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Adjunct Instructor Employment Forms

Welcome to Dixie State University. The following documents are for those that are new to DSU, or if you are returning after a 12 month break.

Adjunct Checklist (pdf) Please use the Adjunct Checklist as a guide to ensure all employment forms are submitted to the Human Resources office. The department administrative assistant, or secretary may complete the form for adjunct member.

New Adjunct Responsibilities (7 Parts)

Online Application for New Adjunct All new adjunct employees are to complete the application, detailing general information.
Background Form (pdf) To be completed for all new and returning adjunct members.
Statement of Acknowledgement (pdf) For new employees who will be working with minors at Dixie State University.
W-4 Tax Withholding (pdf) W-4 form is used to set your tax marital status and allowances for federal withholding tax. Fill out numbers 1-7. Sign on the Employees signature line and date.

Adjunct instructors complete Section 1 of the I-9 form by clicking on one of the colleges, based on the hiring department.


College of the Arts

College of Business & Communication

College of Education

College of Health Sciences

College of Humanities & Social Sciences

College of Science & Technology


All other departments

New and returning adjunct members are to complete the online Employment Eligibility Verification (I-9) on or before your first day of employment. Once this is complete, employees take their forms of ID to the Human Resources office to complete Section 2. The I-9 form is used for verifying the identity and employment authorization of individuals hired for employment in the United States. BOTH employees and employers must complete the form.For details about accepted documents, see the U.S. Citizenship and Immigration Services, Accepted Documents.New employees must bring their original unexpired acceptable documents into the Human Resources office.  Any expired documents, copies, faxes, digital copies, or unacceptable documents cannot be accepted and will delay the process of payments.
Health Insurance (pdf) As part of the Affordable Care Act, employers are required to provide a notice of the availability of a Health Insurance Marketplace Coverage.
Direct Deposit (pdf) Use the DSU Direct Deposit Form to participate in the direct deposit program. Deposits may be made to any bank or credit union checking or savings account. See DSU Policy 342 for additional information.

  • Bring a void check, or a deposit authorization from the bank

Form used for Full Time Staff Member Request to Adjunct:

Overload Assignment Authorization This form is to be completed for full time exempt staff employees to request to teach part time.

Additional Resources