Requester Information (supervisor or person filling out this form) Department * Requester * Requester's Telephone * Requester's Email * Employee Information First Name * Last Name * Nickname NetID * University ID * Employee Type * - Select -Full-time FacultyPart-time FacultyAdministratorStaffGAStudent Worker Employee Extension (if known) Employee Title * Employee Start Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20182019202020212022 For Student Workers Legal First and Last Name * Expected Job End Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201920202021202220232024 Nature of work to be done (to help best determine the job title) * Proposed hourly rate * Estimated number of hours per week * Proposed weekly work schedule Please specify if the student should be paid from a special budget? (i.e. a faculty member’s budget) Chartfield Will the student employee be doing any digital design work? * Please note: if yes, the student must complete digital design training Yes No Office, or Workstation Location Check if this office currently occupied Yes Functional Area (e.g., Faculty, Student Services) Business Cards - None -Do Not OrderOrder NowWait to Order Keys Keys Master (all doors) Semi-master (floor entrances) Specific room / floor keys (please specify) Other: Specified room / floor key Building Access Building Access Weekdays 8:00 a.m. to 9:00 p.m. 8th Floor File Room Weekends, After Hours, & Holidays (please specify reason) After Hours Access Telephone Extension Telephone Extension New extension needed Employee should use current extension Please place appearances of the following extensions on phone: Extension Appearance1 Extension Appearance2 Extension Appearance3 Create Gallatin Network Computer Account Yes No SIS/Albert Yes No Registrar Electronic Memo Yes No Student Records Reporting Dashboard Yes No Requires Access to Archived Student Files Yes No Requires Email Direct Submit/Approve Access Yes No CMS Access Yes No Access to Hermes Yes No Add to Email Aliases or Google Groups Shared Drive Access, G: Gallatin Yes No Shared Drive Access H: Yes No Shared Drive Access, Other Yes No Special Folders/Access Needed WebNow/ImageNow Student Records Access Yes No ImageNow Scanning Access for HR Yes No NYU Box Account? Yes No Add Email Address to Copier for Scanning? Yes No EMS Scheduler/Approver (Desktop Client) Yes No EMS Requester (Web Only) Yes No Submit For people in the EU, see information on your privacy rights under GDPR.