Employee Action Notice (EAN) Form Completion Instructions
Members of Management and Supervision requesting any of the following employee status changes or actions are required to
provide listed information to receive authorization: changes regarding additions to staff, replacement of employees,
promotions, transfers, wage / salary changes, terminations, leave of absences (LOA) and 2nd rates.
Line 1) Requesting management is required to indicate the employee action to be taken: addition to staff, replacement,
promotion, wage / salary change, termination, leave of absence, 2nd rate.
Line 2) Requesting management is required to indicate the proposed effective date that the change or action is to become
Line 3) Requesting management is required to provide Employee Name for all changes / actions, excluding addition to staff.
Line 5) Requesting management is required to provide Employee’s current title & grade, excluding addition to staff action.
Line 7) Requesting management is required to provide Employee’s department name & supervisor, excluding addition to staff
Line 9) Pay rate – Requesting management is required to provide if requesting a wage change or promotion excluding addition
Line 11) Requesting manager is required to provide pay type (hourly, salaried), employment type (FT, PT) and shift, excluding
addition to staff action.
Line 13) Management is required to provide name and pay grade of the employee who is being replaced.
The upper right column of this form is to be used for additions to staff, employee promotions and transfers:
Line 6) Proposed Title & Grade - is required by management when requesting addition to staff, an employee transfer or
promotion of an individual listed on line 3).
Line 8) Proposed Department / Supervisor - is required by management when requesting addition to staff, an employee
transfer or promotion of an individual listed on line 3).
Line 10) Proposed Pay Rate – indicated amount is determined using pay increase guidelines.
Line 12) Proposed Pay Type / Employment Type / Shift – Requesting management is required to indicate proposed pay type,
employment type and shift.
Line 14) Prior Pay Increase –Completed by HR
Justification – Is required for any employee changes. This section should be used to provide additional
instructions, justification or clarification regarding requested changes.
Terminations – Employees reason for separation should be circled.
Signatures – Requesting management must sign and obtain the signature and date of their appropriate AGM or
designated authorized signers. Completed and signed EAN forms should than be submitted to the
Human Resources department for signatures, processing and referral.
Type of Transaction
(Please complete listed lines for following employment transactions )
ADDITION TO STAFF: 1, 2, 4, 6, 8, 10, 12
REPLACEMENT OF EMPLOYEE: 1, 2, 4, 5, 7, 9, 11, 13
PROMOTION: 1 – 12, 14
TRANSFER: 1 – 12
WAGE / SALARY CHANGE: 1 – 5, 7, 9 – 12, 14
TERMINATION: 1 – 5, 7
LEAVE OF ABSENCE (Military, Jury Duty, Personal, Medical, Worker’s Comp): 1 – 5, 7
2nd RATE: 1 – 12
MAA / HR