Student Payroll Authorization
The payroll authorization must be completed and approved before an individual begins work.
Responsibility for obtaining approval rests with the area in which the employee is to work. If students are
unable to apply and accept positions on the student job board, please complete this form and submit to Human
FName______________________ LName__________________________ A # ___________________
Department_____________________________ Job Title___________________________________
All fields must be completed Fund_________ Org ________ Acct________ Prog______ %__________
Ex. 1000 10650 6610 60 100%
Fund_________ Org ________ Acct________ Prog______ %__________
For New Students
Check One Dept. FWS Grant
Check One LSSU Student High School Student International Student Off Campus Student
Average Hours per Week__________________ No. of Weeks _________________________
Hourly Rate ____________________________ Total Authorized_______________________
If above minimum, attach approval email
Date on Payroll__________________________ Date Off Payroll_______________________
For Updates
Check One Dept. FWS Grant
Change rate from $__________________ to $_______________ Effective Date______________________
Attach approval email
Change Funding From Fund_________ Org ________ Acct________ Prog______ %__________
Ex. 1000 10650 6610 60 100%
Change Funding To Fund_________ Org ________ Acct________ Prog______ %__________
Supervisor Approval______________________________________ Date __________________________
For HR Office Use
Academic Year Enrollment ___________# credits Summer Enrollment ___________# credits
FICA Yes No Position Number__________________________
Completed by_________