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Office of Human Resources
HRIS PAYROLL ADMINISTRATION
Phone:(818) 677-2101
Fax: 818) 677-5870
Mail Drop: 8229
Special Pay Authorization Form
Submitted by Pay Period / Session
(Print this form in landscape format)

I. TO BE COMPLETED BY ORIGINATING DEPARTMENT:  *REQUIRED
* CSUN ID: DEPT ID: DEPARTMENT NAME: INSTRUCTIONS
POSITION NUMBER: REPORTS TO:
LAST NAME: FIRST NAME: M.I.:  

II. EMPLOYEE TYPE:   (CHECK ONLY ONE BOX) CURRENTLY EMPLOYED AT CSUN AS:
STAFF FACULTY ONLY EMPLOYED IN JOB CODES 2322,2323,2356,2363, or 4660 NOT CURRENTLY EMPLOYED AT CSUN IN ANY CAPACITY
NOTE:Teaching Associates, Graduate Assistants, Student Assistants, and Work-Study Students may not be concurrently employed in any of these SPECIAL PAY JOB CODES.

III. JOB CODE:  (SELECT ONE ONLY)
   
# OF WHOLE DAYS:
HOURS:
TENTHS:
UNITS:
TENTHS:
SESSION/COURSE:
RATE:
SUBTOTAL:
2322 Instructional Faculty-Spec. Prog. (Credit)
(Pays by Units/Tenths of Units Only)
2323 Instructional Faculty-Extension (Credit)
(Pays by Units/Tenths of Units Only)
2356 Substitute Instructional Faculty-Extension
(Pays by Hours/Tenths of Hours Only)
2363 Instructional Faculty-Extension (Non-Credit)
(Pays by Hours/By Session/Course)
4660 Project Employee (aka Special Consultant)
(Pays by Daily Rate Only)

PLEASE CONFIRM TOTAL PRIOR TO PRINTING FORM TOTAL:
IV. FACULTY APPOINTMENT: (SELECT ONE ONLY)
LECT L / Assistant LECT A / Instructor LECT B / Asst Prof LECT C / Assoc Prof LECT D / Professor
V. DATE(S) WORKED IN PAY PERIOD / SESSION:
BEG DATE: END DATE: LIST EACH DAY WORKED:    

PROGRAM CODE: COURSE TITLE: TICKET #: ENROLLMENT #: PREPARED BY: EXT.

VI. PROJECT EMPLOYEE ONLY - DESCRIPTION OF WORK PERFORMED:
DISTRIBUTE CHECK TO: EXT:
   
 
Signatures certify that the work described has been completed and is in compliance with university policies.
EMPLOYEE SIGNATURE: DATE: EXT:

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DEAN/DIRECTOR OR DESIGNEE:

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FACULTY AFFAIRS APPROVAL FOR FACULTY:

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HR APPROVAL FOR STAFF:

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PAY CYCLE / PAYDAY: Payday for Special Pay is the same day each month as for Students and Hourly Intermittents, which is usually the 15th of the month. Please note the symbol l on the Payroll Calendar. Special pay documents received by HRIS/Payroll Administration by the second business day of the pay period (see symbol v on the Payroll Calendar) will be paid in that pay period. Special pay documents received by HRIS after the second business day of the pay period will be paid in the next pay period.

PA-120 (CSUN AUTOMATED) rev. 03/2005