January 2, 2020- Student labor/forms/Student Employment Request
Arkansas Tech University
Request/Assignment for Student Employment
Last Name: _____________________________ First Name: ________________________________ M: _____________
T#: Estimated hours worked per week: ________________________
*Work-Study Requested Earnings: $_______________ *Non Work-Study Requested Earnings: $__________________
**A STUDENT WORKER’S COMBINED HOURS FOR THE UNIVERSITY MAY NOT EXCEED 28 HOURS PER WEEK. **
Is this person employed in any other position for the University? Yes No
If yes, what department: _______________________________________________________
Is this person enrolled in the Graduate College Program? Yes No
Is this person on a Graduate Assistantship? Yes No
If yes, he/she will need to contact the Graduate Office for approval prior to working (signature below).
Graduate College Approval: ___________________________________________________________________________________
First day of work for pay: ____________ Last day of work for pay: _____________________________
*Others $: (Special Rate) Signature (V.P. Admin/Finance):
* S.S. FELLOWSHIP ($11.00) ** SIGNATURE (V.P. ACADEMIC AFFAIRS):
Budget Name: Index Code: Banner Position #:
Building/Room #: Supervisor/Electronic Timesheet Approver: _____________________
Supervisor phone #: Assignment Notification Email Address: ______________________________
Purpose of Job & Qualifications:
Duties & Responsibilities:
*** DEPARTMENT HEADS ARE RESPONSIBLE FOR ALL EXPENDITURES MADE FROM THEIR BUDGETS. DEPARTMENT HEADS WILL BE GIVEN ACCESS TO VIEW ALL STUDENT LABOR
TIMESHEETS THAT ARE PAID FROM POSITIONS WITHIN THEIR BUDGET. ***
____________________________________________________ ____________________________________________________
Designated Supervisor’s Printed Name Department Head or Dean’s Printed Name – (Required)
Designated Supervisor’s Signature Department Head or Dean’s Signature - (Required)
OFFICE USE ONLY
STUDENT ASSIGNMENT IS APPROVED AS REQUESTED. STUDENT’S MAXIMUM EARNINGS:
$ SIGNATURE: DATE:
HR APPROVAL:
THIS SECTION MUST BE COMPLETED IF THE STUDENT IS NO LONGER EMPLOYED IN YOUR DEPARTMENT.
*** If your department is anticipating the student to return the next semester, do not complete this section. ***
PART II TERMINATION OF ASSIGNMENT
Please terminate this assignment effective (physical last day of work):
Termination of employment: Reason- ______________________________________________________________________
Supervisor’s Signature:
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
