Fillable Request-for-Employment-of-a-Student-Worker-2311-Form Request For New Employment of a Student Worker

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Request-for-Employment-of-a-Student-Worker-2311-Form Request For New Employment of a Student Worker

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The Request-for-Employment-of-a-Student-Worker-2311-Form Request For New Employment of a Student Worker form is 2 pages long and contains:

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  • 8 check-boxes
  • 59 other fields

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File type: PDF

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_______________________________________________________________ _____________________________
____________________________________________________________________________________________________________
________________________________________________________ _______________________________________
____________________________________________________________________________________________________________
Pasadena Area City College District
Office of Human Resources
REQUEST FOR NEW EMPLOYMENT OF A STUDENT WORKER (2311)
(Limited to 20 hours per week)
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 Public Employees’ Retirement System (CalPERS)? Yes _____ No_____
Are you currently working in another department or division? Yes ___ No___ Please indicate where: _________________________
I understand and agree that I am limited to working 20 hours per week.
Signature Date
(Please complete reverse side)
`
TO BE COMPLETED BY SUPERVISOR
IMPORTANT: This form should ONLY be used to hire a new Student worker. 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 Professional Expert to Student Worker). If you
are unsure, please contact the Human Resources Office for assistance at (626) 585-7388.
Contact Person _____________________________ Ext. _________ Department _______________________________________
Requested Start Date:________________________ Student Worker:__________________ Pay Rate:_______________
Labor Distribution: ___________ 2311 __________ ___________ EMP#:___________________
___________ 2311 __________ ___________ EMP#:___________________
Duties:_______________________________________________________________________________________________________
PLEASE NOTE: New employees CANNOT start employment until the manager receives an email approval indicating the effective
start date from Human Resources.
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_____________
Request for New Employment of a Student Worker (2311) Revised March 2019
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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
OATH OF ALLEGIANCE
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
_________________________________________________ __________________ _________________________
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 a Student Worker (2311) Revised March 2019
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Request-for-Employment-of-a-Student-Worker-2311-Form Request For New Employment of a Student Worker

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Completed 7 February 2020

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