Remote Access Allowance Request Form

auditormineMobile - Wireless

Nov 24, 2013 (3 years and 4 months ago)

64 views


For Processing Purposes


copy maintained in Controller’s Office


Human Resources

Controller’s Office


Job profile updated on file:


Reviewed by / date:

Index and amount::

Reviewed by

/ date
:



06/06/07

Remote Access
Allowance Request Form


Employee Name:

Banner ID:

Indicate
Monthly
Allowance Requesting



Cell Phone

Job Title:

Index to be charged:




Personal Digital Assistant (BlackBerry)

Department:
:

Cell phone number:




Home
I
nternet


Indic
ate Employee Eligibility:

(check one)

Please note: employee eligibility must be included in
job profile
.
Generally, e
mployees may
only qualify for one allowance.


Business Travel:

The need for constant

use of a
wireless communication device
for an emp
loyee who must
frequently

travel
off campus
to do business, but needs to remain in touch with others at the university.

Please describe the travel component and needs of your position:



□ up to 300

cell

bus
.

min
.

($
3
0
mo.
allow
.)

□ 300


1,000
cell
b
us. min.
($
50

mo.
allow
.
)


PDA Allowance

($
70

mo.
allow
.
)





Daily/After
-
Hours Communication:

The need for
constant

and immediate communications through the day
(if your
position requires you to be away from your desk frequently)
or after hour
s for an employee who supports or is otherwise
responsible for programs, services or systems.

Please
describe your need for immediate business communications via a
wireless communication device
:





home internet access

($
3
0
mo.
allow
.)

□ up to 300

cell

bus
.

min
.

($
3
0
mo.
allow
.)


□ 300


1,000
cell
bus. min. ($
50

mo.
allow
.
)



PDA Allowance

($
70

mo.
allow
.
)




Emergency Contact:

The
requirement

to be available
for emergency contact as an employee whose duties require them to
be
immediately

contacted, anywhere anytime.

Please describe your emergency contact role:



□ up to 300
cell
bus. min. ($
3
0
mo.
allow
.
)


Employee and
Manager/Supervisor
Certification a
nd Signature:

I certify that the requested allowance is
required in
this
job profile

to cover work
-
related expenditures due to
wireless
communication device

use as described above. I further certify that I have read, understand, and intend to comply with
the
University of St. Thomas
Allowance

Policy.


_______________________________
__________
___

____________
_____
___________________________


_____________

Employee: Print Name




Employee: Signature





Date


_______________________________
__________
___


__________
________________________
_____
_____


_____________

Manager/Supervisor:
Print Name



Manager/Supervisor:
Signature




Date


Academic & Administrative Leader
ship

Group Member
Certification and Signature:

I certify that the requested allowance

is needed for this
exempt
employee, to cover work
-
related expenditures due to
wireless
communication device

use as described above. I further certify that I have read, understand, and intend to comply with the
University of St. Thomas
Allowance

Policy.


_________________________________
__________
_

__________________________
_____
_____________


_____________

Print Name





Signature






Date


Executive Vice President
Approval:


____________________________
__________
______

_____________________________
__
_____
________


_____________

Print Name





Signature






Date



Send form to
Human

Resources at AQU21
7
.

A copy should be kept on file in the employee’s department.