Fillable Employee Request For Compensation For Activities Form printable pdf download

EMPLOYEE REQUEST FOR COMPENSATION FOR ACTIVITIES

#__________

(For current employees ONLY)

To be used for Western Connecticut State University employees only.

To expedite the processing of this form, please make sure that all questions are answered completely. Requests should be filed at least THREE

(3) WEEKS prior to the start of the engagement. If you have any questions, please contact the Human Resources office at ext. 78662.

UNDER NO CIRCUMSTANCES ARE ANY SERVICES TO BE PERFORMED UNLESS THE DEPARTMENT HAS RECEIVED APPROVAL.

Procedure:

Complete the form and obtain signature for PART A and forward to the Associate Vice President for Human Resources. If the payment

requested is above $500, PART B must be completed by the appropriate Vice President prior to forwarding to Human Resources.

After approval by the Associate Vice President for Human Resources, a copy will be sent to the Financial Manager who is responsible for the

Banner Org. Account and the Payroll office. This is the Financial Manager’s notice that the request has been approved.

After the engagement has been completed, in order to process the payment, the Financial Manager requesting the payment must complete

PART E and return the form to the Payroll office. If the payment is for the Financial Manager or the Financial Manager is unavailable, the

signature of the Dean/VP or President will be required*. The payment will be included with the employee’s regular payroll.

Department ____________________________________________________ Payment Requested By ____________________________________

Signature of Financial Manager _______________________________________________________ Date ________________________________

Banner Org. # ________________________________________ Financial Manager (print name)________________________________________

Payment To Be Made To _____________________________________________________________ Banner ID # __________________________

Complete Description of Services ___________________________________________________________________________________________

______________________________________________________________________________________________________________________

Date(s) of Engagement _______________________________________________ Amount Due Employee $______________________________

When Applicable: Cost of Fringe (Due University) $___________________

APPROVALS:

PART A

Signature of Dean/VP/President _______________________________________________________ Date _______________________________

PART B (required if request is over $500)

VP. of Appropriate Division/President ___________________________________________________ Date _______________________________

PART C

Associate VP, Human Resources _______________________________________________________ Date _______________________________

PART D

Fiscal Affairs Office ________________________________________________________________ Date _______________________________

PART E

Notice to Payroll Office: I verify that the service described above has been performed and approve payment for the same.

Signature of Financial Manager* _______________________________________________________ Date ______________________________

*Signature of Dean/VP/President _______________________________________________________ Date ______________________________

(

)

*Only required for payments on behalf of Financial Manager

Request for Employee Compensation – Rev. 12/12

Employee Request For Compensation For Activities Form