Second Campus Job
LOCK HAVEN UNIVERSITY OF PA
Student Application for New Employment or Fund Center Change
*Student may not begin work until employment paperwork is complete
It is the policy of the PASSHE that you cannot
work until you have a social security number
If your address changes at any time, please notify Enrollment Services or Student Payroll
PERNR#
Name Social
Security
Number
Date
of
Birth
Local or
Cell
Telephone Number
Beginning
Da
te
of
Employment
Effective
January
1,
2008
the
Emergency
and
Muni
cipal
Services
ta
x
is
being
replaced
by
the
Local
Services
Ta
x.
If
you
expect
to
earn
less
than
$12,000
during
the
calendar
year,
you
can
apply
for
an
exemption
from
this
tax
by
completing
the
included
LST
Tax
Exemption
Form.
Please mark
t
h
e
appropriat
e
box.
U.S.
Citizen
Resident
or
Nonresident
Alien
(Every calendar year you must complete Statement of Citizenship in the International
Office. You will not be put on the payroll until all paperwork is completed.)
Gender:
Male
Female
Check
here
if
you
are
a
veteran
Currentl
y enrolled in classes at Lock Haven University
I
declare
that
this
statement,
to
the
best
of
my
knowledge,
is
true
and
correct.
Falsifying hours
worked will result in IMMEDIATE TERMINATION of Student Employment
Student
Sign
a
ture
Date
LHUP E-
mail
address
For information receiving pay checks, please check with your department time keeper.
NOTE TO SUPERVISORS: Students may work no more than 20 hours per week during the semesters. Prior
approval must be obtained, in writing, from Department of Student Affairs to work more than 20 hours.
Students may work 37.5 hours per week, a maximum of 7.5 in a day, during summer and scheduled breaks provided
there are sufficient monies in your department fund center.
Completed paperwork is to be forwarded to Student Payroll Office, EC J207. Delay in submitting paperwork
will result in student not being paid in a timely manner.
1. __________
____________________ _______________
Department Date
__ __ __ __ __ __ __ __ __ __.__ __ __ __ __
10 digit Fund Center (Grant WBS)
2.
_
____________________________
Supervisor - Printed Name
__
___________________________
Supervisor - Signature
click to sign
signature
click to edit
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