HRMS Job ID:
August 31 , 2015 – May 15 , 2016
st
th
FEDERAL WORK-STUDY AUTHORIZATION/CONTRACT
Department Name:
Department Code:
WS Job Title:
Workers Comp Code:
Hourly Rate: $
Location:
Building
Room
Paperwork to: Name
City/State/Zip
E-mail
Campus Address
Phone
The student listed below is qualified to work in my department. I understand the student will be paid from Federal WorkStudy funds only for those hours worked as an eligible student and only if he/she has unearned funds remaining. I
understand it is the joint responsibility of my department and the student to insure that no excess hours are worked. If an
ineligible student submits hours for payment, I understand it is the responsibility of the department to compensate for these
hours. I agree to obtain & post all hours worked during any pay period by the appropriate payroll deadline so that the
student will be paid bi-monthly, according to University policy. I agree to provide adequate supervision and to assure that
the student will be paid only for those hours actually worked.
Supervisor:
____________________________
Printed Name
Signature
Date
Phone
Date
Phone
Designated Department Representative:
____________________________
Printed Name
Signature
***********************************************************************************
STUDENT:
Employee ID:
Student Name:
Last
W#:
Total Award: $
SSN:
First
Birth Date:
Semester Award: $
$
Fall ’15
M/F:
I-9:
Spring ’16
Date Completed
I understand that it is my responsibility to maintain a record of my time worked and that I will receive no compensation,
from Work-Study funds, for hours worked in excess of my Federal Work-Study eligibility. I will submit my hours worked
during any pay period by the appropriate payroll deadline so that I will be paid bi-monthly, according to University policy.
I further understand that this contract expires no later than May 15th, 2016. I hereby certify that I have read this statement
and fully understand the expectations of employment under the Federal Work-Study Program.
__________________________________
Signature
Check/Check Stub Address
W2 Address
Date
E-Mail Address
Phone