EMPLOYEE STATUS CHANGE NOTICE - Occidental College



Employee Action Request

|EMPLOYEE ID NUMBER |LAST NAME, FIRST NAME |CHANGE EFFECTIVE DATE |

| |MI | |

| | | |

|EMPLOYEE CLASSIFICATION: CURRENT PROPOSED |ECLS Code: (HR use only) |

| | |

|FACULTY CONTRACT COACH ADMINISTRATOR STAFF UNION STAFF |FR FC F1 FS FA |

| | |

| |AR AP AS AC EM |

| | |

| |SR SP SS SC BU |

|Employee Status: Current Proposed | |

| | |

|Regular Adjunct Supplemental Assignment Temporary/Casual Part-Time | |

|Action Requested: (Check all that apply) |

| |

|New Hire Rehire Reclassification/Promotion Salary Adjustment Labor Distribution Leave of Absence |

| |

|End of Assignment Resignation Probationary Release Retirement Termination of Employment Other (see Comments) |

Current Proposed

|Supervisor | | |

| | | |

|Department | | |

| | | |

|Job Title | | |

| | | | | |

|Position Information |Position |Grade |Position# | |

| | Fund-Orgn-Acct |Percent |Fund-Orgn-Acct |Percent |

| | | | | |

|Labor Distribution | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | |Semi-monthly | |Semi-monthly |

|Compensation |$ | |$ | |

| | |Per hour | |Per hour |

| |Annualized: $ |Annualized: |

| | | |

| |Full Time Part Time |Full Time Part Time |

| | | |

| |Hours/week: __________ |Hours/week: ____ |

|Terms | | |

| |Months per year: _____Pays per year______ |Months per year: ____ Pays per year____ |

| | | |

| |If applicable: |If applicable: |

| |Ending Date: _______________ |Ending Date: _______ |

|Comments: |

| |

| |

Signatures: Processing:

| | |

|Prepared by: ________________________________ Date: _______________ |Grants/Contracts:______________ Date: ________ |

| | |

|Dept/Division Approval: _______________________ Date: _______________ |HRIS: ______________________ Date: ________ |

| | |

|Human Resources Approval: ____________________ Date: _______________ |Budget Office: _______________ Date: ________ |

| | |

| |Payroll: ____________________ Date: ________ |

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