Central Connecticut State University
Recommendation for
University Assistant Appointment
Fiscal Year 2006-2007
Renewal _______ New Appointment_______
Social Security Number:
|___|___|___| - |___|___| - |___|___|___|___| (if new employee)
CCSU ID# |___|___|___|___|___|___|___|___|
Name: _____________________________________________________________________________
Last First MI
Address: _____________________________________________________________________________
Street
_____________________________________________________________________________
City State Zip Code
Telephone #: ( _______ ) ________ - __________
Department: _______________________________
Supervisor: __________________________________
Alternate/Proxy: _____________________________
Duties: ___________________________________________________________________________________
___________________________________________________________________________________
Approver: |___|___|___|___|___|___| Start Date ______/______/______
Position Code:
|___|___|___|___|___| End Date ______/______/______
Banner Index:
|___|___|___|___|___|___| Total Weeks: ___________
Total Salary for 2005-06 Employment Period:
$_________ (rate/hour) x _________ (hours/week)* x __________ (total weeks) = $________________
*The number of hours assigned and worked by the University Assistant may not exceed an average of 19 hours
per week for the term of the employment. Hours worked may not exceed 40 hours per week.
Recommended by ___________________________________ (Supervisor) Date ___________
Approved by ________________________________________ (Dean, Director, etc.) Date ___________
Approved by ________________________________________ (Executive Officer) Date ___________
Approved by ________________________________________ (Grants-for ALL Grants) Date ___________
New appointments ONLY:
(To be filled in after appointment is approved) Date of Birth _____/______/______ Race ______ Sex M / F
For Personnel Office Use Only
Citizen Y / N I-9 ______ W-4 _______ Employee # ______________
If No – VISA or PRA
