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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