Student Employee Exception to Work Request
Last Name:____________________________ First Name:_________________________
Student ID #:__________________________ Emp ID #:___________________________
Department/Campus location: ___________________________________________________________________
Position Title: ______________________________________________________________________________________
**************************************************************************************
Dates Needed: _____________________________________________________________________________________
Total Number of Hours requested: ______________________________________________________________
_______Over 20 hours/week _______Non-operating district hours
_______Weekend _______Other
Specific reason/task why additional student hours are needed: _____________________________
______________________________________________________________________________________________________
Supervisor terms: The purpose of this request form is to provide additional support to a
department that may have extenuating circumstances. It is not used to provide a department
with additional staff to conduct normal business. It cannot be used by a department when
permanent staff may be absent or on leave. Students are not allowed to work over eight hours
in a day. Students cannot work more than 28 hours in a given week. Students cannot work
during their class instruction time. Your signatures indicate that you agree to these terms.
This agreement is between the supervisor and student for requested dates only.
Student Signature: ________________________________ Date: ____________________
Supervisor Signature: ____________________________ Date: ____________________
Dean Signature: ___________________________________ Date: ____________________
____________________________For Financial Aid Department use only_____________________________
__________ Approved
_________ Denied
__________ Pending: more information needed______________________________________________________
Student Employment Coordinator Signature: ____________________________ Date: _______________
