Adopted: January 2010
Revised: June 2013
Download 704.1P - Agreement for the Use of or Supplemental Compensation for a Cellular Device
If the responsibilities of your job as an employee of District 196 require you to have the use of a cellular device such as a cell phone, smartphone or pager, you must complete this form.
To insure district compliance with state and federal laws, choose one of the following options:
Option 1: Employee-owned Cellular Devices
If your supervisor has determined your job or program justifies the use of a cellular device for the fulfillment of your job responsibilities (refer to section 2.1 of Regulation 704.1AR, Cellular Devices), you will receive monthly supplemental compensation from the district. Depending upon the level of service deemed appropriate by your supervisor, supplemental compensation will be $45 per month for a cell phone or $90 per month for a smartphone and you will agree to waive any and all additional communications expense reimbursements.
This agreement must be resubmitted annually prior to June 30!
Option 2: District-owned Cellular Devices
If your supervisor has determined your job or program justifies the use of a district-owned cellular device for the fulfillment of your job responsibilities (refer to section 3.1 of Regulation 704.1AR, Cellular Devices), you must acknowledge that this cell phone, smartphone or pager will only be used for business purposes and never for personal use. The district is exempt from federal and state tax only when personal use of district-owned cellular devices is prohibited. All district-owned cellular devices are subject to periodic internal audits for compliance. Monthly statements will be reviewed by you and your supervisor.
I acknowledge that I have read and agree to the conditions in Administrative Regulation 704.1AR, Cellular Devices. Reasonable precautions must be taken to safeguard the privacy and security of student information or other private or confidential information stored or received on a cell phone or smartphone. Such devices must not be used to store or communicate private or confidential data unless security features, such as encryption or password protection, are utilized. All private or confidential information stored on a cell phone or smartphone must be removed upon separation of employment.
Employee name (print) Employee number
Employee signature Date
School/department Cellular phone number
Effective date: ___________
Check one: □ Option 1 If Option 1, indicate level of service: □ cell phone □ smartphone
□ Option 2 Provider
Rationale for decision Date
FUND org prg fin obj crs
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Principal/coordinator signature
Director’s signature Date
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Submit to Accounts Payable