Personnel Action Form 2012

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Personnel Action Form 2012 Powered By Docstoc
					                                                 PERSONNEL ACTION FORM


Employee Name:________________________________                                       Date: _______________________________

         Please complete all relevant sections of this form. All requests must be approved by the Manager and Executive.

OFFER of EMPLOYMENT / Request to Generate OFFER LETTER (must attach candidate’s application & resume):

Candidate Name _________________________________________                       Position _________________________________________

Manager___________________________________________________                     Location _________________________________________

Compensation $___________________ per  Hour  Bi-Weekly                       Anticipated Start Date_______________________________

Classification:    Full Time OR      Part Time _______________ (approximate hours/week)                Exempt OR  Non-Exempt

                                      Temporary       Approximate End Date: _________________________________


CHANGES IN STATUS:              Compensation Adjustment              Job Change          Leave of Absence

COMPENSATION                    Current Compensation $ ______________________ per  Hour             Bi-Weekly     Annual
  ADJUSTMENT:
                                New Compensation       $ ______________________ per  Hour           Bi-Weekly     Annual

                                Effective Date    _______________________           Reason ____________________________________

                                Bonus Amount $ _______________________               Reason ____________________________________

JOB CHANGE:                     New Job Title ___________________________ New Manager__________________________________

                                New Location____________________________ Effective Date of Change_________________________

                                 Full Time        Part Time        Exempt       Non-Exempt       Temporary     Hours/week_______

LEAVE OF ABSENCE:          Type:    PDL           PDL / FMLA           FMLA / CFRA          CFRA             Workers’ Compensation

                          Comp:     Vacation: _______________hours               Sick: _______________hours         Unpaid

                                   Start Date:________________________ Anticipated End Date:_______________________________


SEPARATION:                    Voluntary         Involuntary         Layoff           End of temporary assignment

                                              Eligible for Rehire      Yes       No

                               Date of Separation _______________________ Date Paid Through___________________


Additional Comments:




Manager APPROVAL:                                                      Executive APPROVAL (if applicable):

Signature ______________________________________________                  Signature __________________________________________

Printed Name ___________________________________________                  Printed Name ______________________________________

Date ____________________________________________________                 Date______________________________________________



                    Logged by HR_____________ Copy to Payroll__________   Labor Notice __________         v.03.29.2012

				
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