CPC PAYROLL INFORMATION FORM FOR CAL POLY FOUNDATION FUNDS

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					                                                    CPC PAYROLL INFORMATION FORM FOR CAL POLY FOUNDATION FUNDS ONLY
                                                      (applies to employees working under Cal Poly Foundation accounts beginning with “9”)



 Legal Last Name:                                                         Legal First Name:                              M.I.:        SS #:
                                                                                                                                                                                 Sex:  Male  Female

 Address for W2:                                                                                                                                                                 Birth Date:

 City:                                                                         State:            Zip:                        Phone Number:                                       Local Phone Number:


 Are you currently working on campus?  Yes  No
 If so, where?  State  Cal Poly Corporation  ASI (Check all that apply)

 Action:                                                           Position Title:
                                                                                                                                         Complete the following if applicable
  New Hire ___/___/___                                            Student Assistant * (Cal Poly Students only)
  Termination                                                         Undergraduate (minimum 6 units)                                  CPSU Position                       FTE     Annual Rate $_________
 Last Day Worked: ___/___/___                                          Graduate (minimum 4 units)                                       AY____ CY_____ Other______________
  Reason:____________________                                       Intermittent **    (1000 hrs. fiscal yr. maximum)                  Must notify Cal Poly Corporation HR/SP if employee is in a CPSU
                                                                   Add Comp ***         (addt’l 25% time maximum)                        position or the FTE or rate changes for this position.
  Status Change
     (check all that apply)                                            CPSU Staff        Exempt  Non-exempt
           Primary Assignment                                         CPSU Faculty  Exempt  Non-exempt                                        FOR OFFICIAL USE ONLY (To calculate hourly rate)
           Add Org Key/Account(s)                                               (FERP Retirees ineligible for employment)               10 Month Employee: Annual Rate / 1360 hrs = $            / hr (A/Y)
           Rate (no retroactive changes allowed)                   Provisional                                                         12 Month Employee:   Annual Rate / 1720 hrs = $              / hr (C/Y)
           End Date                                                Temporary
           Other ______________
                                                                                                          Title
  Mail Check: ___________
                                                                    Regular                                                             Salary Grade:                                 Benefited Employees Only:
  (to above address only)
                                                                                                        Title                        (if applicable)                                Full Time
                                                                                                                                                                                        Part Time


 Comments:


 *                    Students cannot work more than 35 hours per week during any quarter in which they are enrolled. Pay rates must be hourly.
 **                   Intermittent employees may not work more than 1,000 hours during any fiscal year (7/1 – 6/ 30) and are hired on an “as needed” basis only. Pay rates must be hourly.
 *** Cal Poly full-time CSU employees are limited to 125% time. Faculty employees will not be paid beyond an average of 25% effort during an academic year, excluding quarter breaks. All part-
                       time CSU employees are limited to work up to 100% time. Full-time CSU staff employees can work up to 10 hours/week.


                                                                W/C Code        Effective        End Date            Pay Rate    Org Key                         W/C           Effective     End Date          Pay
                                                                                                                                               Account         Code                                          Rate
                                Org Key         Account                           Date           (if applicable)                                                                 Date        (if applicable)


  Primary                   9
                            9
     Other Accounts




                            9
                            9
                            9

           W/C Codes: Longshoreman = 0990 Agriculture = 0040 Newspaper Print = 4304 Newspaper Edit = 8807 Campus Dining = 9079
                                     Retail = 8008 Admin/Clerical = 8810 Other College/Univ = 9101 Lab = 4512 College/Univ Professors = 8868

PLEASE NOTE: All CPC employment and employment using Cal Poly Foundation funds is “at will”; either the employee or the Cal Poly Corporation can terminate
employment at any time with or without cause or notice. The Cal Poly Corporation retains the right to change conditions of employment, i.e. wages, hours, position, etc. at any
time at its sole discretion. CalPERS retirees are limited to 960 hours per fiscal year without retirement penalties. FERP retirees are ineligible for additional compensation.
Public Contract Code (PCC) prohibits CSU employees from being employed by the Cal Poly Corporation if the source of funds for the activity comes from CSU funds (CSU
employees with CSU teaching or research responsibilities are exempt). Violation of this code may result in criminal prosecution of the employee. By approving you are
confirming that there is no violation of the PCC.
STUDENTS ONLY: By signing below you certify that you are currently enrolled at Cal Poly for 6 or more units for undergraduate studies, 4 or more units for graduate studies.
If you drop below the required number of units during the quarter, you must notify your supervisor and Cal Poly Corporation Human Resources.

Employee:                                                                                                                                                                       Date:

Authorized By:                                                                                                                      Telephone #:                                Date:
                                          Dept. Head/Project Director/Supervisor Signature         PRINT NAME
Campus Programs/Other:                                                                                                                          Human Resources Director:

IMPORTANT!! Forms must be turned into the Cal Poly Corporation Human Resources Department prior to the effective date of the change or for new
employees within three days of hire.                                                                                Rev. 11/06