Ministry:
Effective Date
FT OTGH LCA
PERSONNEL ACTION
PT Employee
TRBC
LBN
TEMP LU MMLF
1. IDENTIFICATION (COMPLETE IN ALL SITUATIONS)
5. TRANSFER
Name: Last First MI From Dept. (Name & #) To Dept. (Name & #)
Address Prior Job Title New Job Title
Phone SSN Prior Pay Grade New Pay Grade
Dept. Name Dept. # Prior Salary New Salary Amt. Change
2. NEW HIRE
Work Week (Hrs.) Replacing (Employee)
FT PT Temp.
Job Title Pay Grade Shift:
1st 2nd 3rd Weekend
Salary Work Week (Hrs.)
6. NAME / ADDRESS CHANGE
Dept. Name Dept. #
Service Date Shift:
1st 2nd 3rd Weekend Change Name to: Last First MI
Replacing (Employee)
Change Address to:
3. LEAVE OF ABSENCE
Dept. Name Dept. # Change Phone # to:
Reason:
7. TERMINATION
Personal Maternity
Dept. Name Dept. #
Illness Military
Last Day Worked Return to Work Job Title Pay Grade
4. PROMOTION / ADJUSTMENT / MERIT
Shift:
Type of Change:
1st 2nd 3rd Weekend
Promotion Adjustment Merit Last Day Worked
Eligible for Rehire?
Job Title
Yes *No
*Attach Documentation
Prior Pay Grade New Pay Grade Reason:
Resignation Lack of Work
Prior Salary New Salary Amt. Change Two-week Notice Given:
Yes No
Work Week (Hrs.) Shift
8. DEPARTMENT APPROVAL
1st 2nd 3rd Weekend
Date Date
Replacing (Employee)
9. ADMINISTRATIVE / BUDGET APPROVAL
Date Date
REMARKS
10. IMMIGRATION CHECK
Date
APPROVED P-8
11. PERSONNEL APPROVAL
Date Date
SAVE A COPY AND FORWARD TO HUMAN RESOURCES
