Fillable Hr102-form HR102 Change To Employee Terms Form

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Hr102-form HR102 Change To Employee Terms Form

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Country of origin: IRELAND
File type: PDF

Ireland forms for Health Service Executive

BROWSE IRELAND - HEALTH SERVICE EXECUTIVE FORMS

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Change To Employee Terms and Conditions
HR 102
This Form is to be used when there is a change to employee’s contractual terms and conditions due to one of the reasons listed in
Section 2. This form should be completed by the line manager in conjunction with the employee, and must be approved by the
appropriate authorised/delegated officer and forwarded to Personnel Administration, Human Resources. Please complete form in
Block Capitals/Tick appropriate boxes.
HR 102 V8 Aug 2018 Page 1 Revised 27/08/2018
Section1. Employee Details
Surname
First Name
Grade
Personnel
Number
Location
PPS No
Section 2. Reason for Contract Change Place () in appropriate box
Promotion
Return from Internal Secondment
Internal Secondment
Renewal of Contract
Change of Contract Hours
NCHD Extension of Contract
Job Sharing
Job Sharing Renewal
Grade Change
Return from Job Sharing
Non officer to Officer
Return from Special Leave with
Nominal Pay
Return from Career Break
Reference Number:
Cessation of Temporary
Appointment
Temporary to Permanent Contract
Officer to Non Officer
Return from Flexible working
External Secondment
Transfer
Section 3: Effective Dates
Date Change Effective from
D
Section 4. Organisation Details
Cost Centre:
Care Group:
Personnel Area
Position Number to
be assigned
Position Name
Employee Group
Permanent
Temporary
Officer
Non Officer
If on a Temporary Contract please confirm contract expiry date
Employee Sub Group
Whole time
Part time
Casual
Fees/Sessions
Flexible Wking
Job Share
Contract type
Indefinite Duration
Indefinite Duration Std T&Cs
Fixed Term
Fixed Term Std T&Cs
Indefinite Duration Std
T&Cs 06/2014
Fixed Term Std T&Cs 06/2014
Specified Purpose
Std T&Cs 06/2014
If Faxing please ensure Employee’s Name and Personnel Number are included for each page of form
Employee Name ____________________________ Personnel Number
HR 102 V8 Aug 2018 Page 2 Revised 27/08/2018
Specified Purpose
Specified Purpose Std T&Cs
Expiry/review date
Replaced Employee
Personnel Number
Section 5. Working Week
Standard Full Time hours for this grade
Weekly Contracted hours (use decimals)
.
Work Schedule rule details (SAP Phase II Sites Only)
Working Week
Mon – Fri 5/5
Mon – Sun 5 / 7
Note if an employee works a Monday to Friday roster they are classed as 5/5. These employees will never be paid
Saturday allowance, Sunday premiums or Public Holiday premiums. Alternatively if an employee may work on a
Saturday or Sunday they are classed as 5/7, this will allow them to be paid the relevant allowances and premiums
Work Schedule Rule*
Start week of Rotational Roster
* (If employee is casual, enter HRPD)
Section 6. Pay Details
Work Location
Annual Salary
Level (point on Scale)
Pay Scale Type
Pay Scale Area
Grade Code
Next Increment due
D
D
M
M
Y
Y
Y
Y
Payroll Area / Group:
Pay slip distribution
Internal External
Payroll Frequency
Weekly
Fortnightly
4 weekly
Monthly
Section 7. Allowances
Complete this section if the contract change results in the payment / cessation of an allowance
Attach supporting documentation if appropriate
Allowance
Amount/Unit
Effective Date
Pay Allowance
Cease allowance
payment
Wage type/
Pay Code
Section 8. Employee Declaration
I declare that the above information is accurate and correct on the date indicated below.
Signature:
Date:
DDDDD
D
M
M
Y
Y
Y
Y
Name:
Grade:
Contact Phone Number:
Mobile Number:
Section 9. Line Managers Declaration
I declare that the above information is accurate and correct on the date indicated below.
Name:
Grade:
Signature:
Date:
D
D
M
M
Y
Y
Y
Y
Contact Phone Number:
Mobile Phone Number:
If Faxing please ensure Employee’s Name and Personnel Number are included for each page of form
Employee Name ____________________________ Personnel Number._______________________
HR 102 V8 Aug 2018 Page 3 Revised 27/08/2018
E-mail Address:
Section 10. Delegated Officer Approval – Regional HR
Name:
Signature:
Contact Phone Number:
Date:
D
D
M
M
Y
Y
Y
Y
Section 11. To be Completed by Human Resources Personnel Administration
System updated by:
Date:
D
D
M
M
Y
Y
Y
Y
Comments:
Section 12. Payroll Section
Location Code
Name:
Signature
Tel Number:
Date
D
D
M
M
Y
Y
Y
Y
Section 13. Payroll Interface (Phase 1)
Location
Wage Type
Payroll Area
Employment Signal
Payroll Area Change Details
Effective
Date
D
D
M
M
Y
Y
Y
Y
Updated by:
Date
D
D
M
M
Y
Y
Y
Y
Section 14: Area Employment Monitoring Group
Approval Number:
Date:
D
D
M
M
Y
Y
Y
Y
Section 15. Circulation List
1
2
3
4
5
6
7
8
HR 102 V8 Aug 2018 Page 4 Revised 27/08/2018
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Hr102-form HR102 Change To Employee Terms Form

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Completed 8 April 2020

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