STUDENT EMPLOYMENT ACKNOWLEDGEMENT
UPS OPERATIONAL POLICY: GEN 20 FOR STUDENT EMPLOYMENT
UPS Operational Policy: GEN 20 outlines the University of Wisconsin System (UWS) provisions specific to student
employment and provides guidance to students and university departments in compliance with the Patient
Protection and Affordable Care Act of 2010 (“ACA”) as it relates to student employment. UW-Green Bay’s Campus
Procedures for ACA reporting have been developed to assist the campus in ensuring compliance with UPS
Operational Policy, GEN 20.
By signing below, I understand and acknowledge:

Effective January 1, 2016 student employees will be required to follow the weekly hours limit as outlined
on the UW-Green Bay Student Payroll Calendar. The weekly hour limits includes any and all positions
(work study, regular, and lump sum) employed through UW-Green Bay or other UW System employment.
I agree to promptly report all hours worked, as requested by my supervisor, to assist with monitoring and
compliance.

UW-Green Bay, as my employer, has the unilateral discretion and right to determine my hours of work in
accordance with the operational needs of the institution and to comply with the ACA and related laws and
policies.

I have been informed of UPS Operational Policy: GEN 20 and UW-Green Bay’s Campus Procedures for ACA
reporting and it is my responsibility as a student employee to read and abide by this policy and procedure
and all related institutional, system and Board of Regent policies regarding student employees, including
state and federal laws or regulations.

My student employment is an “at will” employment relationship with UW-Green Bay. I hereby agree that
UW-Green Bay shall have the immediate and unilateral right to end my student employment for any
reason, including failure to adhere to the terms herein, with no required notice.

I need to inform my supervisor of any other positions (hourly or lump sum) that I may have on campus
and any conflicts with the number of hours I am scheduled to work.

If I have additional questions about this acknowledgement or policy, I will ask my supervisor or contact
Human Resources.
Student Name:
Empl ID:
Signature:
Date: