Clear Form
Instructions
SALARY/JOB CHANGE FORM
This form is used to change the salary or job status of an employee. To reclassify an employee you must submit a Position Form.
Current Staff: HR/PPPL Monthly Staff HR/PPPL Biweekly Staff
Correction Explain: _______________________________
SECTION I. EMPLOYEE INFORMATION
Employee Name: _____________________________________________________________________________
Last Name First Name MI
Empl ID: ____________ Dept #: ______ Department: ______________________ Business Unit: (drop down) Select One
SECTION II. SALARY/JOB ACTION
Effective Date: _________________
MM/DD/YY
Type of Salary/Job Change: Select One (drop down)
CLICK here for Salary/Job Change Type Descriptions
To extend a term appointment: New estimated termination date: __________
MM/DD/YY
For Acting Appointments only: Position #___________ Est. Duration of Acting Appointment: ___________
SECTION III. SALARY INFORMATION
From: FTE Salary: ______________________ Actual Salary: ____________________ # Actual Pay Periods: ______________
(per year)
To:
FTE Salary: ___________________________ Actual Salary: _________________________ # Actual Pay Periods: ___________________
(per year)
Duty Time: ______________________
Duty Time: ___________________________
Comments: _________________________________________________________________________
_______________________________________
Authorized Department Signature Date ______________________________________________ Print Name
____________________________________
Authorized Human Resources Signature Date
Fax or mail to your Office of Human Resources: • Main Campus HR – 8-2420, 1 New South • Library HR – 8-0454, Firestone Library • PPPL Human Resources - 243-2050, MS33 C-Site
3/2008