EASTERN MICHIGAN UNIVERISTY
WIRELESS ALLOWANCE FORM
Please print
Date_______________
Name_________________________________________________________
(Last) (First) (Initial)
Job Title ______________________________________________
Department____________________________________________
Effective Start Date ___________________________
EID Number E____________________
Cell Phone Number (with Area Code)_____________________
Campus Department Fund/Org To Be Charged _____________________
Campus Phone ________________
ECLASS _____________ Monthly Allowance $____________
____Discontinue Allowance Effective _______________
(Date)
I authorize the Cell Phone allowance to be added to my pay check, I understand that it will
continue unless I or the University discontinues this allowance, and I have read and agree to the
Administrative Cell Phone Policy. I understand and have met one or more of the criteria listed
below; (please check all that apply)
____Is routinely called by the University for emergency purposes (more than 12xs per year) or
____Works more than 50% "in the field" AND Does Not have a desk or office at EMU or
____Works more than 50% "in the field" and performs extensive recruiting. (must be included
in employment contract)
_____________________________________ _____________________
Staff Signature Date
_____________________________________ _____________________
Supervisor Signature Date
_____________________________________ _____________________
Vice President/Dean Signature Date
_____________________________________ _____________________
CFO or Designee Date
_____________________________________ _____________________
Human Resources Date
