Current Information
Position Change Form
Current Working Title: Job Family (HR Use Only): Job Family Zone (HR Use Only):
System Title FLSA Status (HR Use):
Employee’s Name: Department Name:
Supervisor Name:
Proposed Changes
Proposed Working Title: Job Family (HR Use Only):
Job Family Zone (HR Use Only):
System Title Position Number: FLSA Status (HR Use):
Department Name:
Position Number:
SAP Personnel #:
Title Code (HR Use):
Section 1: Title Determination
Section 1: Title Determination
Justification for Salary Decision Note: Provide sufficient detail to clearly show reasons for salary decision.
Actions requiring HR consultation/review prior to effecting action:
Temporary Responsibility pay (limited to 20%)
Voluntary Reduction
Actions requiring HR approval prior to effecting action:
Market Adjustment
Equity Adjustment
Other: __________________________________
Section 2: Salary Determination
Salary Change Information
Old rate of pay: $ New rate of pay: $ Percentage change: %
Effective Date: Stop date:
Requestor: I have consulted with HR regarding this salary action.
&RVW Center/WBS
Justfication for Title Change:
*An updated Job Description is required to accompany this form
Revised 0
Requestor and Designated Unit Authority: I certify that the process used to determine this salary was made in accordance with
Human Resources guidelines, FLSA, Title VII of the Civil Rights Act of 1964, ADA and other employment laws and regulations
Requestor (Supervisor/Manager): Date:
Dean/Director Approval(s): Date:
Vice Chancellor/Chancellor Approval:
Human Resources : Date:
Obtain all approval signatures and forward this form to
HR, 1200 Warner Hall prior to submission of Requisition and/or PAF.
Budget: (salary only)
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