Name: ______________________

Dept.__________________________

Hrs/Wk________ Pay Rate________

Date Started____________________

______________________________
Supervisor’s Signature

OFFICE USE:

I understand that until this form is completed, I will not receive any wages.

I accept the terms of this assignment and acknowledge that the college

Is not obligated to meet, through campus work, all the financial

Assistance for which I am eligible if my work is unsatisfactory.

_________________________________
Student’s Signature