Part-Time Agreement Returning Employee

Account No. NEW EMPLOYEE

(Credentials Attached)

PART-TIME AGREEMENT RETURNING EMPLOYEE

This form must be completed by the Dean of the division and approved by appropriate College officials before processing and/or payment.

Name:Social Security No.:

Address:

Street AddressCityStateZip Code

Phone (home):EEO Required Information:

(office):Sex: Race: Date of Birth:

*Retirement Information: Are you a member of one of the following retirement systems? YesNo

If yes, which one? TRSL (Teachers) VALIC AETNATIAA-CREF

Are you retired from a Louisiana retirement system? YesNo

*My signature at the bottom of this form acknowledges the following. As an active employee of Delgado Community College I agree to notify the Human Resources and Payroll Departments upon my date of retirement from any state retirement system. I am aware that

re-employment during the 12 months immediately following my retirement may result in a suspension of benefits.

AGREEMENT INFORMATION

Start:End:

Effective Dates: Semester/Session: Fall SpringSummer

Division: Contract Type: Teaching SupervisoryTutor

Campus:Time: Day Night

Course/Section / Title / Building/Room / Days/Time / Total Contract
Hours Per Course / Dollar Amount
Per Course
Title III Academic Objectives / Implement, review, and report results of Pilot Plan / $1,000.00

If agreement is for a tutor position, enter total hours worked per week: Hourly Rate:

It is understood that the amount paid per course includes all time and effort required in preparing instructional materials, providing instructional services, keeping and reporting student attendance and records, and submitting final grades. It is further understood that the Business Office will make payments according to the latest approved part-time contract pay schedule and that final payment will not be made until final grades and records and a completed End-of-Semester Checkout Form are submitted. I also understand that this agreement is null and void if the College cancels this course.

It is further understood that, in the event the faculty member must be absent from duty, he/she is responsible for arranging for a qualified substitute who is approved by the Dean of the division. If these arrangements are not made, a substitute will be selected by the College and paid at the usual hourly rate and that amount will be deducted from the contracted amount.

I understand that as a part-time faculty member I am required to be available on a regularly-scheduled basis for out-of-class conferences with students for a minimum of one-half hour per week per course. I further understand that conference periods must be scheduled at times that facilitate student access to instructors and must be approved by the Dean of the division.

*Faculty Member’s Signature: ______Date: ______

I CERTIFY THAT THE CLASS SCHEDULE, CONTRACT HOURS, AND AMOUNT PER COURSE ARE TRUE AND CORRECT:

______

Division DeanDate Campus ProvostDate

CREDENTIALS VERIFICATION (for new employees only):

______

Vice Chancellor for Learning & Student Development Date

Form 3242/002 (Rev. 3/05)