REGULAR STUDENT EMPLOYMENT FORM

REGULAR STUDENT EMPLOYMENT FORM
Student’s Name: ___________________________________ ID: ________________________________
Student’s Permanent Mailing Address: _____________________________________________________
(Do not use local address)
_____________________________________________________
Home Department: _________________________ Dept. Box # _____________ Date: _______________
RSE Award Amount $______________ Rate of Pay ______________ Org Number:_________________
Grant: ______________ Fund: ___________ ORG: ___________ Acct: _________ Program: __________
Start Date: __________________________
Circle the semesters the student will work:
End Date: ____________________________________
Fall
Spring
Summer I
Summer II
Has student worked ANYWHERE on campus before? _______For What Dept._________ Year ______
The student will be expected to carry out the responsibilities of the department. Students must
complete a time sheet for hours worked. The expected workload is 10 or fewer hours per week. Any
student who works more than 27.50 hours per week will immediately become ineligible for regular
student employment and will be terminated. Student must turn in time sheets to their department
supervisor in a timely manner.
By signing this form, the student and supervisor are acknowledging they have read the above
statement.
______________________________________
____________________________________
Supervisor’s Signature
Student’s Signature
Position Number____________________
If the student is a new employee to Delta State University, please send student along with this form to
the office of Payroll located in Kent Wyatt Hall, 212.
________ E-VERIFIED
________ DATE
Mail this form to:
Samantha M. Phillips
Kent Wyatt Hall 212
Campus
REGULAR STUDENT EMPLOYMENT FORM
Termination and Evaluation
Complete this section and return to the office of Payroll at the time the student’s job assignment ends.
Keep a copy for your records. This form MUST be completed for each student employee. It is kept with
the student’s employment records and may be used in job reference.
Reason for Termination:
_____Unsatisfactory Work
_____Student Request
_____Lack of Work
_____Schedule Conflict
_____End of Assignment
_____Unsatisfactory Conflict
_____Graduation
_____Transferring to Another School
Other: ______________________________________________________________________________
Rate the Student’s Work Performance:
1-Excellent
2-Good
3-Average
4-Below Average
5-Poor
_____Appearance
______Attitude
_____Ability
_____Reliability
______Initiative
_____Cooperation
Would you rehire this student? _______
Is this student returning to Delta State? _______
Comments:____________________________________________________________________________
_____________________________________________________________________________________
Student Signature:
__________________________________________________________
Date Student Notified:
__________________________________________________________
Date of termination:
__________________________________________________________
(Date of termination should be the last day of the month in which the student worked.)
Signature of Supervisor: _____________________________________________________________
Mail this form to:
Samantha M. Phillips
Kent Wyatt Hall 212
Campus