Public Affiliate

Step 1 of 3

Today's Date(Required)

Unit/Department(Required)

Manager/Supervisor Name(Required)

Supervisory Org #

Responsibilities Requiring Affiliate Status(Required)

Security Roles Required(Required)

For additional role requests, please contact EBOT manager.

Procurement Card Data Entry Specialist

Financial Data View Only

Hours/Week (enter 1 to 39)(Required)

Appointment Start Date(Required)

Appointment End Date(Required)

(3-year max)

Title(Required)

Public Affiliate

Job Profile(Required)

7999-NN-Public Affiliate

Work Shift(Required)

Regular Shift

Time Type(Required)

Part Time

Personal Information

Legal First Name(Required)

Name as it appears on driver's license

Legal Last Name(Required)

Name as it appears on driver's license

Date of Birth(Required)

Gender(Required)

Female

Male

Other

Current/Former WSU employee?(Required)

An EBOT coordinator will reach out to the employee to get their SSN if they are not a current/former WSU employee.

Yes

WSU ID Number(Required)

Contact Information

Phone(Required)

Email(Required)

Mailing Address(Required)

Street Address City State

County Name(Required)

Extension Office Information

County Extension Location(Required)

Phone

Email Address(Required)

Office Address

Street Address City State

County Director Approval

Director Name(Required)

Date(Required)

Comments

Provide any instructions that EBOT may need to know.

Public Affiliate

Contingent Worker Request Form

Personal Information

Contact Information

Extension Office Information

County Director Approval

Comments

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