HUMAN RESOURCES OFFICE
USE ONLY
Received: ____________________
HR Approval:_________________
Account Number to be charged:
________________ %
________________ %
Budget Authorization___________
(if required)
PAYROLL AUTHORIZATION
Employee Name:
ID#:
Address:
Regular
Temporary
CHANGE
FROM
TO
TITLE
GRADE
FTE
PAY
CLASSIFICATION
EFFECTIVE DATE
SUPERVISOR
ALTERNATE
SUPERVISOR
DIRECTORY INFORMATION
PHONE EXT.
BUILDING
REASON FOR CHANGE
HIRED
REHIRED
PROMOTION
TRANSFER
MERIT INCREASE
FTE CHANGE
PROBATION PERIOD COMPLETED
RECLASSIFICATION
COMMENTS IF NECESSARY:
Authorized by: Date: _________________
(Department Head/Budget Manager)
Revised July 2013