REQUEST FOR PERCENT TIME CHANGE
(Classified Staff Only)
UW School of Medicine and Public Health – Human Resources
EMPLOYEE NAME: EMPLOYEE ID: POSN. ID:
TITLE: UNIT: UDDS:
A) Employee Requested Permanent Reduction in Percent Time
I request that the percent time of my appointment be reduced permanently from % to
% effective / / (date).*
Contact your department payroll staff for information on the effect of this reduction in percent
time on your benefits.
Date (Mo/Day/Yr) Employee Signature
B) Employer Requested Increase in Percent Time
We request that the percent time for this appointment be increased from % to
%. This is a permanent / temporary (check one) increase and will be effective
/ / (begin date) to / / (end date, if temporary change).
Employee agrees Yes No (check one)
If the employee does not want the additional hours, the employer must provide a reasonable
amount of notice prior to implementing the change. Review this situation with School of
Medicine and Public Health Human Resources to establish the appropriate timeframe for
C) Employer Requested Reduction in Percent Time
Reduction in percent time for a classified appointment is likely to constitute a layoff situation.
Contact School of Medicine and Public Health Human Resources for advice.
Date (Mo/Day/Yr) Supervisor Signature
Date (Mo/Day/Yr) Department Signature
Date (Mo/Day/Yr) School of Medicine and Public Health Human Resources Signature
Email completed form to: smph_hr - at - hslc.wisc.edu 6/13/2011