Pasadena Area City College District
Office of Human Resources
Request For Additional
/ Change Of Assignment
Short-Term/Substitute
Important: This fo
rm should only be used to change or add an assignment for a current Short-Term/ Substitute. 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 Short-
Term/ Substitute), a new Request for New Employment of Short-Term/ Substitute Form needs to be completed. If you are unsure,
please contact the Human Resources Office for assistance at (626) 585-7388.
Employee (Last Name, First) Employee ID #
Employee Telephone # Employee Email Address
Contact Person Ext. Department
Additional Assignment
Add Assignment(s)
_____ _____ ______ ______
EMP#:
_____ _____ ______ ______
EMP#:
Working Title: Pay Rate: Effective Date:
Will this additional assignment result in the employee working over an average of 30 hours per week (Note: Combine
hours
for
all
assignments worked, if applicable)? Yes No
Change of Assignment
From:
____ ____ ____ ____
To:
____ ____ ____ ____
EMP#:
CHANGE OF PAY RATE
Working Title:
From
:
To:
Pay Rate:
From: To:
Effective Date:
Will this change of assignment result in the employee working over an average of 30 hours per week (Note: Combine
hours
for
all
assignments worked, if applicable)? Yes No
Please Note: Employees can
not 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 #
T
o Be Completed by Human Resources
Director, Human Resources Signature Date Authorized Start Date
Request for Additional/ Change of Assignment ShortTerm – Aug 2017
click to sign
signature
click to edit
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click to sign
signature
click to edit
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