Human Resources Department
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Status Change Form

(Note: All fields are required before form can be submitted)

Employee Information

Form Completed by:


Employee Name:


Department:


Position Number:


Effective Date of Change:


Funding information/Speed type:


Status Change Explanation and Details

Please explain the action to take place. For example: “Employee position upgraded from Senior Administrative Assistant to Administrative Specialist effective date above; salary increase to $___/hour.” OR “Employee will be changing status from part-time .50 FTE to full-time 1.00 FTE due to increased work load. If the employee will be on a probationary status due to the position change, please state how long the probation period will be, e.g., 3 months; 6 months.


When sending this form, you are issuing an electronic signature that will hold you accountable as though it were a physical signature.

For questions call Human Resources ext. 3-2615.


 

Last Modified: May 5, 2008