College-Owned Communications Device OR Reimbursement for Employee-Owned Device
Employee / Supervisor Information
Employee Name / Click here to enter text.
Division/Department / Click here to enter text.
Office Location / Click here to enter text.
Employee Mobile Device Phone Number / Click here to enter text.
Supervisor Name / Click here to enter text.
Valid Business Need (check all that apply)
☐ Need to be readily accessible
☐ Required to spend a considerable amount of time outside his/her assigned office/work area during normal working hours
☐ Required to be accessible outside of normal working hours
☐ Receive or initiate communication in emergency or time sensitive situations
☐ Access to electronic and telecommunications devices is not readily available
Action
☐ Issue a college-owned mobile communications device to an employee
☐ Initiate a reimbursement for an employee-owned mobile communications device
☐ Change in college-owned device plan
☐ Change from a college-owned device to a reimbursement for an employee-owned device
☐ Terminate use and return a college-owned mobile communications device
☐ Change amount of an allowance for an employee-owned mobile communications device
☐ Change from a reimbursement for an employee-owned device to a college-owned device
☐ Terminate a reimbursement for an employee-owned mobile communications device
Reimbursement Information
Service Provider Name / Click here to enter text.
☐ Individual Plan PLEASE ATTACH
☐ Family Plan CURRENT BILL / Base Plan Minutes Per Month
Click here to enter text.
☐ Data
☐ Text / Base Plan Cost Per Month
Click here to enter text.
Estimated Business Percentage (per table below) / Click here to enter text.
Monthly Reimbursement (per table below) / Click here to enter text.
Type of Service / Partial Business Usage (less than 50%) / Full Business Usage (over 80%)
Basic Plan / $20 per month / $40 per month
Basic Plan with Data / $30 per month / $60 per month
Select Plan / $80 per month / $80 per month
Authorization: Supervisor AND Division/Department Head
I certify that the employee has a valid business need and is eligible for a college-owned mobile communications device or reimbursement for an employee-owned mobile communications device. If the employee no longer has a valid business need for a mobile communications device, transfers to another division/department, or terminates from the college, the employee will return the mobile communications device or the reimbursement will end.
I will review the employee's need annually, at a minimum.
I have read the college’s Mobile Telecommunications Device Guidelines.
Supervisor Signature: Date:
Division/Department Head Signature: Date:
☐ College-Owned Mobile Communications Device Employee Agreement
I understand that I will use the college-owned mobile communications device in the performance of my job responsibilities. Minimal personal use is allowed. I am responsible for charges in excess of the college’s plan resulting from personal use.
Damage or loss of the device must be reported to my supervisor immediately.
I understand that all records on a college-owned mobile communications device may be subject to Freedom of Information Law (FOIL), subpoena and any other laws or regulations for which the college is subject.
If my division/department determines I no longer have a valid business need for a mobile communications device, or if I transfer to another division/department, or if I terminate employment from the college, I understand I must return the device and this agreement will end.
I understand that this agreement will be reviewed annually and could be terminated or adjusted at that review.
I understand this reimbursement can be terminated or adjusted at any time.
I have read the college’s Mobile Telecommunications Device Guidelines.
Employee Signature: Date:
☐ Employee-Owned Mobile Communications Device Employee Agreement
I understand that I will use my employee-owned mobile communications device in the performance of my job responsibilities and will receive a reimbursement toward a portion of the business use of the device.
The service contract purchased is my personal responsibility and must be adequate to perform my job responsibilities and the service must remain active for the life of the allowance. Any maintenance and repair costs, escalatory cost increases, and/or costs associated with my initiation of a plan change or termination prior to the end of my service contract are solely my responsibility.
I understand that college compensation for the purchase of a mobile communications device, mobile communications service activation fees (if applicable) and mobile communications service plan is taxable income and is NOT part of my base salary.
I understand that any business-related records on plans subsidized by Empire State College may be subject to Freedom of Information Law (FOIL), subpoena and any other laws or regulations for which the college is subject.
If my division/department determines I no longer have a valid business need for a mobile communications device, or if I transfer to another division/department, or if I terminate employment from the college, I understand the allowance will end.
I understand that this agreement will be reviewed annually and could be terminated or adjusted at that review.
I understand this reimbursement can be terminated or adjusted at any time.
I have read the college’s Mobile Telecommunications Device Guidelines.
Attach current bill.
Employee Signature: Date:
OFFICE OF ADMINISTRATION REVIEW/APPROVAL
Reviewed/Approved
Monthly Reimbursement Amount
Quarterly Reimbursement Amount
Effective Date
Submit to the Office of Administration after obtaining supervisor and Division/Department Head signature
July 26, 2017