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EMPLOYEE PERSONNEL CHANGE FORM GUIDELINES (FACULTY, ACADEMIC STAFF (University of Wisconsin - Parkside)

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Revised: December 11, 2019
EMPLOYEE PERSONNEL CHANGE FORM GUIDELINES (FACULTY, ACADEMIC STAFF AND UNIVERSITY STAFF)
The purpose of the Change Form is to document and identify changes to an existing employee’s appointment OR for Lump
sum payments to existing employees:
Additional duties (ex. Chair/Director appointments)
Appointment/Contract extension (ex. extensions of current appointments)
Appointment percent/FTE (ex. increase/decrease in working hours)
Compensation rate/amount (ex. changes in salary)
Title (ex. promotions, title reviews)
Organizational Department and/or Funding source
Associate Lecturer changes
Approver changes for leave or time
Note: The Change Form is NOT to be used for new hires or new appointments (ex. current employee hired into a
different position) or for changes to University Staff Temporary employees. Interim appointments need to be discussed
with the HR Office to determine the appropriate form. For terminations, please use the Departure Form.
Divisional support staff/designee will be responsible for reporting any changes to the employee’s appointment, funding, as
well as submitting the Change Form for review, approval and signatures of the appropriate parties (HR Office should not get
the Change form prior to all approvals).
Fully completed and approved Change Form will be forwarded to the HR Office for final processing.
Caution: Please contact the HR Office (x2204) if you have any questions about how to fill out the form. If the reported
information is incorrect/incomplete, or the appropriate offices did not sign off (ex. Budget Office), the form will be pushed
back to the department and payment to the employee for services rendered will likely be delayed for at least a payroll (see
Unclassified and/or University Staff Payroll Calendars for payroll deadlines).
This form has been modified to include additional information that will serve as a contracted agreement of changes and/
or additional payments to be made.
Thank you!
EMPLOYEE PERSONNEL CHANGE FORM
F
ACULTY, ACADEMIC AND UNIVERSITY STAFF
*SUBMITTED BY (REQUIRED):
APPOINTMENT TYPE:
If unable to use dropdown circle above Appointment Type
EMPLOYEE INFORMATION (EMPLOYING DEPARTMENT)
Position of Trust YES NO
/
EMPLOYEE ID #: Leave/Time Approver
LAST / FIRST (LEGAL NAME ONLY)
*CURRENT TITLE /TITLE CODE:
/
Leave/Time Back-up Approver
POSITION/APPOINTMENT CHANGE (EMPLOYING DEPARTMENT)
APPOINTMENT EXTENSION/RENEWAL LEAVE OF ABSENCE
*START DATE: *END DATE: Start DATE: END DATE: PAID LEAVE
UNPAID LEAVE
RATE CHANGE/MERIT PAY INCREASE
START DATE: END DATE (IF APPLICABLE): CURRENT RATE (FULL-TIME EQUIVALENT): NEW RATE (FULL-TIME EQUIVALENT):
REASON: CURRENT ACTUAL RATE: NEW ACTUAL RATE:
JOB PERCENTAGE/FTE CHANGE
START DATE: END DATE (IF APPLICABLE): REASON: CURRENT APPT %: NEW APPT %:
TITLE CHANGE/ RECLASSIFICATION
START DATE: END DATE (IF APPLICABLE): NEW TITLE AND OFFICIAL TITLE CODE
/
REASON: NEW WORKING TITLE:
OVERLOAD/LUMP SUM/ONE TIME ( LUMP SUM) MERIT INCREASE PAYMENT (EMPLOYING DEPARTMENT)
AMOUNT: FREQUENCY:
FUNDING (EMPLOYING DEPARTMENT) % UP TO 2 DECIMALS
START DATE END DATE DEPARTMENT FUND PROGRAM PROJECT/GRANT
% (MUST TOTAL
G
G
ADDITIONAL INFORMATION/NOTES (be specific; include rationale for payment amount, title of project, etc…) Also include WHY this work is needed
RATE OR TITLE CHANGE
APPT. EXTENSION/RENEWAL
APPT. PERCENT/FTE CHANGE
FUNDING CHANGE
LEAVE OF ABSENCE
MERIT INCREASE
OVERLOAD/ LUMP SUM/ADDL PAY
CANCEL (PREVIOUS SUBMIT)
LEAVE/TIME APPROVE CHANGE
Employee Agreement (applies only to faculty and staff with a current employment contract at UWP)
I have agreed to provide the services described above through a written or verbal agreement with my employer.
Date
Employee Signature
Home Department/Unit Agreement (Dean/Director must sign)
As the above employee’s supervisor/department chair, I understand the limitations of the overload policy and certify the duties described above are performed.
Dean/Director Signature
(Print name) Date
AGREEMENTS
Hiring Authority Signature
(Print name) Date
Budget Signature
(Print name) Date
Date Received Recorded (Initial/Date) Pay Dates
HR USE
Revised: December 11, 2019
Grant Approver Signature
(Print name)
Date
Please Select
Please select Pay Frequency:
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EMPLOYEE PERSONNEL CHANGE FORM GUIDELINES (FACULTY, ACADEMIC STAFF (University of Wisconsin - Parkside)

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Completed 31 August 2020

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