Fillable Out Of District Load Verification For Web LOS MEDANOS COLLEGE Human Resources

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Out Of District Load Verification For Web LOS MEDANOS COLLEGE Human Resources

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PART-TIME COLLEGE LEVEL ACADEMIC WORK VERIFICATION
DIABLO VALLEY COLLEGE HUMAN RESOURCES
TO MY EMPLOYER:
EMPLOYEE NAME:
SSN/ID #:
AUTHORIZING RELEASE SIGNATURE:
Please provide the College Human Resources Assistant with my part-time academic experience listed by your schedule type in
the following format. If more space is needed, please copy this form prior to completion.
This verifies part-time academic service for _________________________________________________:
(Faculty Member’s Name)
This institution is on the
following schedule:
Quarter
Trimester
Semester
Summer
_Other: ____________
These courses were:
Full-term
_Short-term: _______ weeks
Held in campus facilities
On-line courses
At this educational institution, a full-time load
is considered:
Lecture ________hours/week
Lab ___________ hours/week
Non-Instructional Faculty -
(Counselor/Librarian/LrnDisSpec)
________________hours/week
Schedule & Year
Course Title, Number &
Section Or Assignment
P/T Hours Worked
Per Week vs.
F/T Base
Percentage of
Full-time Load
(Hours / FTE)
Example: FA 00
Anthropology 005-1234
6 hrs/15 hrs
.400
By signing below, I verify that the above person was employed in the capacity listed for the time period indicated.
Name
Signature
E-Mail Address (MANDATORY)
Date Completed
PLEASE RETURN THIS COMPLETE ORIGINAL FORM OR YOUR LETTER TO:
Coleen Lento, College Human Resources
Diablo Valley College
321 Golf Club Road
Pleasant Hill, CA 94523
(925) 969-2020 direct
(925) 689-0640 fax
M-F 8:00am-5:00pm
FORM # 7381-A Rev. Jan. 2007
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Out Of District Load Verification For Web LOS MEDANOS COLLEGE Human Resources

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Completed 28 February 2020

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