Request for Student Employment
2020-2021
(06-22-2020 CB)
Supervisor (ALL FIELDS MUST BE COMPLETE AND TYPED)
Student ID Number Job
Number Phone Number
Student’s Last Name First Name Email
Street Address, City, State, Zip Date of Birth
(MM/DD/YY )
Department Supervisor (person(s) signing timecard) Hours Per Week
DL Number
Budget Code:
%
%
Budget Approval (i.e. CalWORKs, Athletics) Supervisor’s Signature Date
Budget Approval (i.e. CalWORKs, Athletics) Supervisor’s Signature Date
Administrator
Administrator’s Signature Date
Work Study Coordinator Use Only
Start Date: ______________ Notification to Supervisor/Student: ______ Awarded Amount: __________ Removed CCN: _______
Program: IWS FWS CalWORKs
Work Study Coordinator/Financial Aid Signature
Releasing the Student (Complete this section and forward a copy to the Work Study Coordinator)
Last Day Worked Reason For Release
Would you recommend student for rehire? Yes No
Supervisor’s Signature Date
Will Student be allowed/required to drive a district vehicle? (i.e. Car/Golf cart/Van)
Yes No
If “Yes”
Approved
Denied
Approved
Packet I
FP Results
Denied
Packet II
Summer 2020
Units:
SAP
Comments
Fall 2020
Units:
SAP
Comments
Spring 2021
Units:
SAP
Comments
Summer 2021
Units:
SAP
Comments
Fall 2021
Units:
SAP
Comments
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