Career Development Center

WORK AUTHORIZATION FORM

PLEASE NOTE: This form must be completed for students to be placed on the work-study payroll. Paychecks will not be processed until this form and all additional paperwork is complete.

Section A: (To be provided by Career Development)

Amount of work-study award: $

Category:

Rate per hour: $

Dates of Employment:

Section B: (To be completed for Student)

Student Name:

Phone/Campus Ext.:

Campus Box #:

E-Mail:

Salve ID Number:

Date of Birth:

Class Level: Freshman Sophomore Junior Senior Graduate

Year of Graduation:

Campus/Local Address:

RI Resident? Yes No

Home Address:

Home Phone:

Section C: (To be completed by Supervisor)

Agency Name :

Job Title:

Duties:

Supervisor Name:

Date:

Other Notes or Comments:

REMINDER!!

NO STUDENT WILL RECEIVE HIS/HER PAYCHECK UNTIL ALL PAPERWORK IS COMPLETE AND ON FILE IN THE CAREER DEVELOPMENT CENTER. Students will not be paid earnings that exceed the maximum amount above.