 |
|
|
| Home Cellular Service Request Form |
March 6, 2006
|
Name (Last, First, MI): Doe, Jane, A. |
Employee W#: Wxxxxxxxx |
|
Department: Telecommunications |
Office Phone: 626-xxxx |
|
Work Address: 000 University Circle, Ogden, UT 84408 |
eMail Address: JaneDoe@weber.edu |
The following one-time compensation for purchase of a communication device is approved:
|
Dept. Mgr. Initials |
Approved One-time $ |
MOBILE COMMUNICATION DEVICE DESCRIPTION: (Make & model of cellular phone, BlackBerry, SIM Card, etc.) |
| J.S. | $349.00 | Blackberry 8700 |
| J.S. | $35.00 |
SERVICE ACTIVATION FEES (if applicable) |
| J.S. | $384.00 |
TOTAL APPROVED ONE-TIME AMOUNT |
The following compensation for ongoing cost of a mobile communication plan is approved not to exceed one year, beginning
05/01/2006 and ending 04/30/2007 :
| Mobile Device (Cell) Number: (801) 000 - 0000 | ||
|
Dept. Mgr. Initials |
Approved Monthly $ |
MOBILE COMMUNICATION SERVICE PLAN: (Vendor name, base minutes, data plan, special features, etc.) |
| J.S. | $39.99 + $20.00 tax = $60.00* |
Cingular plan with 450 anytime minutes, 5000 night and weekend minutes, free mobile-to-mobile. *Total rounded up to nearest increment of 10 to cover regulatory fees, surcharges, cell phone tax, and and tax on stipend. |
Business justification and/or comment and explanation:
|
I am on call 24 hours a day 7 days a week. I also attend conferences throughout the year and need to keep in contact with my office.
|
Employee Mobile Communication Services Agreement
(Cont.)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.
Jane Doe 04/18/2006
Employee Signature Date
APPROVED:
John Smith 04/18/2006
Supervisor (required) Date
Jenny Johnson 04/18/2006
Department Head Signature (required) Date
Weber State University,
Telecommunications Office
Ogden, Utah 84408-2302 (801) 626-6000, telecom@weber.edu |