Hampshire College Human Resources Change Form (Non-Faculty)
Please complete all data for changes in status of current employee and forward to the human resources office.
MISSING DATA WILL DELAY PROCESSING
Name: ___________________________________________________________________________________________
Last First Middle
Start Date or Effective Date (for changes) ____________ End Date (if other than regular status)___________________________
Position Title: ____________________________________________________________________________________________
Classification: Administrator - 61101 Staff - 61201 Intern - 61303 Casual – 61401
Appointment Reason: (please check all appropriate boxes)
Additional Appointment Demotion Split GL Position (requires a form for each position) *Promotion Re-Appointment
Change in Title Only Transfer *Change in Salary Change in General Ledger Number
Other/Comments __________________________________________________________________________________________ (please indicate reason for change)
*Please indicate employee’s current rate/salary – information required for promotions/adjustments/change in salary:
Hourly Rate: ___________ Annual Salary:______________
(bi-weekly employee) (monthly employee)
FTE/Pay Grade/Work Schedule Data
Regular FTE (for position):________ Regular Salary (PBDS) (for position):_______________
Current FTE (for person in position):________ Current Salary (PWAG) (for person in position):_______________
Budgeted FTE (FTE currently budgeted):________ Budgeted Salary (XPOS/PBDI)(amount currently budgeted):____________
FTE:
(Please check appropriate box if applicable. Should match current FTE) PERFORMANCE EVALUATION SUPERVISOR ______________________
1.0 - Full Time .50 - Half Time .88 Full Time/10.5 mos. .83 - Full Time/10 mos. .75 - Full Time/9 mos. .57 - 20 hrs./wk Other ________
Pay Grade: ______ Hourly Rate: ___________ Annual Salary:______________
(bi-weekly employee—rate x annual hours should match current salary) (monthly employee – should match current salary)
Position Type: (if applicable) 12 month 10.5 month 10 month 9.5 month 9 month Standard Dept. Work Week: 35 40
Employee’s Scheduled Hours: 35 40 Other _____ Employee’s Daily Scheduled Hours: _____ _____ _____ _____ _____ _____ _____
SUN MON TUES WED THUR FRI SAT
Employment Cycle: (if position type is less than 12 months, indicate employment period) __________________________ to __________________________
Funding Source: General Ledger Account Number: 80 90 0 _______ _______ _______ _______ _______
Department Fund Name or Grant Name and Department: _____________________________________________________________________
Office Information (OFFI)
Building: __________ Office :____________ Ext: ___________ Campus Mail Box: _____________
Time Card Authorization – (as designated by the Business Office)
Please print
______________________________________________________ __________________________________________________
Supervisor Alternate Supervisor
Authorization – REQUIRED SIGNATURES
Signatures and Dates required from:
_______________________________________ ________________________________________ _____________________________________
Budget Manager/Supervisor Date Division Head Date Dir. of Strategic Budgeting & Analysis Date
Human Resources Processing HR Recommendation: Pay Grade: Salary:
Position ID#___________________________________________________________ __________
EP
MP
Department Abbreviation Object Code(3 digit) Title Abbreviation Pay Class Pay Cycle
Close Vacated Position? YES
NO
LEVS: VAC__ PER__ SIC__ XHRS: Medical FTE_____ Benefit Start Date__________ HR PROCESS DATE/INITIAL: _________
This document is confidential and should be treated accordingly.
Payroll HR/Benefits HR/Personnel File Budget Mgr/Supervisor SOC ________________
Staff Change Form 8-2015
