1. Mobile Communications Agreement and Request Form
      1. Required for Employees Below the Dean or Assistant Vice Chancellor Level:
      2. 2.  Complete Questions A-D -
      3.      
      4.      
      5.      
      6. I certify that:




 Mobile Communications Agreement and Request Form

Name:           Job Title:              
Department:      
 
Mobile Device Provider      
& Full Account Number:         Mobile Phone # for Request :      
 

 
Reimbursement Start Date:      
Reimbursement End Date: June 30, 2022
(Up to one year from start date)

Justification:       
 
Check only one box next to the reimbursement service requested (level of reimbursement will be determined by supervisor based on job title/level/requirements):
 

 
    Level I - Vice Chancellors, Campus/Site Executive Deans, Exceptions approved by the Chancellor - Up to $100.00 per month 
    Level II - Assistant Vice Chancellors, Division Deans, employees designated as key personnel needed in the event of an emergency as deemed by the Vice Chancellor for Business and Administrative Affairs, and other employees required to be available 24/7 to perform critical, immediate responsibilities outside the normal business day that cannot wait to be performed until the next business day on a daily or near daily basis. Employees with such duties occasionally required are NOT eligible. - Up to $80.00 per month
    Level III -
Employees required to be available 24/7 to perform critical, immediate responsibilities outside the normal business day that cannot wait to be performed until the next business day on at least a weekly basis. Employees with such duties occasionally required are NOT eligible. - Up to $40.00 per month

 


Required for Employees Below the Dean or Assistant Vice Chancellor Level:
1. Attach Documentation to support the request, including job descriptions, and examples and frequency of regular duties.

 



2.   Complete Questions A-D -
 

A. Is the employee designated as key personnel needed in the event of an emergency? If yes, describe the specific duties and how frequently (daily, near daily, weekly, occasionally).


     

 
B. Do the daily or near daily duties of this position require employee to be frequently out of the office in remote locations and communication is essential to the business functions of the department? If yes, please provide examples of instances whe
re and when this occurs.


     

 
C. Does the job function require the employee to frequently work for a considerable time outside of normal working hours (i.e. evenings and weekends)? Is it important that the employee be accessible during those
times? If yes, describe the regular functions that fit the criteria, include specific examples of necessary work that occurs after hours, and describe how frequently (daily, near daily, weekly, occasionally).


     

 


 

D. Does the job function
of the employee require frequently providing critical information to management outside of working hours? Does the job function of the employee include receiving and returning critical calls outside of normal working hours (i.e. evenings and weekends)? If yes, provide specific examples and describe how frequently (daily, near daily, weekly, occasionally).
     




I certify that:

· I understand that to receive reimbursements, I am required to be reachable by means of mobile or electronic messaging device at all times when: 1) Delgado management needs to contact me at all times 24/7 or for emergencies, 2) Delg
ado management and college personnel need to reach me when away from the office during working hours and, 3) College or State personnel need to reach me outside of working hours.
· I have attached a copy of my personal mobile communications service plan for which I am requesting future reimbursement, and I certify that the mobile or electronic messaging device is in my name and I am solely responsible for complying with any contract entered into with the service provider including but not limited to the payment of all expenses incurred (long distance, roaming fees, taxes, penalties, etc.).
· I have read and agree to the College’s Mobile/Electronic Messaging Device policy ; I understand I must also adhere to the requirements of the College’s Information Technology Security policy while using the personal mobile or electronic messaging device when performing official
business;
· I understand that the above reimbursement will be used toward expenses I incur for mobile/electronic messaging device usage while conducting official business for the College;
· I understand that the monthly reimbursement must not exceed the expenses in maintaining the appropriate service plan;
· I know I am responsible for immediately notifying the Controller’s Office regarding any changes to my plan that would affect reimbursement, and if the service plan changes and the reimbursement amount exceeds the service plan, I must return the excess funds within 90 days; and
· I understand that access to the College’s electronic resources is a privilege and not a right; therefore, I further understand that the College has the right to require security products to be placed on my personal device in order to protect College assets.

 
 

_______________________________ __________  _____________________________ ____________
Employee's SignatureDateSupervisor’s Signature    Date

 

Approval:                                                                                 Approved Monthly Reimbursement (if applicable):

 __________________________________________________
Executive Director, Accounting Services/ Date
Associate Controller  

____________________________________________________________
Vice Chancellor for Business & Admin. Affairs or Chancellor Date
(Required for Employees Below the Dean or Assistant VC Level)


For Office Use:

Copies: Employee, Supervisor; Original: Controller’s Office

 

 
 
 
 
 
 
 
 

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Form BAA-E01/001 (6/21)


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