Pay Rate:_____________
* Describe duties being performed on an additional page for each assignment
Index Code:____________ or Fund: ________________ Org: ______________ Acct: 1430 Prog: ______________
Start:____________________ End:___________________ Hourly Rate:$ ___________ NTE* Amt: $________________
* NTE = not to exceed
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
___________________________________________ ________________________________________________
Originator's Name (Please Print) Ext./Date Faculty Member Date
___________________________________________ ________________________________________________
Division Dean Date Vice President Date
___________________________________________ ________________________________________________
Associate V.P. of Instruction Date Director, Budget & Personnel Date
*All Additional Pay is presumed No Load unless initialed by the A. V.P. of Instruction. Load Initialed by: _____ AVPI
COLA: Yes No
NOTES: Submit this signed authorization form to Campus Personnel Office prior to start of assignment. Timesheets cannot be
processed without an additional assignment authorization form. Monthly timesheets must be submitted. Submit timesheet to
Campus Personnel Office (Administration Building Room 137) by the 13
calendar day of the month for inclusion in the month-end
pay cycle.
For Payroll Use Only
Position #: ___________________ Entered by:_________________ Date: _____________________