RIVERSIDE CITY COLLEGE
STUDENT EMPLOYMENT
EMPLOYMENT ACTION REQUEST
Academic Year
Today's Date
Employment Action A
Student ID # __________
Last Name __________________________
First Name ____________________
MI _____
Department / Site: ___________________________________________________________
Pay Rate: $
Program Type:
(Check all that apply)
Department Funding
Federal Work Study
Calworks Work Study
International Student
(Referral by RCC Calworks Office Required)
(Department Funding Required)
Educational Assistant
(RCC Academic Senate Award Required)
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Funding Source:
Department Funding (Educational Assistant budgets will be assigned. You do not need to provide a budget)
Job Category:
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Job Title:_____________________________________________
Budget #4: ______________________________________________
Budget #5: ______________________________________________
Budget #6: ______________________________________________
Budget #1: ______________________________________________
Budget #2: ______________________________________________
Budget #3: ______________________________________________
Federal Work Study Funding
Program:
On-Campus/RCCD/Satellite Dept: (75%) 12-DZE-1190-0-7091-0304-2331 / (25%) 12-DZE-1190-0-6460-0304-2331
Community Service (ex: Off-Campus Admin, ECE, Tutorial, DRC, Ctr for Soc. Justice)
(75%) 12-DZE-1190-0-7091-0300-2331 / (25%) 12-DZE-1190-0-6460-0300-2331
Calworks Match #1 (CWS/Preferred) (On-Campus/RCCD): (25%) 12-DZE-1190-0-7091-0305-2331
Calworks Match #2 (CWS/Community Service): (25%) 12-DZE-1190-0-7091-0307-2331
Calworks Match #3 (CWS/Alternate) (On-Campus/RCCD): (75%) 12-DZE-1190-0-7091-0306-2331
Reading Tutoring (Off-Campus K-8/ECE): (100%) 12-DZE-1190-0-7091-0301-2331
Math Tutoring (Off-Campus K-8/ECE): (100%) 12-DZE-1190-0-7091-0302-2331
Literacy (Off-Campus K-8/ECE): (100%) 12-DZE-1190-0-7091-0303-2331
Employment Action B
Department (if different): ______________________________________________________________
Budget #1: _______________________________________________
Budget #2: _______________________________________________
Budget #3: _______________________________________________
Budget #4: _______________________________________________
Budget #5: _______________________________________________
Budget #6: _______________________________________________
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By signing below, I have read , understand and agree to the Employment Action, Terms and Conditions of Employment and the
FERPA Confidentiality Agreement. I also understand that non-compliance of the FERPA Agreement and the Terms and
Conditions of Employment may result in termination.
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Manager - Signature
________________
Date
________________________________
Manager - Print Name
_________________________________________
Employee - Print Name
________________________________
Employee - Signature
________________
Date
Date Received
(Office use only)
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