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WESTERN TEXAS COLLEGE PERSONNEL ACTION FORM Following is (Western Texas College)

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WESTERN TEXAS COLLEGE
EQUAL OPPORTUNITY INSTITUTION
PERSONNEL ACTION FORM
Date:________________________________________________ SS#_____________________________________
Name:_______________________________________________ Phone #___________________________________
Address:_______________________________________________________________________________________
Street City State Zip
Following is needed for reporting purposes only and is not used as a criterion for employment.
DOB:______________________________ Sex:___________________ Race:_______________________________
From:______________________________________________________________ Date:______________________
(1) Immediate Supervisor/DC__________________________________________ Date:______________________
(2) Affirmative Action/Human Resources_________________________________ Date:______________________
(3) President________________________________________________________ Date:______________________
Job Title_______________________________________________________Department______________________
Grade/Level/Degree__________________________________________________ Salary______________________
Salary Account No.__________________________________ Date of Employment___________________________
Full Time Employees 9-months 10-months 12-months
Employee would like for checks to be issued in __________________monthly increments.
Part-time Temporary
Starting Date __________ ___________
Ending Date __________ ___________
REASON FOR THIS ACTION: Hired:________________________ Re-hired:_____________________________
Probation: Yes No How long?_____________ Probation Ended: Yes No Date:______________
Promotion_______________________________________ Transfer_______________________________________
Re-evaluation of existing Job________________________ Resignation____________________________________
Discharge/Termination: (Give reason below)
Additional Information:
FOR PAYROLL USE: W-4__________ I-9 W/Supporting Doc.___________ Approved by Payroll___________
_____________________________________________________ ____________________________________
Signature of Employee Date
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WESTERN TEXAS COLLEGE PERSONNEL ACTION FORM Following is (Western Texas College)

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Completed 27 July 2020

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