Human Resources
Notification of Employment
Work Study Students, Discretionary Students, Eligible Senior Discretionary Workers, Special Needs and Grants
This form must be completed and signed by the Dean prior to start of employment. For discretionary/grant-funded students, please forward completed NOE to: Payroll, MS #2.
For work study students return completed NOE, FA/Work Study Approval Form, and job description to the Financial Aid office. This information is required to be on file in Payroll. If
you have any questions regarding the proper funding account number to use, please call the Business Office at 860-512-3640.
STUDENT WORKER INFORMATION
First Name MI Last Name SSN (last 4 digits)
Address
Is the student worker currently taking classes (credit or credit-free) at MCC?
n
Yes
n
No
Department
STUDENT WORKER EMPLOYMENT CONTRACT INFORMATION
Contract start date (must be the start date of a pay period)
______ / ______ /______
Employment Dates
Start ______ / ______ /______ End ______ / ______ /______
Total Amount Allocated
Hourly Pay Rate (select only one)
n $11
.00
n $11
.10
n $1
1.20
n
Other _____________________
Hours Per Week (Not to exceed 17 per week when attending classes.)
Semester of Employment (select only one)
n
Summer
n
Fall
n
Spring
n
Winter
Fiscal Year
Funding Account (Please select type of funding. Dean’s approval required.)
Work Study (select only one))
n
FWS
n
MCCWS (per work study approval)
Discretionary Funds (account number required)
Grant/Other (grant name and account number required)
Mid-semester Funding or Pay Rate Changes (Dean’s approval to change funding is required.)
Only complete this section when work study/other funds are exhausted or for pay rate increases affecting department budget.
Enter new required funding account number or pay rate increase (select only one)
n
Switch to discretionary/grant/other funding account number ________________ OR
n
Pay rate increase from $_________ to $____________
Termination Date:
Select either next payroll processing date or specify the date when a student is no longer working.
n
Next payroll processing OR
n
Other date _____________________________________
SUPERVISOR/DEAN SIGNATURE
The Dean’s signature is required once per fiscal year within the same department/fund account.The supervisor’s signature is required for all semesters of the fiscal year.
Supervisor Signature Date
Dean Signature Date
FOR PAYROLL OFFICE USE ONLY
Employee/Rec # __________________________________
Background checks are completed by the HR office for students working in Admissions/Registrar/Financial Aid, Business Office,
PCN __________________________________________
Continuing Education and Human Resources, but only apply to certain positions that handle DCL3 confidential data, have a
fiduciary/financial responsibility or are in safety/security position per the CSCU’s Pre-employment Background Verification
CE ___________________________________________
Policy (Revised 01/21/2016).
September 2019/PR
