Student Employment Authorization Form
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1Student Employment Authorization Form
INSTRUCTIONS:
1. Student - complete the student section and forward it to the department supervisor.
Time Sheet Sent___
Hire Card Sent ___
2. Supervisor or Department Head - complete the supervisor section and return to the Office of
Human Resources, OC 212.
3. Employees new to Carroll also need to complete the W-4, I-9, Support Obligation Disclosure and
Statement of Confidentiality Forms.
STUDENT SECTION:
______________________________________________________________________________________
Last Name
First Name
M.I.
Carroll ID#
______________________________________________________________________________________
Local Address
______________________________________________________________________________________
Permanent Address
_________________________________
________________________________________
Local Phone #
Parent's Phone #
_________________________________
________________________________________
Cell Phone #
Preferred e-mail contact address
_________________________________
________________________________________
Social Security
Academic Standing (freshman, sophomore, junior, senior)
SUPERVISOR SECTION:
Pay Rate_________________________________
Date Employment Begins__________________ Position Title___________________________________
_____________________________________________________
_____________________________
Department Name
Department Code
Department Account #
I authorize this student to work in the department indicated above. I have verified that
_____work-study
______regular college funds are available for these wages.
__________________________ _____________________________________
_________________
Supervisor Signature
Print or Type Name
Date
Supervisor Carroll ID Number_________________________________
HUMAN RESOURCES SECTION:
_____________________Date Received
This student is _______work study eligible _________regular college
______ Time-sheet information input ______ Pre-employment paperwork completed
___________ Pay Rate
BUSINESS OFFICE SECTION:
_______ Position control input
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Parent category: Business