Fillable Mixed-Use Mobile Communications Allowance Agreement Form printable pdf download

(revised 11/10)

MIXED-USE MOBILE COMMUNICATIONS ALLOWANCE AGREEMENT

(Note: this agreement provides the minimum structure required. Units may create their own agreement provided these

minimum points are addressed).

Employee’s Name and Title (please print): ___________________________________________________________

In the course of carrying out job responsibilities, there is a regular need for business-related mobile communications

(including cell phones, smartphones, mobile email/web devices, and other wireless/handheld devices which require a

service contract for operation) on the employee’s device. Therefore, the employee is eligible for a mobile communications

allowance. At least one of the following criteria is met (CIRCLE ONE OR BOTH):

1) The job function of the employee (during the employee’s normal working hours) requires considerable time

outside of the assigned office or work area, and it is important to the University that the employee is

accessible during this time.

2) The job function of the employee requires them to be accessible outside of scheduled or normal working

hours (while at home, out of town, etc.).

Amount of recurring monthly, quarterly, or annual (circle one) service allowance: $ ________________

If applicable, amount of non-recurring equipment allowance and month/year paid: $ ____________ _____________

(attach copy of receipt supporting amount employee paid for equipment).

Mobile communications allowances are subject to all applicable taxes.

If the employee is terminated, resigns, transfers, or is no longer eligible for a mobile communications allowance, the

employee’s supervisor is responsible for notifying the appropriate unit administrator to discontinue processing future

allowances.

All service contracts are to be between the employee and the service provider. As such, if prior to the end of a service

contract, the employee for any reason needs to change or end the service contract, the employee will bear the cost of any

associated contract change or termination fees.

Employees receiving an allowance are required to maintain an active service contract for the life of the allowance.

The employee’s supervisor is responsible for an annual review of the business need for a mobile communications

allowance to determine if allowances should be changed or discontinued. The supervisor is to initial and date the bottom of

this form as evidence of each annual review.

A copy of this completed form must at all times be kept on file in the employee’s department.

The use of a cell phone can negatively impact the ability of a driver to safely operate a motor vehicle. Research studies

show it is a distraction and can impair the level of concentration needed to drive. For the safety of the driver, vehicle

occupants, pedestrians and other drivers, it is important that appropriate precautions be taken if a cell phone must be used

while driving.

I have read this Agreement and Manual of Business Procedures Section 79 and I understand that my mobile

communications allowance is taxable income, is not part of my base salary, and that any mobile communications

equipment and service contract purchased is my personal responsibility. I also understand that I am required to provide

my mobile phone number to my supervisor. I understand that the mobile communications will be used at least in-part in

the performance of my MSU job responsibilities as defined by my supervisor.

Employee Signature: ___________________________________________

Date: _______________________

Approved: Unit Administrator Signature: _________________________

Date: _______________________

Mixed-Use Mobile Communications Allowance Agreement Form