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May 1, 2006
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Name (Last, First, MI): |
Employee W#: |
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Department: |
Office Phone: |
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Work Address: |
eMail Address: |
The following one-time compensation for purchase of a communication device is approved:
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Dept. Mgr. Initials |
Approved One-time $ |
MOBILE COMMUNICATION DEVICE DESCRIPTION: (Make & model of cellular phone, BlackBerry, SIM Card, etc.) |
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SERVICE ACTIVATION FEES (if applicable) | ||
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TOTAL APPROVED ONE-TIME AMOUNT |
The following compensation for ongoing cost of a mobile communication plan is approved not to exceed
one year, beginning ________________________ and ending _____________________:
| Mobile Device (Cell) Number: (801) - | ||
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Dept. Mgr. Initials |
Approved Monthly $ |
MOBILE COMMUNICATION SERVICE PLAN: (Vendor name, base minutes, data plan, special features, etc.) |
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Employee Mobile Communication Services Agreement (Cont.)
Business justification and/or comment and explanation:
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I have read and understand the employee responsibilities detailed in the Employee Mobile
Communication Procedures, PPM 3-65. I understand that university compensation for the
purchase of a mobile communication device, mobile communication service activation fees
(if applicable) and mobile communication service plan is taxable income and is NOT part of
my base salary. I also understand that any device purchased is my personal responsibility.
I certify that the mobile communication device will be used for the performance of my Weber
State University job responsibilities as defined by my supervisor. I am responsible for the
payment of any costs that exceed the university compensation approved on this form.
I understand that I am not authorized to use a mobile communication device to conduct
Weber State University business while operating a motor vehicle.
This agreement supersedes previously executed agreements.
____________________________________________ ____________________
Employee Signature Date
APPROVED:
_____________________________________________ ____________________
Supervisor (required) Date
_____________________________________________ ____________________
Department Head Signature (required) Date
Weber State University Ogden, Utah 84408 |