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					                                                                 PAYROLL ACTION FORM
                  USE FOR: New Hire | Rehire | Transfer | Reclass | Promotion | Demotion | Tops to Career | Equity | Stipend | Other Salary Actions

A. Employee/Department Information                                                                                 Dept Code:

      Name:                                                                                                       Employee ID:
      Department Name:                                                                            Employee Phone Number:
      Location Address:                                                                                                       Mail Code:

      Campus contact if intercampus transfer:                                                                            SELECT MAIL CODE

      From Campus or Dept:                                                                             Campus Contact Phone:

B. Current UCOP Appointment                 Use for: Transfer | Reclass | Promotion | Demotion | Tops to Career
      End date of current UCOP appointment:                                              Job Title:                                          Dept Code:


C. New Action         Use for: New Hire | Rehire | Transfer | Reclass | Promotion | Demotion | Renewal of Appointment | Tops to Career | Equity | Stipend

      Action:                    SELECT ACTION                                                           Appointment Type: SELECT APPOINTMENT TYPE

      Program:                   SELECT PROGRAM TYPE                                                  Effective Date/Hire Date:

      BELI Codes:                Select Beli Code                                    Appointment End Date (except career):

      Bargaining Unit:           SELECT BARGAIN UNIT                  Emp Relations Code:         SELECT EMPLOYEE RELATIONS CODE

      Job Code:                                                    Job Title:

      % FTE:                                                          Grade:                                             Step:
      Annual Amount                                         Monthly Amount                                    Hourly Bi-weekly
      (E xempt):                                                 (E xempt):          $0.00              (Non-exempt or TOPS):

      Account/Fund/Sub:                                                         Distribution %:

      Account/Fund/Sub:                                                         Distribution %:

      Account/Fund/Sub:                                                         Distribution %:
                                                                                                                                                 End Date
                    Pay Type:       Fixed                  Pay Schedule:          Monthly                       Pay Reporting:        Exception
                                    Variable                                      Bi-weekly                                           Positive
    Probationary End Date:                                                                               Vacation Leave Code:
     (Does not apply to MSP)                                                                          Next Salary Review Date:
           Job Requisition #:                                                                             Classification Log #:
      Timesheet Approver:                                                                      Timesheet Back-up Approver:

D. Other Compensation (i.e., moving, auto allowance, etc.) - Attach appropriate approvals
                    Reason:                            SELECT REASON

E. Background Screening Completion (Enter month/year completed)
      01   Previous Employer's Reference Check                                  05   Police Officer Background Check
      02   Criminal Convictions Record Check                                    06   Professional License/Cert Verification
      03   Financial Disclosure                                                 07   Educational Degree Check
      04   Security Clearance                                                   08   DMV Driving Record Check

F. COMMENTS




HR Contact                                                                      Phone                                              Date


Prepared by                                                                     Phone                                              Date
                                   OFFER LETTER MUST BE ATTACHED SUPPORTING DEPARTMENT APPROVAL FOR ACTION.
                                                                                                                                                      BRC-PAYROLL 2013b

				
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posted:4/26/2013
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