PLEASE PRINT ON GREEN PAPER LINE#:_______ PP#________
STUDENT ASSISTANT AUTHORIZATION FORM SUNY ID:_________
New Hire Renewal (Rehired)
Name:
Last 4 digits SSN:
Assignment Schedule
DAYS
Sunday
Monday
Tuesday
Thursday
Friday
Saturday
Time In
Time Out
Daily Total
Total Hrs/Week
AUTHORIZATION SIGNATURES
Printed Name Signature
Director/Department
Chair/Dean
Date:
Financial Aid
Date:
Area Vice President
Date:
Budget
Date:
THIS FORM MUST BE SIGNED AND ON FILE WITH HUMAN RESOURCES BEFORE EMPLOYMENT BEGINS.
**FOR PAYROLL/HUMAN RESOURCES USE ONLY**
I-9
SUNY HR
PERSON
SUNY HR
APPT
1040
Payroll
Benefits Eligible?
Time Records
Budget
STAMPING AREA
Revised 5/28/14
STUDENT STATUS
At least ½ time undergraduate
HOURLY SALARY RATE
EFFECTIVE DATE
END DATE
SUNY CAMPUS
DEPARTMENT
SUPERVISOR
NAME OF DEPT. ACCT. TO BE CHARGED
DEPT. ACCT. # TO BE CHARGED
Current NYS employee?
Yes No
If yes, where?
Previously employed by NYS?
Yes No
NYS Retiree?
Yes No
Member NYS Retirement?
Yes No
System & Membership #