Position Title/Job Title Change
________________________________ _____________________________
_________________________________ ______________________________
Job Change Information- Position Title or Job Title
______________________________ ________________________________
Current Position Title New Position Title
_____________________________ ________________________________
Current FLSA Status (Exempt/Non-Exempt) New FLSA Status (Exempt/Non-Exempt)
*If there is a change in exemption status an updated exemption determination form must be included
with this form and requires HR approval
__________________________________ ___________________________________
Current Salary/Pay Rate New Salary/Pay Rate
Change in Supervisor Reporting Relationship
• Is the employee reporting to the same supervisor? Y/N
• Is the employee a new supervisor? Y/N
o If yes who are they supervising? _____________________________________
• If the employee is a current supervisor are they supervising anyone new? Y/N
o If yes who are they supervising? _____________________________________
Reason for Change (Re-Org, Reviewed Job Description, Etc.,) Review with HR
_________________________________________________________________
Supervisor _________________________ Date ___________________
* Supervisor signature confirms that appropriate approvals have been obtained (Dept/Budget)
HR Representative _________________________ Date ___________________
Effective Date _____________________
Attached Documentation:
Updated Job Description Exemption Determination Form Promotion Form
click to sign
signature
click to edit
click to sign
signature
click to edit