*This Form Must Be Completed and Signed by the Dean Prior to Start of Employment

*This form must be completed and signed by the Dean prior to start of employment.

Payroll Department - Notification of Employment Form (NOE HR/PR FORM - REV. (01/01/17)

Work Study, Discretionary Students, Eligible Senior Discretionary Workers, Special Needs and Grants

Fiscal Year: ______Employee/Rec#______(Payroll Use Only)

Name: ______SSN# (last 4 digits only) ______

Address: ______

Is theworker currently taking classes (credit or credit-free) at MCC? Yes_____ No _____

Department______

*Contract Start Date :______( must be the start date of a pay period)

*Employment Dates: start ______end ______Total Amt Allocated______

Hourly Pay Rate: $10.10_____$10.25_____$10.50_____ Other: $_____

Hours per week: ______(Hours may not exceed 15 per week when attending classes)

Semester: Summer ___Fall ___Spring ___ Winter___

A. Funding Account:Please enter the required funding acct. # and obtain your Dean’s approval:

Work Study - please check one (no acct # is needed): FWS____orMCCWS ____ (per work study approval)

Discretionary Funds acct #______

Grant/Other (enter grant name and acct #) ______

B. Mid-semester funding/orpay rate changes (per Dean Approval): Only complete option B when work study/other funds are exhausted or for pay rate increases affecting department budget. Dean’s approval to change funding/pay rate is required. Please enter in the new required funding account number or pay rate increase below and obtain your Dean’s approval:

Switch to Discretionary/Grant/OtherFunding acct# ______or Pay Rate Increase from$______to______

C. Termination Date: Please circle either next payroll processing date or specify the date when a student is no longer working. Next payroll processing or other date ______

D.Supervisor/Dean Signature: The Dean’s signature is required once per fiscal year within the same dept. / fund acct. However, the supervisor’s signature is still required for all semesters of the fiscal year.)

Supervisor’s Signature: ______Date:______

Dean’s Signature: ______Date:______

For Discretionary/Grant funded students please forward completed NOE to: The Payroll Department, MS #2. For Work Study Student’s return completed NOE, FA/Work Study Approval Form,and Job Description to the Financial Aid office. FYI - This information is required to be on file in the payroll office. *If you have any questions regarding the proper funding account number to use, please call the Business Office at 512-3640.

Payroll Use Only
PCN:______CE:______
Background Checks are completed by the HR office for students working in Admissions/Registrar/Financial Aid; Business Office, Continuing Education and Human Resources/Labor, but only apply to certainpositions that handle DCL3 confidential data; have a fiduciary/financial responsibility or are in safety/security position per the CSCU’sPre-employment Background Verification Policy (Revised 06/25/2015).