HUMAN RESOURCES ACTION FORM
1
HR Use Only
BCAT: _________________ Paygroup: ________ FICA Status ___________
DIST COPY: HR/PAYROLL/BUDGETS
Route to hrasu@asurams.edu
Please allow 7 10 business days for processing.
Effective Date
___/___/_____
Empl ID:
Empl Name:
Last First Middle
New Position, or
Individual Replacing
Last First Middle
REQUESTED
ACTION
Acct #
Change
Dept.
Transfer
Reports
To Update
Pay
Change
Title
Change
Separation
Last Day
Worked
___/___/____
Status
Change
Current Data
New Data
Account Number #1
Fund-Dept-Prgm-Class-Proj
Account Number #2
Fund-Dept-Prgm-Class-Proj
Salary
Position Title
Position Number
Department Name
Reports To (Supervisor)
Time Off Appr
EMPLOYMENT STATUS
Full-time Part-time
Full-time Part-time
Regular Temporary
Regular Temporary
Faculty
12 Mo Faculty 10 Mo Faculty PT Faculty
12 Mo Faculty 10 Mo Faculty PT Faculty
Staff
Monthly Bi-Weekly
Monthly Bi-Weekly
Student
Federal Work Study Grad Asst
Student Asst
Federal Work Study Grad Asst
Student Asst
Rehired Retirees
Yes No
Non-Paid Affiliate
Yes No
SIGNATURES
____________________________________________ _____________________________________________
Dept. Head/Dean Date Budgets Date
____________________________________________ _____________________________________________
Vice President/Provost Date Human Resources Date
____________________________________________
Signature Title III (If applicable) Date
2
Reports To and Time Off Approver for Multiple Employees
Last Name
First Name
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