Fillable Hr-action-form Human Resources Action Form

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Hr-action-form Human Resources Action Form

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The Hr-action-form Human Resources Action Form form is 2 pages long and contains:

  • 6 signatures
  • 5 check-boxes
  • 38 other fields

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File type: PDF

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HUMAN RESOURCES ACTION FORM
Revised
9.30.17
INSTRUCTIONS: This form is to be completed to execute all human resources actions regarding employment changes. Supervisors are
responsible for obtaining and including all information on this form. Note that if a salary change other than an annual merit increase
is requested, a separate page must be attached that outlines the rationale and business justification for the requested change. If
justification is not provided, the form will be rejected and sent back to the requesting department head.
Date: Requesting Department/Division:
Employee’s Name:
Supervisor’s Name:
Effective Date of Change:
Check all that apply for proposed human resource action:
Pay Change Promotion
Data Affected
Transfer Title Change Other
☐ ☐ ☐ ☐ ☐
Current Data New Data
Department/Divis
ion and
Department #
Position #
Job Title
Salary
Funding Source
___________________
______________
Page 1
___________________________
Office Location
(Pay group or BCAT code)
Other __
Please attach wr
itten justification for all requested salary increases if other than an annual merit increase.
HR Use ONLY:
Entered by: Date:
Page 2
HUMAN RESOURCES ACTION FORM
Authorizations
Requesting departments are responsible for obtaining authorizers’ signatures prior to routing to Human Resources.
Incomplete forms will be returned.
Name (Print)
Signature
Date
Department Head
(Dean/ Director/ VP)
____________________________
___________________________________
__________
Unit VP/ Senior Leader
____________________________
___________________________________
__________
Budget Director
(State Grant or Title III)
____________________________
___________________________________
__________
SVP for Administration
____________________________
___________________________________
__________
Director of
Human Resources
____________________________
___________________________________
__________
Employee Acknowledgement
Your signature acknowledges that you have been made of aware of this action. It does not indicate agreement or disagreement.
____________________________
___________________________________
__________
Name (Print)
Signature
Date
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Hr-action-form Human Resources Action Form

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Completed 23 February 2020

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