Professional Services Contract NORTHWESTERN OKLAHOMA STATE UNIVERSITY ALVA - ENID – WOODWARD

CONTRACTOR: Name and Address / For School/Dept. Office Use Only
Prepared by: ; Phone:
Date: ; New Hire? No Yes
Date New Hire will complete payroll papers:
Newhire must bring driver’s license, Social Security card, and voided personal check for Direct Deposit of paycheck.
Daytime Ph. No./E-mail Address: / For Business Office Use Only
Soc. Sec. No. (last four digits only): XXX-XX- / Funding:
CONTRACTOR AFFIDAVIT: State of Oklahoma , County of Woods ,
of lawful age, being duly sworn, on oath says: 1. (S)he is the duly authorized agent of (e.g.: self, DOC, Dept of Transportation, etc.), the contractor under this contract, for the purpose of certifying the facts pertaining to the giving of things of value to government personnel in order to procure said contract; 2. (S)he is fully aware of the facts and circumstances surrounding the making of this contract and has been personally and directly involved in the proceedings leading to the procurement of said contract; and 3. Neither the contractor nor anyone subject to the contractor’s direction or control has paid, given or donated or agreed to pay, give or donate to any officer or employee of the State of Oklahoma any money or other thing of value, either directly or indirectly, in procuring this contract. / Are you currently employed by another State Agency of Oklahoma? No Yes
If yes, the payment will be made to that State Agency, unless hours are not contemporaneous, as verified in the attached Non-Contemporaneous Duty Waiver.
Are you currently contributing to Oklahoma Teachers' Retirement? No Yes
If yes, contributions will be withheld from your pay at NWOSU at the rate required by law.
Are you currently retired with Oklahoma Teachers' Retirement? No Yes
If yes, House Bill 2344 requires NWOSU to pay a fee to the System, not to the employee’s account.
Name, address, phone number of State Agency or School where regularly employed:
, ,
List other positions (full or part time) currently held at NWOSU:
CONTRACTOR SIGNATURE: DATE:
ARTICLE I: This Agreement is made and entered into this the day of , , by and between the State of Oklahoma acting by and through Northwestern Oklahoma State University and , herein termed the Contractor.
ARTICLE II: Contractor agrees to provide the following service (List Course Name, Number, Dates for Classes & Workshops):
NOTE: Instructional Contracted Salaries Contingent Upon Minimum Classroom Enrollment of 5 students.
Description & Date(s) of Service(s) / Location* / Type* / Cr Hrs / Rate / Pay
Duties:
Begin Date: End Date: /
/
/
/
/
* Legend Location: A=Alva, E=Enid, W=Woodward
Pay Type: AJ=Adjunct, OL=Overload, IT=ITV ( if broadcast to more than 4 sites, pay additional $100 per site ), TE=Telecourse
ARTICLE III: Northwestern Oklahoma State University agrees to pay the total sum of $ as Full and Final Compensation for said rendered service, to be made in equal payment(s). This Contract and all necessary payroll paperwork must be complete and on file in NWOSU Human Resources Office by the 8th of a given month before payment can be processed in that month.
Administrative Approval (Do not sign until notified by Human Resources that applicant passed any and all Background Screening(s) required by University policy.) / Date Approved
Dean/Supervisor: Cleared by HR for Background Screening
Executive Vice President:
Vice President for Administration:

(Rev. 08-08)