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UniversityAssistants2018-2019fillablerev5.16.18

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Central Connecticut State University
Recommendation for
University Assistant Appointment
Fiscal Year 2018-2019
Renewal
New
Appointment
CCSU ID# | | | | | | | | |
Name:
_
Last First MI
Address:
_
Street
_
City State Zip Code
Home
#:
(
_)
_-
_
Cell
#:
(
)
-
Department:
Supervisor: _
Duties:
Please use either # 1 or 2
1. If working full fiscal year
2. If working partial fiscal year
Position #:
| | | | | |
Start Date 06/22/2018
End Date 06/20/2019
Start
Date
/
/
End
Date
/
/
Banner Index: | | | | | | | Total Weeks: 52 Total Weeks: Total
Salary for 2018-19 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 pay week.
Recommended
by
Print name / Signature
(Supervisor)
Date
Approved
by
(Dean,
Director,
etc.)
Date
Print name / Signature
Approved
by
(Executive
Officer)
Date
Print name / Signature
Approved
by
(Grants-for
ALL
Grants)
Date
Print name / Signature
New appointments ONLY:
(To be filled in after appointment is approved) Date of Birth / _/ _ Race _ Sex M / F
For Human Resources Use Only
Human Resources Received
Citizen Y / N W-4
CT W-4
Ethics/Violence Prevention Policy
If No – VISA or PRA I-9
BKGRD
Employee #
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Completed 8 February 2020

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