Fillable Summer Pay Request Form printable pdf download

Summer Pay Request Form

UID:

Last Name:

First Name:

TEACHING ASSIGNMENT: (

Teaching, please complete the course information below.)

Course #

Total

Credit Hours

Course Dates

N/A

Course Pay

Summer Pay Schedule

Job Code: 660000

Department:

Month

Summer Pay

Account #

Position #

Reports to Position #

May (5/16 to 5/31)

June (6/1 to 6/30)

July (7/1 to 7/31)

August (8/1 to 8/15)

NON-TEACHING ASSIGNMENT (

Non-Teaching, please select what type of activity; grant, URG, or Other (please specify if other)

☐ University Research Grant (URG)/Grant/Other

☐ Other, please specify:___________________________

Summer Pay Schedule

Job Code: 660001

Department:

Month

Summer Pay

Account #

Position #

Reports to Position #

May (5/16 to 5/31)

June (6/1 to 6/30)

July (7/1 to 7/31)

August (8/1 to 8/15)

This appointment is contingent upon (and can be revoked at any time during the appointment period based upon) University needs, including but not limited to: the best

interest of the University or department; the allocation of departmental funds, program and/or departmental needs; and student enrollment and/or sufficient class

enrollment. The monthly salary rate stated herein is subject to appropriation of funds annually by the General Assembly of the State of Illinois and the approval of the

Governor. You will receive further notice only in the event that a term or condition of your appointment changes.

Employee:_____________________________ Date:____________

Print Name:___________________

Supervisor:____________________________ Date:____________

Print Name:___________________

Dean/AVP/VP:_________________________ Date:____________

Print Name:___________________

HR USE ONLY

Request Type: (New/Update)

Hire/Non Ben Elg

Rehire/Non Ben Elig

Pay Rate Chg/Adj