DRC-E
SOUTH PLAINS COLLEGE
Exempt Employee Supplemental Pay Form
To be completed by the immediate supervisor, Dean, Director, or Coordinator
Employee Name __________________________________SSN____________________
Current Job Title__________________________________ Date____________________
Funding Source___________________________________ Act # __________________
Amount $_____________Pay Date__________________ Frequency ________________
Briefly describe the project and how it supports the educational mission of the college.
Start Date ________________________
End Date ____________________________
Does this assignment clearly benefit the college?
Yes ___ No ___
Is this assignment the most effective use of human resources?
Yes ___ No ___
Will the work be done substantially outside of normal work hours? Yes ___ No ___
Is the assignment a substantial addition to the current position?
Yes ___ No ___
Is this assignment outside of the current job description?
Yes ___ No ___
Are there adequate and dedicated funds for this compensation?
Yes ___ No ___
Is this a temporary or short-term assignment?
Yes ___ No ___
I certify the above to be true and correct to the best of my knowledge and accept the
responsibility for the completion of this additional assignment in lieu of the above
stated compensation and in addition to performing my normal job duties.
Employee__________________________ Date__________________________
I certify the above to be true and correct to the best of my knowledge and accept the
responsibility for managing the above described assignment. I further certify that
there are adequate and dedicated funds for this compensation and recommend
approval.
Supervisor, Dean, Director or Coordinator ________________________________
Appropriate Grant Administrator (if applicable) ____________________________
Vice President: Pre-Approval _________________ Post Approval ____________
President: Pre-Approval ____________________ Post Approval ______________
Submit completed form to Human Resources for final payment.