Fillable Samford University Change of Status A. Status Change (Samford University)

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Samford University Change of Status A. Status Change (Samford University)

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Samford University
Change of Status
Employee Name: ______________________________________________________________________________________
School/Dept.: __________________________________________ SUID: __________________________________
A. Status Change
B. Salary Change
(Check Pay Category)
Current: Biweekly Monthly Rate: __________________________ Salary Grade: _________________
Proposed: Biweekly Monthly Rate: __________________________ Salary Grade: _________________
Effective Date: ___________________________ Date of Last Increase: ____________________________
Reason for Change: ________________________________________________________________________________
C. Leave of Absence
Begin Leave: ______/______/_____ Return from Leave: ______/______/______ With Pay Without Pay
Long-Term Disability Family/Medical (additional forms are required) Personal Sabbatical
D. Termination
Voluntary Involuntary (requires preapproval of Human Resources Director) Retirement
Last Day Worked: ______/______/______ Last Day Paid: ______/______/______ Full Time Part Time
Reason for Termination: ____________________________________________________________________________________
Would Re-employ? Yes No Will this position be lled? Yes No
1. Dept. Head/Chair: Date: _____/_____/_____
2. Vice Pres./Dean: Date: _____/_____/_____
3. Executive Vice Pres./Provost/Associate Provost: Date: _____/_____/_____
4. Position Control: Date: _____/_____/_____
5. Human Resources: Date: _____/_____/_____
HR Only: E-mail sent: ______/______/______ VPO Pay ID: ___________________
Please send original to Human Resources
Type
From
To
School/Dept.
Banner FOAPAL
Name
Address
Telephone #
Title
Employment Status: Full Time Part Time
Position Control #
Index | Fund | Org. | Acct. | Prog.
Index | Fund | Org. | Acct. | Prog.
If less than 12 months, give dates of assignment: from: _______________ to: _______________
Rev. 7/10
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Samford University Change of Status A. Status Change (Samford University)

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Completed 26 August 2020

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