Fillable Districtwide Student Hire Card 4-9-19

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Districtwide Student Hire Card 4-9-19

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The Districtwide Student Hire Card 4-9-19 form is 1 page long and contains:

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  • 17 check-boxes
  • 26 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Los Medanos College

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4/9/2019
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
_____________________________________________
Signature Date
To be completed by Financial Aid (if applicable)
__________________ _________________ ______________________________________
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 Supervisor Employer ID # Signature Date
___________________________________________
Name of Next Level Supervisor Employer ID #
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)
Pay Level:
☐
Student Workers
☐
Student Intern/Tutor
☐
Police Aide Corporal
Duration of Employment:
(If unsure please select all)
☐
Fall
☐ Spring
☐ Summer
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Districtwide Student Hire Card 4-9-19

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Completed 24 April 2020

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