MUST BE COMPLETED. (for Tempus Unlimited, Inc. payroll processing: Client is authorized # of hrs per weekhours per week)
MUST BE COMPLETED. 9. Enter the mailing address if it is different from the legal address in line 8.
MUST BE COMPLETED. (for Tempus Unlimited, Inc. payroll processing: Client is authorized hours per week)
MUST BE COMPLETED. I authorize NCUA to initiate electronic funds transfer payments to the credit union (and from the credit union if Xxx.Xxx option was elected). This authorization replaces all previous authorizations and remains in full force and effect unless NCUA receives a new authorization, 60 days prior to the next established payment date. NAME OF AUTHORIZED REPRESENTATIVE TITLE Please Print Please Print SIGNED DATE PLEASE KEEP A COPY FOR YOUR RECORDS. Please complete and return to: National Credit Union Administration By Fax to: OR By Mail to: 000-000-0000 National Credit Union Administration Office of the Chief Financial Officer 0000 Xxxx Xxxxxx Alexandria, VA 22314-3428 OMB No. 3133-0135 9/30/06
MUST BE COMPLETED. Please print NCUA CHARTER NUMBER (FCU) OR INSURANCE CERTIFICATE (FISCU) CREDIT UNION NAME ADDRESS CITY STATE ZIP EMPLOYER’S ID NO. [TAXPAYER ID NO]. CONTACT PERSON PHONE NO. EMAIL FINANCIAL INSTITUTION NAME 9-DIGIT ROUTING & TRANSIT NO. (RTN) ACCOUNT NO. (must be at least 4 digits, and only contain numbers, spaces, or dashes) If using a corporate credit union, please call your corporate to verify correct RTN and account info for ACH use.
MUST BE COMPLETED. BY THE OWNER OR OWNER’S AUTHORIZED AGENT (please print) SECCION 2: DEBE SER COMPLETADA POR EL DUENO O PROPIETARIO (favor de escribir en molde) Was unit built before 1978? □ Yes □ No Is this a HUD assisted unit: □ Yes □ No Name of Owner or Owner’s Authorized Agent: Nombre del Dueño o /Agente Autorizado: Name of Managing Company (if applicable): Nombre de la Compañía Encargada (si es aplicable): Mailing Address: Domicilio: Unit #: # de Unidad: City/Zip: Ciudad/Código Postal: Home Phone: Work or Daytime Phone: Teléfono: Número durante el día o del trabajo: Signature: Date: Firma: Fecha: By signing this form, the owner or owner’s agent and the tenant grant the contractor permission to enter the dwelling unit and to perform or install weatherization measures, minor home repair, and/or rehabilitation including but not limited to repair or replacement of doors and windows, caulking, door thresholds, water heater blankets and pipe wrap, insulation, setback thermostat, carbon monoxide detectors, mechanical ventilation, repair or replacement of inefficient or unsafe gas appliances (furnaces/stoves/water heaters), and additional measures to prevent the loss of heat and reduce the amount of energy consumption to the above-described unit, and agree to the following:
MUST BE COMPLETED. If my pet(s) identified on this record become ill, I request that the following veterinarian or veterinary practice, ! Countryside ! Other Clinic , provide all medical/surgical treatment it deems necessary, with fees not to exceed $ I acknowledge that in the event of my pet’s illness, the staff at the above named veterinary facility may not be able to contact me immediately. Nonetheless, they are authorized to initiate appropriate treatment until my agent or I can be reached. I agree to pay all related expenses associated with the treatment of my pet until I am available to discuss further care and related fees with the attending veterinarian.
MUST BE COMPLETED. (6) Enter name, telephone number and email of owner, partner or company employee who will be the contact person.
MUST BE COMPLETED. Joe's Mom Mother in Law 0000000 Emergency Contact Relationship Phone
MUST BE COMPLETED. Work assignments involve 20 hours per week (50 percent appointment) or 10 hours per week (25 percent appointment) as defined by immediate supervisor; or serving as the instructor of record for a maximum of two 3-hour courses. Additional work may be done by the student for his/her own research: COMPUTER SCIENCE & COMPUTER ENGINEERING (7) All graduate assistants must earn at least 3.25 grade point average on all courses taken for graduate credit each semester of appointment. ***NOTE*** IF A GRADUATE ASSISTANT IN ANY WAY BREAKS THIS CONTRACT BY WITHDRAWING FROM THE UNIVERSITY, DROPPING BELOW THE MINIMUM REQUIRED REGISTRATION CREDITS, OR IN ANY OTHER WAYS NOT SATISFACTORILY MEETING THE REQUIREMENTS OF THE APPOINTMENT, THAT PERSON WILL BE REQUIRED TO REIMBURSE THE UNIVERSITY ON A PRO RATA BASIS FOR ALL TUITION AND FEES PAID FOR HIM OR HER FOR THAT SEMESTER. FOR POLICIES RELEVANT TO GRADUATE ASSISTANTSHIPS, PLEASE SEE THE GRADUATE ASSISTANT GRIEVANCE POLICY, AS WELL AS RELATED POLICIES, ON THE GRADUATE SCHOOL WEB SITE (xxx.xxxx.xxx/xxxx) PLEASE NOTE THAT THE ACADEMIC RECORD OF STUDENTS HOLDING GRADUATE ASSISTANTSHIPS/FELLOWSHIPS MAY BE MADE AVAILABLE TO THE UNIVERSITY SPONSORS OF THOSE ASSISTANTSHIPS/FELLOWSHIPS. By my signature below, I verify that I have read this agreement, understand and accept the terms outlined within, and agree to abide by these policies. If circumstances change such that I am not able to fulfill the duties of my assignment, I agree to notify my immediate supervisor immediately. This agreement will be considered null and void if I am not fully accepted for Graduate Admission. Date Student Signature Date Supervisor Signature Date Department Head Signature Please leave phone number where you can be reached. *NOTE*: A phone number is required to create your Workday account. Cell: Work: Home: COMPUTER SCIENCE & COMPUTER ENGINEERING
