Employee Action Personnel Form (EPAF)
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Employee Name: ___________________________________________________________________________________
ID Number: A_______________ Date of Birth (if no ID #): ________________ EPAF ACTION: __________________
Present Job Status (update to current employee only):
Job Title: ___________________________________________________________________________________
Effective Date: ________________ Position Number: _________________ Employee Type: ______________
Pay Period: ___________ Salary/Hour Rate: _______________________ Hours per Day: _________________
Fund/Org #s: __________________________________ Supervisor (time sheet approver): _________________
Proposed Job Status (New, Transfer, Promotion, Re-hire):
Separation
Reason for Separation: ________________
Last Day of Work: _____________________
Form Prepared By: _________________________________ Date: _______________ Extension: _________
Supervisor Signature: _________________________________________________ Date: ______________________
Depart. Chair Signature: ______________________________________________ Date: ______________________
President Stafford: ___________________________________________________ Date: ______________________
HR Signature: _________________________________________________ Date: ___________ EPAF#: __________
Job Title: ___________________________________________________________________________________
Beginning Date:___________________ End Date: __________________ Position Number: _______________
Employee Type: _________________ Pay Period: __________________ Salary/Hour Rate: _______________
Hours per Day: _______________ Fund/Org #'s: __________________________________________________
Supervisor (time sheet approver): _______________________________
