Fillable TEMPORARY EMPLOYMENT REQUEST FORM (California State University, Sacramento)

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TEMPORARY EMPLOYMENT REQUEST FORM (California State University, Sacramento)

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Temporary Employment Request Form – 072420 Page 1 of 3
TEMPORARY EMPLOYMENT REQUEST FORM
Submit the following to Human Resources, Classification & Compensation:
• Completed Temporary Employment Request Form
• Organizational Charts (must include names, classifications/skill-levels, and show reporting relationships)
o
Current & Proposed
• Proposed position description
• Background check form
Scan and send the request by e-mail to classandcomprequests@csus.edu
. If you do not have scanning capability, mail the
request to Campus Zip 6032, ATTN: Classification & Compensation
.
Appointment Type:
Requested By (Name of Manager/MPP):
Title and Administrator Level:
Prepared By:
Request type (check one):
Initial Request
Request for extension
If extension, list date of initial request:
Is a recruitment needed?
Yes
No
If yes, anticipated recruitment date:
Department/Location:
Appropriate Administrator:
Ext: 8 -
Job Classification*:
*Job Classification will ultimately be determined by HR, Classification & Compensation, based on the position description provided.
Requested Start Date:
Expected End Date:
1. REQUEST JUSTIFICATION
2. REQUEST DETAILS
Select Type
Temporary Employment Request Form – 072420 Page 2 of 3
Based on the federal regulations under the Affordable Care Act (ACA), individuals who meet the new criteria for benefits eligibility
will be offered the opportunity to enroll in medical coverage for self and eligible dependents. Medical coverage can be waived, and
the employee can opt for FlexCash in lieu of medical coverage.
POSITION TIMEBASE
Will the position work an average of 130 hours (0.75 timebase) per month or more during the duration of the
appointment? Yes No
Employee Timebase:
.01 (ex: Events)
.5 (Avg. 20 Hrs)
.75 (Avg. 30 Hrs)
1.0 (Full-Time)
NOTE: Any change in timebase during the duration of the appointment requires an updated PTF.
Name of selected candidate:
Previous CSUS Employee?
Yes
No
Currently Enrolled as a CSUS Student?
Yes
No
If yes, is the candidate currently working in a student assistant position?
Yes
No
RETIRED ANNUITANT INFORMATION
Sacramento State Retiree?
No
Yes
If yes, Retirement Date:
CalPERS Retiree?
No
Yes
If yes, Retirement Date:
Agency Name:
Proposed salary:
Manager Authorization
Date
Dean/Director/AVP Authorization
Date
Vice President/Provost Authorization (REQUIRED)
Date
2. CANDIDATE/EMPLOYEE INFORMATION
3. SALARY INFORMATION
4. ADMINISTRATOR REVIEW & AUTHORIZATION (For HEERA Designated Managers ONLY)
Temporary Employment Request Form – 072420 Page 3 of 3
Approved as (appointment type):
C&C Approval Signature
Date
ES Approval Signature
Date
FOR HUMAN RESOURCES USE ONLY
Select Type
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TEMPORARY EMPLOYMENT REQUEST FORM (California State University, Sacramento)

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Completed 28 January 2021

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