Fillable Payroll Action Request Adjunct Faculty New Hire Form - Southern Utah University printable pdf download

Payroll Action Request Adjunct Faculty New Hire Form - Southern Utah University

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SOUTHERN UTAH UNIVERSITY

HR Office Only:

T #

__________________

Payroll Action Request

I-9 Completed [ ] Init ______

Adjunct Faculty New Hire Form

Job # ________________

*Hire Date: _______________

Pay: _____________________

EMPLOYEE SECTION - Please Print:

Employee Name (Last, First, MI)

Marital Status: Single ______

Married ______

Divorced ______

Widow

Sex: Male ______ Female ______

Ethnic Origin:

White _______

______

Black _______

Hispanic _______

Other _______________

American Indian/Alaska Native _______

Asian/Pacific Islander ________

Email Address

Mailing Address for Paychecks (if no direct deposit)

Date of Birth

Phone Number

_________ I am not related to any current SUU staff or faculty employee(s).

If you are currently enrolled for 6 credit hours

_________ I am related to the following current SUU staff or faculty employee(s).

or more, please mark here [ ]

Name

Department

Relationship

I acknowledge that I have received information on SUU's drug-free workplace and sexual harassment policy websites. I certify that I will provide the proper tax forms to

Human Resources and transcripts/resume to the Provost Office. I recognize that if I am enrolled for 6 or more credit hours per semester during my employment that

these wages will be exempt from unemployment benefits. I acknowledge that any future contracts will be submitted electronically and copies can be obtained from the

department. I state that the above information is complete and accurate and I accept this appointment under the terms and conditions specified.

Employee Signature

Date

EMPLOYER SECTION - Please Print:

Start Date of the Semester

__________ /_________ /____________

(I-

9 documentation must be completed before or on start date*)

End Date of the Semester

__________ /_________ /____________

Class this Adjunct Faculty will teach (ENG 1010-01, etc)

Initiating Authority Signature (Admin Asst)**