UWF Office of Human Resources
STUDENT INFORMATION AND DECLARATIONS
Ethnicity
Are you Hispanic or Latino?
If you have identified yourself as Hispanic or Latino, you are
not required to select an additional race category below.
Yes
No
Race
Select one or more races to indicate what you consider yourself to be.
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
White
Submission of personal demographic information is voluntary. Refusal will not subject you to any adverse treatment.
See attached for category definitions.
Date:
Signature:
Last:
First:
MI: Maiden:
Telephone:
Date of Birth:
Gender
Female
Male
Marital Status
Single Married
SECTION 1: DEMOGRAPHIC INFORMATION
Revision: 01/05/2018
In accepting this appointment, I hereby declare that my primary endeavors at UWF are to pursue an education, that my purpose in being
employed is to support my pursuit of education, and that I am not employed by another state agency in any capacity.
I further understand that:
- Upon termination of this employment, I may not be entitled to unemployment compensation due to this employment,
- If I withdraw from classes, I must immediately notify my hiring department and will be ineligible to continue working as a student
employee at UWF,
- If hired as non-UWF student, I must provide proof of enrollment/fee payment from the institution I am attending at the time of hiring
and each semester that I am employed at UWF but not enrolled at UWF,
- As an employee eligible for overtime pay for hours worked exceeding 40 hours per work week, it is my responsibility to obtain prior
approval from my supervisor prior to working over 40 hours. The 40 hours per workweek limitation includes a combined total of all
hours worked for the university, and
- I have received/read the Social Security Number Collection and Usage by Human Resources information.
The following documents must be completed and received by Human Resources prior to processing for payroll purposes:
- W-4 Form with copy of the signed Social Security Card (Note: A verification printout with the employee name and Social Security -
Number is acceptable until the card is received if I-9 verification is provided),
- I-9 Form and copy of verification documents,
- Loyalty Oath signed in the presence of a Notary Public, and
- Direct Deposit Form with a voided check, copy of savings account I.D., or portion of Higher One Statement with routing and account
number (must be forwarded to Financial Services/Bldg. 20E/Attn: Payroll Section).
STUDENT SIGNATURE IS REQUIRED (Please read Declaration before signing.)
I acknowledge that I have reviewed and accept the declaration above as a condition of employment.
