NON-BENEFITED POSITIONS
NOTIFICATION AND AUTHORIZATION
TEMPORARY (AD) /STUDENT (AM) EMPLOYMENT
INSTRUCTIONS
- Section 1 to be completed by supervisor, including all necessary signatures.
- Obtain employee’s signature in Section 2; copies to be distributed with ENSRC to supervisor, employee, Payroll Office, and Campus Compliance Officer. South Campus Only: Forward completed ENSRCs and this form to the campus Compliance Officer (Program Services).
It is the supervisor’s responsibility to make sure the following documents are completed prior to the effective date of employment (a new AD/AM form is also required upon change of employment status, e.g. student to hourly worker): (1) Hourly (AD) / Student (AM) Employment Agreement and Authorization Form; (2) Employment Eligibility Verification (I-9) form.
SECTION I: APPOINTMENT INFORMATION
Employee’s Name: SS#:
Department: Rate of Pay: Hours/Week:
Name of college attending (SCCD students only & excludes work study):
STUDENT EMPLOYMENT: Work 516 hours or less in any six consecutive months, exclusive of hours worked in a temporary position (s) during the summer and other breaks in the academic year.
NON-STUDENT EMPLOYMENT: Performance of work which does not exceed 1,050 hours in any 12 consecutive month period from the original date of hire.
Effective Date of Hire: Termination Date (on or before):
Brief description of duties::
Supervisor’s SignatureDateCampus Compliance OfficerDate
SECTION II: EMPLOYEE VERIFICATION
Note: Per Washington State Federation of Employees (WFSE) Bargaining Agreement with the Seattle Community College District, this temporary appointment is exempt from the provisions of the Collective Bargaining Agreement unless hours worked exceed three hundred fifty (350) hours in any twelve (12) consecutive month period from original date of hire. Employment in this status does not establish eligibility for all fringe benefits. Per the WFSE Collective Bargaining Agreement individuals in temporary appointments who work between three hundred fifty (350) hours and one thousand fifty (1,050) hours in the twelve (12) consecutive month period defined above are governed by the specific terms of the Agreement. Remedial Action: If a represented individual has worked more than one thousand fifty (1,050) hours in the twelve (12) month period defined above, he or she may request remedial action from the Director of the Department of Personnel in accordance with WAC 357-49 and Article 4.6 of the WFSE Bargaining Agreement.
In the past twelve months, have you been or are you currently employed in any position in the Seattle Community College District? (This includes North Seattle, Seattle Central, South Seattle, Seattle Vocational Institute, and the Siegal Center.)
Yes No
If yes, state:
I understanding that this position is not benefit eligible position.I have read and received a copy of this document.
Employee’s SignatureDate
Rev. 3/2008