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