September 2017
QUARTERLY REQUEST FOR EXTRA LABOR
OFFICE OF HUMAN RESOURCES
Date:
This request is for quarter: (select only one quarter per request):
July-Sept. Oct.-Dec. Jan.-Mar. Apr.-June
Please assign: T#:
(Name)
to
(Department) (Org Number) (Position Number)
in the position of at a hourly rate of $ for hours.
(Job Classification/Title)
This person reports directly to . First Work Date:
(Supervisor)
WILL THIS EXTRA LABOR EMPLOYEE NEED BUILDING ACCESS AFTERHOURS? YES NO
IF YES, TO WHICH ACADEMIC BUILDING?
IS THIS PERSON BEING HIRED WITH THE INTENT OF WORKING 80 HOURS OR MORE PER MONTH
FOR THREE (3) CONSECUTIVE MONTHS? IF YES, THE STATE REQUIRES PARTICIPATION IN A RETIREMENT PLAN.
PLEASE MAKE ALLOWANCES IN YOUR BUDGET. YES NO
***DEPARTMENTS ARE RESPONSIBLE FOR STAYING WITHIN EXTRA LABOR BUDGET AND FOR ANY OVERAGES THAT MAY OCCUR. ***
Signature of Department Head Dean’s Signature (if required by Dean)
Individuals must complete an application prior to being hired for employment and must meet state job requirements.
A background check must be conducted prior to individual being hired.
Extra Labor employees can work no more than twenty-eight (28) hours per week without prior approval.
Request form is due in the Human Resources Office two weeks prior to quarter worked.
Extra Labor employees are eligible to work a limit of 1500 hours in a fiscal year.
Any exception to the payment of the rate of pay must be requested and approved in writing by the Vice President for Finance and
Administration prior to the first work day of employment.
Pay periods should be requested for one quarter at a time: Jan-Mar.; Apr.-June; July-Sept.; or Oct.-Dec.
Special Approval:
Human Resources Date
HR APPROVAL: PAYROLL APPROVAL:
THIS SECTION MUST BE COMPLETED IF THE EXTRA LABOR EMPLOYEE IS NO LONGER EMPLOYED IN YOUR DEPARTMENT.
TERMINATION OF ASSIGNMENT (ATTACH FINAL TIME SHEET)
Please terminate this assignment effective (last date of work)
Reason for termination:
Supervisor’s Signature:
click to sign
signature
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click to sign
signature
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click to sign
signature
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