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Pasadena Area City College District
Office of Human Resources
WARRANT(S) RECIPIENT DESIGNATION
Under the provisions of Section 53245 of the California Government Code, in the event of my death I hereby designate the following-
named person to be entitled to receive all warrants payable to me by the Pasadena Area Community College District had I survived:
Designee’s Name in Full Relationship
Address City State Zip
This designation cancels and replaces any previously signed by me for this purpose and shall remain in effect until canceled in writing by me. It is expressly understood
and agreed that the Pasadena Area Community College District is not obligated to deliver said warrants to the person designated hereinabove unless said designated
person, within two years after the date of said warrant or warrants, claims said warrant(s) from the Pasadena Area Community College District and provides to said
School District sufficient proof of identity pursuant to the provisions of Section 53245 of the California Government Code.
ETHNIC CODE, please check one:
_____ American Indian or Alaskan Native _____ White (Non-Hispanic)
_____ Black or African American _____ Native Hawaiian or Pacific Islander
_____ Hispanic / Latino _____ Two or More Races
_____ Asian _____ Unreported or Unknown
I, ___________________________________________, do solemnly swear (or affirm) that I will support and defend the Constitution of the United
States and the Constitution of the State of California against all enemies, foreign and domestic; that I will bear true faith and allegiance to the
Constitution of the United States and the Constitution of the State of California; that I take this obligation freely, without any mental reservation or
purpose of evasion; and that I will well and faithfully discharge the duties upon which I am about to enter.
Signature of Employee (Use Payroll Name) Date
Subscribed and sworn to before me this_____day of__________________, 20______
By_____________________________________________________________
Name of person administering the Oath
Deputy Title
TO BE COMPLETED BY FISCAL SERVICES
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Position Control # Job Class # Work Location #
_________________________________________________ __________________ _________________________
Budget Approval Date Budget Reference #
TO BE COMPLETED BY HUMAN RESOURCES
_______________________________________________ __________________ _________________________
Assistant Director, Human Resources Date Authorized Start Date
Request for New Employment of an Instructional Aide (2410) Revised March 2019
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