July 11, 2017- 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.
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 ($9.00) ** SIGNATURE (V.P. ACADEMIC AFFAIRS):
Budget Name: Index Code: Banner Position #:
Building/Room #: Supervisor/Electronic Timesheet Approver:
Supervisor phone #: Assignment Notification Email Address: 1)
2) 3) 4)
Purpose of Job & Qualifications:
Duties & Responsibilities:
*** DEPARTMENTS ARE RESPONSIBLE FOR STAYING WITHIN STUDENT LABOR BUDGET AND FOR ANY OVERAGES THAT MAY OCCUR. ***
Supervisor’s Signature Dean’s Signature (if required by Dean)
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 (last day of work):
Termination of employment: Reason- ______________________________________________________________________
Supervisor’s Signature:
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