Special Consultant Pay Form
**Mandatory
03/2020
SUBMIT ONE FORM PER PAY PERIOD
Exempt classification code 4660
Non-exempt
classification code 8379
1) Employee ID:
2) Employee Name:
First Name MI Last Name
3) Employee Office:
4) PeopleSoft Position #: Unit: Classification Code:
5) Chart Field:
Account
Fund
Dept. ID
Program
6) Pay Period: Daily Rate: Total Amount:
MM/YYYY
7) Prepared By:
Minimum $104/day
Date:
Extension:
Name MM/DD/YYYY
Indicate days worked according to the payroll calendar.
30 4 9 14 19 24 29
31 5 10 15 20 25 30
1 6 11 16 21 26 31
2 7 12 17 22 27 1
3 8 13 18 23 28 2
Total Number of Days Worked:
Description of Services:
**Work Schedule (if current employee):
I certify that I have worked the days as recorded.
Employee Signature Date
Approval:
Print Supervisor Name Supervisor Signature Date
Print Approving Authority Name Approving Authority Signature Date
HRM USE ONLY:
Employee Record:
Initials:
PS Processing Date
:
Calculated Field
Clear Form
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