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Certification of Service and Authorization for Uniform Allowance

Campus Security Assistant (04841) Campus Security Officer (04842) Campus Peace Officer (04844) Campus Public Safety Sergeant (04846) $324 per annum $540 per annum $540 per annum $540 per annum

This form is to be used for the authorization of the first three payments of the uniform allowance for newly appointed employees in the titles Campus Security Assistant (04841), Campus Security Officer (04842), Campus Peace Officer (04844) and Campus Public Safety Sergeant (04846). Please prepare this form at the appropriate time interval, and attach it to the paperwork sent to Payroll for processing. After the third payment has been made, the employee is then put on the regular June/ December allowance payment schedule and no further special authorization is required. Employee Name: Social Security Number: College: Appointment Date: Job Level: Amount of Payment: Leaves of Absences w/o Pay:

1st payment (2 months service completed) on the date of:

Signature & date: (College Personnel Director, or designee) 2nd payment (6 months service completed) on the date of:

Signature & date: (College Personnel Director, or designee) 3rd payment (in that June or December that first follows the 2nd payment by 6 months or more.) NOTE: to receive a June payment, the employee must have completed one full year of service by May 31; to receive a December payment, he or she must have completed one full year of service by November 30: June or December

Signature & date: (College Personnel Director, or designee) After the third payment has been made, the employee is then put on the regular June/December allowance payment schedule and no further special authorization is required.

cuny uniform allowance form 001 (rev. 1/01)

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Certification of Service

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