Pasadena Area City College District
Office of Human Resources
Form Request New College Assistant (2312) Revised July 2015
REQUEST FOR NEW EMPLOYMENT OF A COLLEGE ASSISTANT (2312)
TO BE COMPLETED BY EMPLOYEE
_______________________________________________________________ _____________________________
Name (please print) Social Security #
____________________________________________________________________________________________________________
Address City State Zip
(______) ___________________________ _______________ Male_____ Female____ ___________________________
Area Code Phone Number Date of Birth Email Address
Are you presently a member of the California State Teachers Retirement System (CalSTRS) ? Yes _____ No _____
Are you presently a member of the California Public Employees’ Retirement System (CalPERS)? Yes _____ No_____
Are you currently working in another department or division? Yes ___ No___ Please indicate where: _________________________
Do you have any criminal convictions for any offenses (other than a minor traffic violation/infraction)? Yes_____ No _____
If you have a record of convictions for offenses (felonies or misdemeanors) other than minor traffic violations as an adult, you must
complete Form No. 10, available in Human Resources. Failure to do so is cause for dismissal. A conviction record does not necessarily
exclude you from employment with the District.
I understand and agree that during this semester my only employment with PCC can be as a College Assistant or Instructional Aide. I also
understand and agree that I am limited to working 900 hours or 170 days, whichever comes first, during a fiscal year (July 1-June 30).
________________________________________________________ _______________________________________
Signature Date
(Please complete warrant, ethnicity and oath on reverse side)
TO BE COMPLETED BY SUPERVISOR
IMPORTANT: This form should ONLY be used to hire a new College Assistant. Also, use this form if there is a break in service or a
classification change (example: not worked for a semester or employee is switching from Student Worker to College Assistant). If you are
unsure, please contact the Human Resources Office for assistance at (626) 585-7388.
Contact Person ______________________________ Ext. _________ Department _______________________________________
___________ 2312 ______________ ________________ EMP#:___________________
___________ 2312 ______________ ________________ EMP#:___________________
Requested Start Date:________________________
College Assistant:____________________________ Duties:_____________________________ Pay Rate:_______________
Is this individual:
Reasonably expected to work 30 or more hours per week? ☐
Reasonably expected to work 30 hours or less per week? ☐
Seasonal/variable hour – cannot reasonably estimate the expected number of hours per week? ☐
PLEASE NOTE: Employees cannot start employment until the Human Resources Office approves their assignment. HR will send
an email approval to the Cost Center manager indicating the effective date.
By signing this document, I certify that I have adequate funding in my budget to accommodate this expenditure (including any
employer mandated costs (FICA, paid sick leave, etc.)
Cost Center Manager’s Name ___________________________ Signature ______________________ Date_____________
TO BE COMPLETED BY FISCAL SERVICES
_________________________________________________ __________________ _________________________
Position Control # Job Class # Work Location #
_________________________________________________ __________________ _________________________
Budget Approval Date Budget Reference #
