Special Consultant Agreement Form
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1Please retain a copy of this agreement for your records
before you forward original to Human Resources & Equal Opportunity
SPECIAL CONSULTANT AGREEMENT FORM
This form may be printed and filled in manually, or, open the form in MSWord and save it to your desktop. Use the TAB key to move
through the form and input information. Right-Click on check boxes. Save completed form. Print and send with signatures to HREO.
Name:
SSN:
-
-
Type or Print Name as it appears on the Social Security Card
Street
City
State
Zip Code
Home:
Phone:
Work:
Check All
Current CSU Employee (Campus)
Current CSUSM Employee
That Apply:
PERS/STRS Member
(Non CSUSM Employees MUST sign on the payroll at HREO)
COMPLETE FOR CURRENT CSU AND CSUSM EMPLOYEES ONLY:
Primary CSU/CSUSM Position:
Full Time
Half Time
Fraction
Hourly
Will this appointment result in more than 125% employment within the CSU system?
Yes
No
Is this appointment outside normal CSU work hours?
Yes
No
If “No” complete the following:
Appointee is taking vacation to complete this assignment (attach form 634)
Adjusted Work Schedule Attached
Academic Year Appointment
DESCRIPTION OF DUTIES (Be Specific)
Beginning Date:
Ending Date:
Daily Rate:
$
Total:
$
Estimated number of days authorized to work:
Pay from Position#
-
- 4660
-
Agy
Unit
Class
Serial
Dept/Division
Dept Contact:
Phone Number:
(
)
ACCOUNT NUMBER
FUNDING SOURCE
ACCT
FUND
DEPT
PROGRAM
CLASS
PROJECT
DAYS TO APPY
HR USE ONLY:
POSITION:
POOL ID:
RECORD:
I have reviewed the special consultant guidelines. This appointment will be consistent with the appropriate CSU guidelines
and collective bargaining agreement.
Dean/Dept Head:
Supervisor:
Vice President:
Signature
Signature
Signature
Date:
Date:
Date:
I have reviewed and agree to the conditions of this consulting appointment. In accordance with the Immigration Reform and Control Act of
1986, I understand I will be required to provide identity documents and complete a form I-9 to verify my right to work in the United States.
Consultant Signature
Date
HREO
Revised: 5/25/05
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