ELIZABETH CITY STATE UNIVERSITY
ELIZABETH CITY, NORTH CAROLINA 27909
Request to Pay Additional Hours Worked for SPA Employees
Note: This form should be used to pay for services when an employee works for another department,
including funded grants. Services rendered must not interfere or conflict with the primary duties.
NAME: _____________________________________________________________________________________________________________
SCHOOL/DEPT: ____________________________________________________________________________________________________
DIVISION/UNIT____________________________________________________________________________________________________
DEPARTMENT/UNIT REQUESTING SERVICES ______________________________________________________________________
BEGINNING DATE ______________________________________
ENDING DATE _________________________________________
DESCRIPTION OF DUTIES __________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
ANTICIPATED NUMBER OF HOURS TO BE WORKED: _____________
Project Director Signature: ______________________________________________________ Date: _______________________________
Budget Code: _______________________________ G/L Account #: _______________________________________________________
Grant Title (if applicable):__________________________________________________________________
METHOD OF PAYMENT
**TIME SHEETS SHOULD BE SUBMITTED TO HUMAN RESOURCES**
OVERTIME: HOURLY PAY RATE $___________________ x 1.5 _________________ = $ _________________
(After 40 hours)
Hours Worked
REGULAR:
HOURLY PAY RATE $___________________
x
_________________ = $_________________
Hours Worked
FLAT RATE: SUM OF PAY $____________________________ PER MONTH
BUDGET
Approved Salary $___________________________________________
APPROVALS
___________________________
Employee’s Supervisor
_________________
Date
___________________________
Vice Chancellor/Unit Head
_________________
Date
________________ __________
Human Resources
_________________
Date
Funding Source ___ Federal ___State ____ Auxiliary ___ Other
Authorized by: ______________________________________________
Division of Business and Finance
Date: ________________________________________________________
______________________________________________________________
Sponsored Programs (If Applicable)
Date