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FUNDING (California State University, Stanislaus)

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SPECIAL CONSULTANT PAYMENT REQUEST
FA/HR USE ONLY
SC#
PART I – GENERAL INFORMATION
Consultant Name:
EMPL ID:
Address:
Dept/Ext:
Email:
Phone:
Contact Name/Ext:
PART II – ACCOUNT NUMBER & DESCRIPTION OF SERVICES
ACCOUNT
DEPT ID
PROGRAM (If required)
PROJECT (If required)
Description of Services - include attachment if content exceeds space provided
PART III – SELECT ALL DATES WORKED:
Enter One Month Only per form
Month:
Year:
1
9
17
25
2
10
18
26
3
11
19
27
4
12
20
28
5
13
21
29
6
14
22
30
7
15
23
31
8
16
24
Daily Rate
Number of Days Paid
Total Pay Due
HR Form 10/2017
PART IV – DISTRIBUTION OF CHECK
☐ Hold Check Cashiers at MSR100
(Not applicable for those on Direct
Deposit)
☐ Mailed
(Must attached self-addressed/stamped
mailing enveloped)
☐ Direct Deposit
(Must have filled out the Enrollment Authorization form
& submit to Payroll at MSR320)
For security purposes, paychecks will not be sent to campus departments.
PART V – AUTHORIZED SIGNATURES
I certify that the above individual has completed the service in a satisfactory manner, as outlined above.
Department Authorized: Signature: Date:
I verify that I have performed the services as outline above and have completed all necessary employment forms.
Consultant Signature: Date:
FUNDING
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FUNDING (California State University, Stanislaus)

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Completed 16 July 2020

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