Adjunct Pay Form
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1ADJUNCT PAY FORM
__________
SELECT TYPE:
TERM/ SEMESTER: _________________
EFFECTIVE DATE: ____________________
EXPIRATION DATE: _______________________
EMPLOYEE IS NEW EMPLOYEE?(
): ______
SELECT
LAST NAME: _____________________________________
FIRST NAME: ____________________________________
MIDDLE INITIAL: ____
ADDRESS: _______________________________________________ APT: __________ CITY: _________________________ STATE: _____ ZIP: ___________
DAY PHONE: _______________________
MOBILE PHONE: _____________________________
EMP ID: _______________________
EMPLOYEE ESSEX EMAIL ADDRESS: _________________________________________
NON-CREDIT COURSE INFORMATION
# OF
REGISTRATION
ROOM
COURSE MEETS
COURSE START
COURSE END
INSTRUCTIONAL
PAYMENT
COURSE NAME
INSTRUCTIONAL
CODE
NUMBER
(DAYS)
TIME
TIME
RATE ($)
AMOUNT ($)
HOURS
TOTAL
BUDGET ACCOUNT NUMBER: _________________________
FUNDS REQUIRED FOR ASSIGNMENT: $ _______________
WRITE YES OR NO
: IS THE ASSIGNMENT GRANT FUNDED?: __________
IF YES, DATE GRANT EXPIRES: _______________________
DEPARTMENT/ DIVISION: _____________________________________
AREA: _______________________________________________
EMPLOYEE CURRENTLY EMPLOYED AT ECC? (
): ___________________________________________
State yes or no; if yes state where and nature of employment
COMMENTS:
4. APPROVALS
1.AREA HEAD
SIGNATURE
DATE
2.DIRECTOR – FISCAL OPERATIONS
SIGNATURE
DATE
ADRIENNE THOMAS
3. HUMAN RESOURCES
SIGNATURE
DATE
RASHIDAH HASAN
(
)
Form Revised 01/2014
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Parent category: Legal