SAMFORD UNIVERSITY
Human Resources Department
Student Employment Change of Status
Please complete all sections below that apply.
Student Name: SU ID:
Department: Position Code:
Job Title: Hourly Rate:
Terminate from job: Effective date: Last day worked:
Reason job ended: Sched
ule Change Took another job
(Check One) Graduated Inactive student
Other
Extension of job: Return Date:
Assignment will end on
Assignment will remain active until Payroll is notified by the department of a change.
Rate of pay change: Effective date: New rate: $
Reason for change:
Budget:
Use department funding for this position
Please check
Position requires federal work study funding
one option:
Use federal work study funds if available, if not use department funding
Banner FOAPAL:
Required for form to be processed
Index:__________ Fund:__________ Org:___________ Acct: 612000 Prog:________ Actv:______
Date
SUID
Date
Supervisor Signature
Print Supervisor Name
Budget Head Signature
Print Budget Head Name
SUID
For Payroll Use Only
Institutional Student Payroll (paid by dept budget) Position
Federal Work Study/FWSCS Total Work Study Funds Authorized
RJASEAR TCP P/R Date Processed
11/17
