Personnel Action Form



Personnel Action Form

Employee Name _____________________________ Date of Request _______________

Department _______________ Position _______________ Effective Date __________

Reason for Change:

|New Employee ( |Annual Review ( |Promotion ( |

|Dept./Job Transfer ( |Leave of Absence ( |Termination ( |

|Other ( (Please indicate reason: _________________________________________________ |

If Leave of Absence, please indicate reason:

|FMLA ( |Military ( |Jury Duty ( |

|Bereavement ( |Personal ( |Workers Compensation ( |

|Other ( (Please indicate reason: _________________________________________________ |

|Type of Change |From (Current Status) |To (Changed Status) |

|Salary | | |

|Bonus | | |

|Position | | |

|Department | | |

|Manager | | |

|Location | | |

|Full-time/Part-time | | |

|Classification | | |

|(Exempt vs. non-exempt) | | |

If New Employee, please complete the following:

Incentive plan Yes ( No ( If yes, please indicate terms: ____________________________

New Position ( Replacement ( If replacement, indicate preceding employee: ___________

Comments: ___________________________________________________________________

_____________________________________________________________________________

___________________________________ _______________________

Human Resources signature Date

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download