University of Washington | Human Resources

STUDENT EMPLOYEE EXCEPTION TO PAY AND CLASSIFICATION SCHEDULE

Reference: Executive Order #50 University Handbook, Vol. IV, 4041a, Section H.

For instructions on completing this form in MS Word see: http://www.washington.edu/admin/hr/forms/instructions.html

ROUTING INSTRUCTIONS: Department: Forward all copies of completed form to Campus HR Operations, Box 359532

SECTION I
Student Last Name: Department Name: Year (check one):

TO BE COMPLETED BY EMPLOYING DEPARTMENT

Middle: Box Number: Student ID Number:

First Name:

Freshman

Sophomore

Junior

Senior Yes

Graduate Student No

Master s

PhD

Major:

Work Study Position:

Registered for Number of Credits this Quarter:

JOB DUTIES TO INCLUDE (use additional pages if needed):

WORK EXPERIENCE (related to job duties):

Number of months student has been employed in this department: ADDITIONAL COMMENTS (if any):

Wage requested:

/hr.

Wage Effective Date:

mm/dd/yyyy

Administrator/Supervisor Signature: Name of Administrator or Supervisor:

Email: Phone:

____________________________
Budget Authority Signature: Name of Budget Authority:

Date:

mm/dd/yyyy

____________________________
SECTION II
Use of job title Student Assistant/Helper IV, class code 0872, approved at hourly rate of

TO BE COMPLETED BY CAMPUS HR OPERATIONS OFFICE

Salary exception not approved falls within guidelines of Student Assistant/Helper I-III. See Operations Manual D44.1. Salary exception not approved. See comment(s) below.

$__________
Comments (if any):

HR Operations Authorization Signature:

___________________________________________________

Date:

mm/dd/yyyy

Phone:

Distribution: Make one copy and send to requesting department.

University of Washington | Human Resources Revised: 05/10/11