PT Faculty - blue FT Faculty - Salmon |
CSU, SAN BERNARDINO
FACULTY CLEARANCE APPROVAL FOR RELEASE OF PAYCHECK
Office of Academic Personnel
Date: _________________________
Name: ________________________ Employee ID ________________________
Department/College: _____________________________________
Quarter: F W S Academic Year:
____________________________________________________________________________
_____Check here if faculty member will be returning next quarter.
(If so, no signatures are required.)
Clearance Received |
Outstanding Obligation Cleared (signature required) |
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Coyote One Card |
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Library |
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Media Services |
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Facilities Management |
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Parking Services |
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Travel Advances / Claims |
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Telecommunications |
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Payroll |
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Academic Department |
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[ ] In addition, the employee, if eligible, has received information on benefits continuation.
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I hereby certify that all equipment issued to the subject faculty member has been retrieved & the Property Management Office has been notified of such. In addition, I certify that the above clearances have been verified electronically, and that copies of the electronic clearances are on file in this department.
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Department Chair/ Department Secretary
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I certify that I have cleared all debts with the campus. If it is determined after my separation that I am liable for a debt, upon written notification I will repay the campus within thirty days.
REV2/07 rt |
Faculty Member
