Fillable food services, bookstore, and other similar contractors. (Shippensburg University of Pennsylvania)

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food services, bookstore, and other similar contractors. (Shippensburg University of Pennsylvania)

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The food services, bookstore, and other similar contractors. (Shippensburg University of Pennsylvania) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Shippensburg University of Pennsylvania

BROWSE SHIPPENSBURG UNIVERSITY OF PENNSYLVANIA FORMS

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Page 1 of 2
Name:
First Last MI
Address:
Street
City State Zip County
Phone:
Home/Cell/Work Personal Email
Emergency Contact Person
This position is unpaid.
Yes
No
Yes
No
Parking Tag
Active Directory/University Login
Blackboard Transaction System
Other
Volunteer/Contractor
REQUEST/APPROVAL FORM
Volunteer or Contractor?
Volunteer
Contractor
Justification for IT Access:
Start Date:
(Anticipated) End Date:
SAP - HR
Banner
University E-mail
Access Needed:
SAP - Finance/Accounting
* Can be extended, please notify Human Resources
University ID
Key(s)/Access
Phone:
Part 1 - To Be Completed by Volunteer/Contractor
This information is necessary to enter you into SAP. Please print clearly.
City/State/Zip:
Name:
Relationship:
Address (street):
* Please answer the following questions:
I have been a resident of Pennsylvania
during the entirety of the past ten-year
period.
Any individual who provides a program, activity, or service to Shippensburg University with
compensation, either directly or indirectly from the university. This includes temp agency workers,
food services, bookstore, and other similar contractors.
Any individual, including students, who provides a program, activity, or service to Shippensburg University
without compensation. This includes club sport and coach volunteers.
Part 2 - To Be Completed by Requesting Department - Accesses Requested
Department:
Page 2 of 2
Print Signature Date
Print Signature Date
Print Signature Date
Print Signature Date
Person Verifying Background Check:
Signature Date
By:
Date Signature
By:
Date Signature
NOTE:
The Requesting Supervisor is responsible for notifying Human Resources at the conclusion of this assignment,
or when access is no longer needed.
Part 3 - Request/Approval
Requesting Supervisor:
Department Head:
Dean (if applicable):
Vice President:
NOTE: Shippensburg University's Human Resources Office is not responsible for ordering background checks for the
following departments: Bookstore, SUSSI, Chartwells, SU Foundation, GBLUES, Head Start, and UPS. All
Volunteer/Contractors working in these departments must submit all three clearances to HR within 90 days of their start
date.
All other departments will need to submit the following three authorization forms to Human Resources: 1)
Volunteer/Contractor Authorization Form; 2) Provisional Hire Form; 3) FBI Fingerprint Questionnaire.
Completed clearances must be submitted to HR within 90 days of their start date.
*Failure to complete or provide copies of the required background checks within the 90 day Provisional Hire
timeframe will result in system access removal.
FBI:
Part 4 - Background Checks
PA State Police:
Child Abuse:
* FBI needed if :
and/or
2) They have not
lived in
PA for the past 10 years
Part 5 - To Be Completed by Human Resources
Entered in SAP:
Separated from SAP:
CONFIDENTIALITY STATEMENT
As a contractor/volunteer of Shippensburg University of Pennsylvania I understand that I may
have access to confidential, personal data and/or records of University employees, students,
customers, and other related constituents. I agree that I will access, use, discuss, release and/or
divulge only the data that is needed to perform my job. I understand that I am prohibited from
access, using, discussing, releasing, and/or divulging this data unless doing so is a requirement of
my job.
I further understand that unauthorized disclosure of confidential information and records applies
to all information on the University computing/networking systems, all printed information, as
well as formal and informal verbal conversations.
I understand that any release of this information will be done only through authorized protocols.
Breaches in confidentiality of such data may result in disciplinary action up to and including
separation from employment and in the case of student employees and graduate assistants,
possible University judicial action. A violation of this agreement also may result in legal action
if it is determined that any local, state, or federal laws have been violated.
I have had the opportunity to discuss this responsibility with a representative of the University,
and by my signature below, I am certifying that I have read, understand, and agree to abide by
the provisions of this statement.
I also agree to notify the Human Resources Office at Shippensburg University at the end of this
assignment and return any property due to the University at that time.
Name _________________________________
Signature ___________________________________________________ Date ___________
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food services, bookstore, and other similar contractors. (Shippensburg University of Pennsylvania)

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Completed 26 August 2020

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