EMPLOYEE STAFFING FORM
Date of Request Date Position Available Location/Division
Heartland
Payment Systems
Job Title
Department Name/SBU
FLSA Classification
Grade
Salary Hiring Range
Approved Job Description on File Yes Hiring Manager’s Job Title
No
Reports To
(Please Print)
Hiring Manager’s Signature
Type of Vacancy:
Intern Temporary,
Length of time:
Vacancy Due To:
Addition to Staff Replacement of: Termination Transfer Promotion
Full-Time Regular Part-Time Regular
(Specify hours and days per week)
Due To:
EVP or SVP
Department Approvals Human Resources
Name (Print)
Name (Print)
Signature
Signature Corporate Approvals if Required EVP Human Resources
President
Name (Print)
Name (Print)
Signature
Signature FOR HUMAN RESOURCES USE ONLY External Placement:
Internal Placement:
Name
Name
Department (coming from)
Hire Date
Effective Date
Salary Source:
New Salary
Request #
Newspaper Agency Employee Referral Web-site Other:
Form #2
D:\Docstoc\Working\pdf\64c00be4-019a-41be-b4f0-e542151430fd.doc Revised: 3/10/00
D:\Docstoc\Working\pdf\64c00be4-019a-41be-b4f0-e542151430fd.doc Revised: 3/10/00
Form #2