SCPD Studio Operator Application

Name:

Email:

SUID:

SS#:

Home Address:

Visa expiration date if applicable:

Home Phone:

Stanford Address:

Cou ntry of Citizenship:

Stanford Phone:

Emergency Contact:

Name: Phone:

Phone:Name:

Year in School: (circle one) t 2 3 4 4+ Grad

In the grid below, shade in the cells where you are NOT available to work.

How many hours per week would you like to work? (circle one) 6 9 LZ 15

lf you are a returning operator, which classrooms have you worked in:

Gates (801, 803) Skilling {191, 193, Aud) Terman Aud Thornton 102

Monday Tuesday Wednesdav Thursdav Friday8:00am9:00am10:00aml-1:00am

NoonL:00pm

2:00pm

3:00pm4:00pm

5:00pm

6:00pm7:00pm +

School of EngineeringSTUDENT HOURLY HIRE (for enrolled Stanford students)

Department: MC: Department Code:

Effective Date Employee ID: EMAIL:

Name SSNLast

Home Address

First Middle

City State

Phone number

Zip

SUPERVISOR:OTHER UNIVERSITY IOBS: DEPARTMENf :

Remarks: (Undergrads - allowed max. L5 hrs per week. Grad Students - a student who has a50%assistantship or is on a full fellowship may not work more than 8 hrs per week. A student onF-l/J-lvisa can work a max of 20 hrs per week - including all assistantships and hourly iobs.

Start Date Stop Date Proiect Task Award % Dist Amount

Iob Information

Hire Date Action/Reason

Job Titlelob Code/lCC

Name (The hiring manager)Employee i.D. (The hiring manager)

Hours per week Hourly Salary:

Cost Allocation

Hiring Supervisor

Department Manager

Research Administration Approval

w

Authorized Signature / Date

Authorized Signature / Date

e/16/08

Authorized Signature / Date9/08

Personnel Information

lvlilitary Status DVeteran[1Vietnam Era Veteran(lf Known) I Disabled Veteran tr Disabled Vietnam Vet.

flActive Reservist ERetired

Citizenship tl United States EOther: Type of ImmigrantDPermanent Resicient Country of Citizenship

Visa Type

Visa Expiration Date

I-9'fype of employment eligibility proof[f Passport tr Other

Descrption

E Driver's License & social security tr Birth Certificate & Driver's LicenseCard

Brief Job

Time Bang_n_t_* *--,- rIII

IIII

.-l

.*****4tIIIII* -**{

Supp]-e$eqtel_-Qqe

For GRADUATE students accepting an

Assistantship at _ hours/week (average, during the 3-month quarter)Hourly job - maximum _ hours/week during the quarterHourly job - maximum

- hours/week during break (between exams and Reg. day)

Please circle yes/no for each question:

Why do we ask all these questions? The Graduate Student Handbook explains thecombination of federal and university rules governing how we can combine differenttypes of graduate student supporUpay. The highlights:

*A student on full fellowship can work a maximum of 8 hours/week in addition. (Yourfellowship source may have more restrictive rules - this is the Stanford max.)

*A student on F- l/J- I visa can work a maximum of 20 hoursiweek -including allassistantships and hourly jobs. (Fellowships do not count as work-for-pay). This means

a50Vo RA orTA who is here on an F-1/J-l visa CANNOT do additional work duringfall, winter, or spring. 2l hours in any one week is a violation of your visa status.

*A student who has a 50Vo (20 hour) assistantship - or a combination of assistantshipsthat totals to SOVo - cannot enroll in more than l0 units, and must not work more than 8hours/week in addition during fall/winter/spring

In addition to this job

Yes / No: I will be receiving fellowship support this quarterIf yes: from what departmenVoutside source:

Yes / No: I will be receiving an assistantship this quarterIf yes: what percent or hours (e.g,257o,10 hours)

DepartmenUfaculty:

Yes / No: I have another hourly job:If yes: how many hours /week maximum:

' Department:

Yes / No: I am in the US on a student visa (F or J)

I understand I n,''t \e enrolledfulltime (8 units or more) during the quarter; and I agreeto notify SCPD Admi,nif any of the information above changes during the time I ambeing paid oy the SCPD.

Signed:

Printed Name:

Departmcnt of Homeland SccurityL!.S. Citizenship irnd lmmigrrtion Services

OlvlB No, l6l 5-00.17; Expires 06/-10i08

Form I-9, EmploymentE li gibility Verificatio n

Please read instructions carefully before completing this form. The instructions must be available during completion of this form.

,\NTI-DlSCRlltlNATlON NOTICE: lt is illegal to discriminate against rvork eligible individuals. Employers CAIN-OTspecify thich document(s) they rvill accept frofr an employee. Theiefusal to hire an individual becausd the documents have afirturd erpiration date may also constitute illegal discrimination.

Section l. Emplovee lnformation and Verification. To be co and si ned bv em at the time

Itrrnt Nrttne: Litsl First lvliddle lnitial !hiden Name

\ddress /.S/rcc, .\unre intl .\rtnther) Apt. #

I am arvare that federal law provides forimprisonment and/or fines for false statements oruse of false documents in connection with the

completion of this form.

Date of Birth lnonth,dav,leur)

Zip Code Social Security *

I attest. under penalty ofperjury, that I am lcheck one ofthe tbllowing):

l-l A ririren or national of the United Srates

f] ,\ larvful permanent resident (A[en #).A,

| | An rlien authonzed to work until

(Alien 4 or Admission #)

Ernployee's Signature Dile ( mt tr th/tlat\'e ar )

Prepafef and/or Translator Certification, (To he tontplcted anJ .rigned il Setrion I is prepared h1 a person t;ther than rhe employee.) I attest. underptnuln ol perjur

Preparer's/Translator's S i gnature Print Name

Address lSlreel ,\ame nkl Numhar, Cih,, State, Zip Codel Dtte ( m o n t h icl av,'-v e a r )

Section 2. Employer Review and Verification. To be completed and signed by employer. Examine one document from List A ORexamine one document tiom List B and one from List C, as listed on the reverse of this form, and record the title, number andexpiration date, if any, of the document(s).

List A

Document title:

AND List C

lssurng authonty

f)ocument #:

Expiration Date Ii/ an.v1

Document #:

Expiration Date (il' ury)

CERTTFICATION - | attest, under penalty of perjury, that I have eramined the document(s) presented by the above-named employee, thatthe above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on(monthidav/vert,)-andthattothebe3tofmyknowledgetheemployeeise|igib|etoworkintheUnitedStates.(Stateemployment agencies may omit the date the employee began employment.)

S!gnllure of Employer or ,\uthorizcd R(presentatlve

nization \ame rnd .\drlress tStreet ,\ume and ,\umher, L itt '.l.tv/l edr)

\. \cw N:rme ttJ applituhlel B. f)rte of Rchrre Int)nIh,Ju.r'. teur) 1iJ upplituh|e1

Docunrent.fitle: [Joeument l: F.xpirrtr,rn Dite tlf cny):

| ?ttest, under penaltl of perjury, thet to the best of my knowledge. this cmplo].,ee is eligible to work in the L nited States, rnd if the €mployee pres€ntcddocument(s), the documenl(s) | hare eramined rppear to be grnuine xnd to rellte to the individual,

)Jle I tn('NlhiLl.rr/1 edr)

OR,t

i;

List B

ing and Reverification. To be completed and si

iriilJltrrc,lt I-ntplo;cr,'r.\'rlh,,fl/dd Rcprcsetttltrre

l'om I-9 tRi:v {)6 l)I i) I ) \

f_

EMPLOYEE'S TAX DATAShr:luld be conroleted annuallv

2007STANFORD UNIVERSITY

l. Use this tbrm to submit or change the number of your rvithholding allorvances or your marital status fbr Federal or California income tax rvithholding purposes or, ifyou are not a U.S. citizen, to submit or change information about 1,our noncitizen status.

2.Underthetirxlarvs.aSocialSecuritytrurtberisto Social Security tax or not. Ifyou do not have a number, you should apply forone at a Social SecurityAdministration olfice.

3. The attached pages contain instructions about completing the income tax wilhholding certitlcates on page 2. After completing this sheet, send it to the Payroll

Department, MC 6l12. Keep the rvorksheets for your records.

NAME (Last) (Middle initial) Stanford ID Number

U,S.Citizen

U.S. Perm. Res,(green card)

All othersMust complete belorv

List beginning & end dates of all

From

Cunently registeredS.U. studentgrad / undergrad

Country of residence

Entry date

stays in the U.S. during last 6 yrs. (& visa type)

To Visa type

RegisteredPost doc

Country of citizenship

Current visa type and #

Employee Signature Date

If claiming treaty exemption, you must complete Forrn 823-1 - Exemption fiom Withholding on Compcnsation atrd the approprinte

attachment, available from your department administrator, the Payroll Department or http://'co.stanford.edu/resources/tbrmsl8233.htmlYou ntust rejle Fornr 8233 for each calendar year in v'lticlt vot ute entitled trt ciain your tre(\' e.rentption.

If you are a nonresident alien, you are limited to one rvithholding allorvance (line 5, page 2),and single marital status on your W-4. Enter "Non-Resident Alien" on line 6 of the form.

(Unless you are lrom Canada, Mexico or Korea.)

gJ321tm7\947344 kge 1

r

Both Fecle.ral and Calfornia certif icates helow must be completed, even if vou are clcrirningthe same number rf withholding allowances on hoth.

I.f clttiming "exempt" )'ut ntttst submit a new foTm each calendar year to rnaintain statt'5.

To complete an online version of"this fonn, visith ttps : //axes s. s t anford. edu

Form W-4Department ot the TreasuryInternal Revenue Seruice

'l Type or print your first name and middle initial.

Home address (number and street or rural route)

City or town, state, and ZIP code

Employee's Withholding Allowance Certificate> Whether you are entiUed to claim a certain number of allowances or exemption from withholding issubiect to review by the lRS. Your employer may be required to send a copy of thls form to the lRS,

OMB No. 1545-0074

2 Your social security number

3 fl Singt" n tvtanieo D uanieo, but withhotd at higher Singte rateNole, lf manied, but legally separated, or spouse is a nonresident alien, check the'single' box

4 lf your last name differs from thai shown on your social security card,check here, You musl call FBAO-772;1213 for a replacement card. ) l-l

1O Employer identification number (ElN)

i

2@07

5

6

Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)

Additional amount, if any, you want withheld from each paycheck

I claim exemption from withholding for 2OO7, and I certify that I meet both of the following conditions for exemption.. Last year I had a right to a refund of all federal income tax withheld because I had no tax liability and. This vear I expect a refund of all federal income tax withheld because I expect to have no tax liabilitv.

lf vou meet both conditions, write "EUnder penalties of perjury, I declare thai I have examined this certificate and to the best ot my knowledge and belief, it is true, conect, and complete.Employee's signature(Form is not valid

it.) > Date >8 Employer's name and address (Employer: Complete lines 8 and 10 only if sending to the lRS.)

\F- Please read pages 5-7 before completing this certificate

EMPLOYEES WITHHOLDING ALLOWANCE CEBTIFICATE(This certificate is for Califomia perconal income tax withholdlng purposes only. tt you ctaimexemption from wlthholding, it will automatically expire on February l Sth of next year unlessyoufile a new Form DE-4 or W-4 with your employer on or before February 16th of next year)

Your Smial

Filing Sfatus Withholding AllowancesEl SINGLE or MAFFIED (with two or more incomes)

E MARFTED (one income)

E HEAD oF HousEHoLD

1. Number ot allowances for Regular Withholding Allowances, Worksheei A

Number of allowances from the Estimated Deductions, Worksheet BTotal Number ol Allowarces (A + B) when using the CaliforniaWilhholding Schedul6s for 2007

OR

2 Additional amounl ol stato income tax lo be withheld each pay perlod (il employer agrees), Worksheet C

Under the penalties of perjury I certity that the number of withholding allowances claimed on this certilicate does not exceed thenumber to which I am entitled or, if claiming exemption from withholding, that I am entitled to claim the exempt status.

Employer's NamB and Address California Employ€r Account Num ber

STATE OF CALIFORNIAEMPLOYI\,4ENT DEVELOPMENT

DEPARTI\,4ENT

;-- Please read pages 3 and 4 before completing this certilicate

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

EMPLOYEE'S WITHHOLDING ALLOWANCE CERTIFICATE

Employee: A{ter completing this form: Send white sheet to Payroll Department, MC 61 12. Keep pages 3 to 7 for your records.Page 2