Student Payroll Signature Authorization Form printable pdf download

Student Payroll Signature Authorization Form

For Timesheets & Work Assignment Forms

Department Name: __________________________________________________________

Please list and obtain the signature of the individuals in your Department who will have authorization to hire

a student and sign Student Work Assignment Forms and/or to approve hours recorded on a student’s

timesheet. Each person listed must read the Roles and Responsibilities below.

Roles & Responsibilities: By signing this form, I understand that: 1) In accordance to federal and NYS Department of

Labor laws a student may not begin working prior to the Payroll Department receiving and approving the

employment paperwork. 2) When the student has provided me, the supervisor, a copy of the approved Student Work

Assignment Form the student may begin working. 3) If, as a Student Employee Supervisor, I allow a student employee

to work prior to employment paperwork being completed I may be putting the College at risk and may forfeit the

opportunity for my department to employ student workers. 4) When I sign a student employee’s time sheet I am

certifying that I have reviewed the time sheet for accuracy and agree that all hours worked have been recorded. 5)

As a student employee supervisor, it is my responsibility to ensure that time sheets for each payroll are submitted by

the scheduled due date for that pay period.

1) Has authorization to sign:

_____Work Assignment Forms and/or ____ Time sheets

Name: ______________________________________________________________________

(Please Print)

Signature: ___________________________________________________________________

2) Has authorization to sign:

_____Work Assignment Forms and/or ____ Time sheets

Name: ______________________________________________________________________

(Please Print)

Signature: ___________________________________________________________________

3) Has authorization to sign:

_____Work Assignment Forms and/or ____ Time sheets

Name: ______________________________________________________________________

(Please Print)

Signature: ___________________________________________________________________

4) Has authorization to sign:

_____Work Assignment Forms and/or ____ Time sheets

Name: ______________________________________________________________________

(Please Print)

Signature: ___________________________________________________________________

Dean/Director/Department Head or Budget Authority Approval:

Name: _____________________________________________ Date: ____________________

(Please Print)

Signature: _____________________________________________________________________

Rev 08/2011

Student Payroll Signature Authorization Form