Business Services Data Information Form
Please fill out all applicable employee information
EMPLOYEE INFORMATION I am applying for: UCI Student ID# Last Name: Permanent Address: Local Address: Home Phone: Date of Birth: US Citizen? Yes No Local Phone: Social Security #: Visa Type: Driver’s License #: Passport #: Yes No If yes, which Department? Telephone #: No Name of relative: Contact Person: Phone: Phone #: First: City: City: Mobile: Sex: Exp. Exp. State: State: Middle: Zip: Zip: email: Quarter: Fall Winter Spring Summer Year:
Permanent Res. #:
Are you now, or have you ever worked at UCI (in a paid position?)
From: Mo ___ Yr ___
To: Mo___
Yr ___
Contact Person: Yes
Do you have any relatives employed at UCI (in a paid position)?
Department: Name of Previous Employer (not UCI): Address: Mark highest degree completed only:
No Acad. Cert. Bachelors High School or Equiv. Masters
From: Mo ___ Yr ___
To: Mo___
Yr ___
Trade School Professional
Associate of Arts Doctorate
Year Awarded: __________________
Do you want your HOME ADDRESS released to employee organizations?
Documents to bring with you to complete the hiring process are:
Yes
No
Social Security Card, Driver’s license or Passport and Permanent Resident Card (if applicable). For Direct Deposit purposes: Bank branch, address, and a voided copy of one of your checks.
UCI STUDENT STATUS INFORMATION Units taken this quarter: Major: Major GPA: Overall GPA: Yes No Do you have Federal Work Study? Yes
*Submit Financial Aid Award Letter
No Amount of Award*: Position(s) applying for: Notetaker Reader/E-text Editor Interpreter Student Assistant Other _____________________ Student Intern What Center?_______________ Position Title?_________________
Do you have any experience for the job(s) you are applying for? If yes, explain:
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Do you have any experience working with students with disabilities?
(For Disability Services Center student employees only)
Yes
No
If yes, please describe:
Academic Status:
Freshman
Sophomore
Junior
Senior
Graduate
Extension/Summer
Not Enrolled
EMPLOYER/SUPERVISOR
Department/Unit Name: Job Title: Start Date: End Date:
Department/Unit Name: Stipend Amount:
NOTE: A current job description must be attached! NOTE: Student employment may end on or before the end date. NOTE: Student Employee will not work over 49% time per week during the academic year. Important Notification: Copies of your hiring documents are retained in the DOS Business Services Office. You are encouraged to review the documents and to retain copies for your personal home file. Please schedule an appointment with the Business Services Office to review your file. Employee Signature: Supervisor Approval: Date: Date: NOTETAKER COURSES (For DSC Employees Only) UCI ID# ______________
Course Code Department Course Number Class Type (Lec, Dis, Lab)
This section to be completed by Business Service Staff
Processed by DOSBS: Title Code: % Time:
Date: Account Number:
DSC
Disability Services Center University of California, Irvine Volunteer Notetaker Program Options
Thank you for deciding to become a volunteer Notetaker for the Disability Services Center. Students with disabilities are grateful for the service you provide. As a volunteer Notetaker at DSC you have several options available to you. 1. Notetaking for Community service hours. At the end of each quarter you will receive a Certificate recognizing your volunteer service at UC Irvine. You may list these community service hours on your resume. The Director of DSC will, at your request, provide a letter of reference or recommendation for employment or for a graduate school application. You must attend a 30 minute Training Orientation within 2 weeks. 2. Notetaking for Elective credits. For each quarter that you provide 30 hours of volunteer note taking services you may receive 1.3 elective credits. This option requires you to register for elective credit and write a 3-5 page Reflection Paper on your experience as a note taker. The Reflection Paper is due on Friday of week 10. You must attend a 30 minute Training Orientation within 2 weeks. 3. Notetaking for a Quarterly Stipend of $25 per unit of credit. (4 unit class = $100) Once you have been selected to be a volunteer note taker, and within 2 weeks, you must attend a Notetaker Training & Hiring Orientation (approximately 1.5 hours in length). This Orientation is mandatory each academic year. You are required to bring your Drivers License and Social Security Card or Passport. Be prepared to fill out necessary Tax-Withholdings documents. You will receive a check at the conclusion of the quarter. 4. If appropriate: a. Review Non-immigration/alien procedures b. Obtain approval from graduate department I have selected the following option: Name____________________________ UCI ID#______________________________ Option 1: Community Services Hours_____ Option 2: Elective Credits_____ Option 3: Quarterly Stipend_____ Signature_________________________ Date__________________________________
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