F3.2
CURRENT
DATE
PLEASE TYPE
PERSONNEL ACTION REQUEST
SECTION A
TYPE OF ACTION: *
(Explain in Comment section below & attach documentation. Requires President's Signature.)
NEW HIRE*
RE-CLASSIFICATION
* PROMOTION* TRANSFER IN ONE TIME PAY
RE-HIRE OVERLOAD DEMOTION* TRANSFER OUT LEAVE*
REAPPOINTMENT STIPEND OTHER SEPARATION LONGEVITY
DR. MISS
MR. MS
SECTION B
Employee ID #:
MRS. First Name Middle Name Last Name
EMPLOYING DEPT. NAME
FUNDING DISTRIBUTION OF POSITION
DEPT ORG CODE
ACCOUNT / INDEX
%
AMOUNT OF
POSITION
BEGIN DATE
OF POSITION
DIVISION #
BOX #
PHONE #
JOB TITLE
POSITION #
SECTION C ASSIGNMENT
START DATE
ASSIGNMENT
END DATE
PAY TYPE **MONTHLY RATE CONTACT
PERIOD
FTE
12 MONTHS
(Only for Faculty and Staff)
Total Contract
9 MONTHS
Hourly Rate
TOTAL CONTRACT
4 MONTHS
One Time Pay
.
2 MONTHS
%
Longevity
Contract Period MONTHS
SECTION D
LEAVE
LEAVE START DATE TYPE OF LEAVE CODE
RETURN FROM LEAVE
DATE RETURNED
BEGIN LEAVE with PAY
(See Instructions) (Attached Documentation)
FROM LEAVE
BEGIN LEAVE without PAY
SECTION E
SEPARATION
(F3.6 "Sick Leave & Vacation Report" & Resignation Letter must
LAST DAY WORKED REASON FOR SEPARATION
be attached
)
RESIGNATION (100
)
RETIREMENT (400)
INVOLUNTARY SEPARATION (200)
DEATH (500)
TEMPORARY ASSIGNMENT (300)
SECTION F
COMMENTS/NOTES/SPECIAL INSTRUCTIONS/WORK SCHEDULE
PAYROLL
FINANCIAL AID HUMAN RESOURCES
SECTION H
DEADLINES
:
STUDENT/HOURLY
20
th
FACULTY/STAFF
And ONE TIME PAY
15
th
ACCOUNT MANAGER
DATE
DEAN OR DIRECTOR
DATE
VICE PRESIDENT DATE
FINANCIAL AID (For Students Only) DATE
BUDGET
DATE
HUMAN RESOURCES
DATE
OFFICE OF THE PRESIDENT (New Hires and Changes Only)
DATE
PAYROLL
DATE
WHITE (original signatures)
-
Human Resources
YELLOW
-
Payroll Office PINK -
Department
FORM NO. 1511/REV 05-13
.
P
END DATE
SECTION G
FEDERAL STATE CAMPUS
NONE
HOURS ENROLLED
AMOUNT
TERM VAC HOURS
COMP TIME
EARNINGS CODE
Yes No
IPEDS
ASSIGNMENT#
DEFAULT HOURS
PAYROLL#
NoYes
ACCRUE HOURS
