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Employee Status Change Request Form

This document is a request form to change an employee's personnel status. It collects information such as the requested effective date, employee name and ID, changes to funding source, FTE percentage, salary, title, grade, department, and reason for leave of absence or termination. The form requires authorization signatures from the department head, accounting office if position is funded by soft money, division head, and human resources by specified deadlines for the biweekly or monthly payroll processing.

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Rona Janoras Gonzales
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188 views1 page

Employee Status Change Request Form

This document is a request form to change an employee's personnel status. It collects information such as the requested effective date, employee name and ID, changes to funding source, FTE percentage, salary, title, grade, department, and reason for leave of absence or termination. The form requires authorization signatures from the department head, accounting office if position is funded by soft money, division head, and human resources by specified deadlines for the biweekly or monthly payroll processing.

Uploaded by

Rona Janoras Gonzales
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Change of Personnel Status

(To request a change in the current status of an employee)

Date Requested: Effective Date: Employee Class Code:


Name: ID Number:
Last First Middle
Change Funding Source Distribution From: Change FTE from _________% to _________%
FOAPAL Department / Grant Name Percent Position # Job Type
(P, S, O)

To:
FOAPAL Department / Grant Name Percent Position # Job Type
(P, S, O)

Change Salary: From: Annual: $ Monthly: $ Bi-Weekly: $ Hourly: $


To: Annual: $ Monthly: $ Bi-Weekly: $ Hourly: $
Change Title: From:
To:
Change Grade: From: To: Change End Date to:
Change Department: From: To:
Leave of Absence: Begin Date: End Date:
Reason (check one):
Disability – Faculty/Admin. (DA) Personal (PS)
Disability – Staff (DS) Unpaid Personal (PU)
Family Medical Leave Act (FL) Sabbatical – Full Year (SF)
Maternity – Faculty/Admin. (MA) Sabbatical – Half Year (SH)
Maternity – Staff (MS) Sabbatical – One Term (SO)
Military Leave (ML) Workers Compensation (SC)
Termination: Reason (check one):
Death (DE) Personal Reasons (PS) Worker's Compensation (WC)
Disability (DI) Retirement (RE) Other (please explain below)
Early Retirement (ER) Terminal Appointment (TE)
Gross Misconduct (GM) Involuntary (IN)
Relocation From Area (LA) Voluntary – Don’t Rehire (VN)
Accepted Other Employment (OE) Voluntary (VO)
Remarks:

Authorization Deadlines __________________________________________________________


(Completed and with ALL Signatures) Department Head/Principal Investigator Date
Biweekly: Thursday by 10 a.m. __________________________________________________________
Monthly: 18th by 10 a.m. Accounting Office (positions funded with Soft $) Date
__________________________________________________________
Copy to: ____Orig Dept ____Dept Division Head Date
____Acctg ____HR __________________________________________________________
2/00 ____ Assoc Prov Human Resources Date

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