Please note that there are two types of employment that are documented on this form.
1. Student at Worcester State College (CCC05) this category is reserved for Worcester State College Students who are working for the college and being paid by institutional or college funds. Students in this category may work up to 15 hours per week during the school year and up to 30 hours per week when school is not in session. Students must fill out Section A of the form and must also complete an I-9 and W-4.
2. All Others: State Employees, (contributing to State Employee Retirement System), State Retirees and None of the Above (Regular 03). (CCC04)This category is reserved for all non-students, non-benefited employees, including students from other colleges. The maximum number of hours for people in this category is 18.5 hours per week during the school year. 03’s must fill out Section A of the form and also complete the following:
1. I-9 (Photocopies establishing Identity and Right to Work must be taken by a full-time WSC employee who must complete Section B and sign and date it.)
3. Application form
4. Declaration of Physical or Mental Handicap form
5. Equal Employment Opportunity form
6. Disabled Veteran and/or Vietnam Era Veteran form
7. Emergency Information Form
8. Medicare Tax Withholding Declaration Form
9. Health Insurance Information and Verification Form
Please keep all required supporting documents together with the Authorization for Temporary/Part Time Employment. If the above forms are already on file with HR, only the Authorization form needs to be filled out. All temporary/part-time employees who fall into the “none of the above” status on line 5, Section a. are required by Federal Law to enroll in the Alternate Retirement Plan (OBRA). OBRA enrollment forms will be sent by and should be returned to the Payroll Office.
Paychecks can be picked up at the Bursar’s Office according to the biweekly payroll schedule or mailed upon completion of a Paycheck Distribution Form (available in the Payroll Office).
Any exceptions to the above must be approved by the Director of Human Resources.
Ethnic Classification Codes: (Please note: # 5 of the Authorization Form must be filled out).
01 Native American 05 Cape Verdean
02 Asian/Pacific Islander 06 White, non-Hispanic
03 Black, non-Hispanic 07 Other/Unknown