Fillable Fm 047 Emp Change Status

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Fm 047 Emp Change Status

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File type: PDF

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CURRENT
INFORMATION
DEPARTMENT/ORGANIZATION NAME
FT/REG PT/REG
NO. of FTE CO. NAME ORG NO.
SEASONAL/TASK
JOB TITLE PAY
GRADE
HOURLY
SALARIED
NON-
EXEMPT
EXEMPT
PAYROLL
CODE
BENEFIT DATE
CHANGE
RECLASSIFICATION
PROMOTION
DEMOTION
TRANSFER
EFFECTIVE DATE
DEPARTMENT/ORGANIZATION NAME
FT/REG PT/REG
NO. of FTE CO. NAME ORG NO.
SEASONAL/TASK
JOB TITLE PAY
GRADE
HOURLY
SALARIED
NON-
EXEMPT
EXEMPT
PAYROLL
CODE
BENEFIT DATE
SALARY CHANGE
RECLASSIFICATION
PROMOTION
DEMOTION
OTHER
RATE OF PAY DATE OF LAST
INCREASE
AMOUNT REASON FOR LAST INCREASE
RATE OF PAY PERCENT CHANGE EFFECTIVE DATE
SHIFT
INFORMATION
SHIFT DIFF. RATE SHIFT
o 1st o 2nd o 3rd o ROTATING o ECB
LUNCH PERIOD
o 1/2 HOUR o 1 HOUR o NO LUNCH
SHIFT DIFF. RATE SHIFT
o 1st o 2nd o 3rd o ROTATING o ECB
LUNCH PERIOD
o 1/2 HOUR o 1 HOUR o NO LUNCH
LEAVE OF
ABSENCE
PERSONAL
MEDICAL/NON-FMLA
WORKER’S COMP.
FMLA
MILITARY LEAVE
o BEGINNING
1ST DAY ABSENT ESTIMATED LENGTH OF LOA:
o RETURNING
1ST DAY BACK ACTUAL LENGTH OF LOA:
REMARKS:
C
U
R
R
E
N
T
C
U
R
R
E
N
T
N
E
W
N
E
W
SIGNATURES/APPROVALS:
(1) (5)
Supervisor Date Human Resources Date
(2) (6)
Department Manager/Chair Date Budget Date
(3) (7)
Dean/Director Date Chief Financial Officer Date
(4)
Vice Pres./Provost Date
CHANGE RECORDED BY PAYROLL
Name Date
FM047 REV. 12012014
EMPLOYEE CHANGE OF STATUS
EMPLOYEE NAME Z NUMBER
SUPERVISOR: Fill out all applicable sections completely.
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Fm 047 Emp Change Status

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Completed 27 February 2020

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