UConn Hartford Student Intent to Hire Request Student Intent to Hire Form This form is to be used by Supervisors that intend to hire Students for employment. Type of Transaction* New Hire Rehire Data Change ( i.e. end date, pay rate, title, supervisor) Seperation What is the reason for the Separation?* Student Employment worker no longer wants to work in department. Student Employment worker has moved onto another UConn campus. Student Employment worker has graduated from UConn Stamford. Type of Data Change* Extended End Date Raise Reclassification Supervisor Change Other ( describe in comments section on next page) Is this student currently employed on campus?* Yes No Is this student employment?* Student Labor Student Work Study Student Employee InformationStudent Employee Name* First Last Last Day of Employment MM slash DD slash YYYY Student Net ID*Student Email*Job Effective Date* MM slash DD slash YYYY Has this student worked for UConn in the past year? Yes No Unsure Is this student on a F1/J1 Visa?* yes No Supervisor InformationSupervisor Name* First Last Department*Current Supervisor Name* First Last New Supervisor Name* First Last Supervisor Email* Supervisor Phone Number*Backup Timecard Approver (optional) First Last Job InformationType of Employment* Student Labor Work Study Was this position posted on JobX?* Yes No JobX ID*Job Title*New Job Title*New 3-Digit Job CodeStart Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Hourly Pay Rate*Please enter a number from 10.1 to 28.8.New Hourly Pay Rate*Please enter a number from 10.1 to 28.8.Average Number of Hours Per Week*7 Digit KFS Account Number*Additional Notes/CommentsSupervisor Signature*By typing your full name, you acknowledge that information submitted is accurate and you agreeto adhere to the policies within this Student Employment Guide, the Universtiy Code Of Conduct, the State Code of Ethics, and other relevant policies.Date* MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.