Fillable Roger Williams University and Roger Williams University School (Roger Williams University)

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Roger Williams University and Roger Williams University School (Roger Williams University)

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Roger Williams University and Roger Williams University School of Law
Staff Personnel Action Form
EMPLOYEE NAME: __________________________________________________EFFECTIVE DATE OF ACTION: _____/_____/______
EMPLOYEE ID: _________________ DEPARTMENT: _______________________ DIVISION: _________________________________
LOCATION: Baypoint Bristol School of Law Providence Metro Center
PLEASE CHECK ALL THAT APPLY:
Separation (Voluntary) Separation (Involuntary)
Additional Position Dept or GL Change
Separation (Retirement)
Rate Change
Change Position Status
Change of Supervisor
Position Extension (from: ___ /___/______ to ___/___/______) Leave of Absence (from: ___ /___/______ to ___/___/______)
POSITION TITLE: _____________________________________________________________________________________________
REPORTING MANAGER: _______________________________________________________________________________________
New Salary/Wage: $_________.____ Hourly Yearly
Old Salary/Wage: $_________.____ Hourly Yearly
Wage Change Reason: ______________________________________________________________________________________
Number of Hours: New _______ Old: _______ FTE: ___.___ Work Schedule: ____:____ AM/PM to ____:____ AM/PM
Position Status: 12 month 11 month 10 month 9 month Seasonal* Other* _______________
*Temporary assignment length: From: ____/____/____ to: ____/___/_____
Please note that unless a PAF is submitted to extend the employee’s temporary assignment prior to its original end date,
Human Resources will terminate the employee using the temporary assignment end date as indicated on the hire paperwork.
General Ledger Account Number: __ __-__ __ __ __ __ __ __-__ __ __ __ __ __ Percentage: _______ %
General Ledger Account Number: __ __-__ __ __ __ __ __ __-__ __ __ __ __ __ Percentage: _______ %
* If more than two funding sources are necessary, use Remarks box below.
PLEASE CHECK ALL THAT APPLY:
STATUS: Full-Time, Reg. Part-Time, Reg. Full-Time, Temp. Part-Time, Temp. Seasonal
CLASS: Executive Administrator Professional Staff Staff
UNION: Facilities Union Food Service Union PSSA Union Public Safety Union
FOR SEPARATIONS:
Last day worked: ____/____/_____ Termination Date: ____/____/_____ To be paid through: ____/____/_____
Reason for separation: _______________________________________________________________________________
_______________________________________________________________________________
Eligible for Rehire? Yes No
Have the appropriate departments (IT, Facilities, Locksmith, Purchasing) been contacted? Yes No
PAF PREPARED BY (Please print): _____________________________________________________ DATE: _____/______/_______
Remarks Authorizations Date Signed
Manager:
/ /
Provost/VP/EVP/Dean of Law School:
/ /
Finance:
/ /
President (if applicable):
/ /
Human Resources:
/ /
FOR HR USE/PAYROLL USE ONLY
Org Chart Updated Processed by: ________ Date Paid: ___/____/____ Benefits Termed: ___/____/____
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Roger Williams University and Roger Williams University School (Roger Williams University)

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Completed 1 February 2021

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