Fillable Districtwide Student Hire Card (Los Medanos College)

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Districtwide Student Hire Card (Los Medanos College)

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Country of origin: US
File type: PDF

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6/25/2019
Office Use Only:
Stud. Ambassador Initials: _____
Date Received: ______________
Districtwide Student Hire Card
(Referral Card)
To be completed by student
____________________________ ______________________ _______________
_______________
Last Name First Name Middle Student ID No.
______________________________________ ________________ _______________ _______________
Street Address City Zip Code Telephone
_________________________________________________________________ _______________________
Emergency Contact Name, Relation and Address: Emergency Contact Phone
_____________________________________________
Student Signature Date
To be completed by Financial Aid (if applicable)
_______N/A________ ____N/A__________ __N/A__________________N/A____________
Annual Amount Cumulative GPA Signature Date
To be completed by Hiring Manager
Location Status Current Term
☐ LMC ☐ BWC
☐ New Hire ☐ Re-hire ☐ FWS
☐ Fall ☐ Spring ☐ Summer
____
______________________________________ ________________ ___________________
Job Title Hourly Wage Hours/Week
__________________ ________________ ________________ ___________________
TB Clearance Date
(if applicable) Start Date End Date (Must have an End Date) Position ID
___________________
Position ID
___________________
Position ID
___________________________________________
Department
___________________________________________ _______________________________________
Name of Direct Supervisor
(required) Employer ID # Supervisor Signature (required) Date
___________________________________________ _______________________________________
Name of Alternative Supervisor Employer ID # Alt. Supervisor Signature Date
___________________________________________ _______________________________________
Name of Dean/Manager
(required) Employer ID # Dean/Manager Signature (required) Date
To be completed by Business Office or Employment Center
_____________________ _____________________________________________
Actual units of enrollment Signature Date
Enrollment Check:
☐
≥ 6 units (Min. Fall/Spring)
☐
≥ 12 units
☐
≥ 3 units (Min. Summer)
(**International students: must have
full-time status every semester**)
Pay Level:
☐
Student Workers
☐
Student Intern/Tutor
☐
Police Aide Corporal
Duration of Employment:
(If unsure please select all)
☐ Spring 20__
☐
Summer 20__
☐ Fall 20__
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Districtwide Student Hire Card (Los Medanos College)

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Completed 5 September 2020

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