Office of Human Resources
1725 State Street, 144 Graff Main Hall
La Crosse, WI 54601
EMPLOYEE ACTION
Review instructions at www.uwlax.edu/human-resources/employee-action-forms.
Contact Human Resources at (608)785-8013 with questions.
Employee Information
Employee name: Enter employee’s legal name
Email address: Enter employee’s email address
Graduate Program enrollment: Enter graduate program
HRS Employee ID #: Enter Employee ID
Phone: Enter employee’s phone number
Student ID #: Enter student id #
Action Information
Type of action:
Select an action
Employee type: Graduate Assistant
Position #: _____________
Title: Select title
Department: Enter department
Reports to: Enter Supervisor”s first and last name
Pay Basis: Choose an item
☐ Semester Select semester
Select FTE & Salary: Select FTE & Salary
☐ Academic Year Select academic year
Select FTE & Salary: Select FTE & Salary
☐ Academic Year Other: Choose start date to Choose end date
Academic Year Other: FTE: Enter FTE
Enter Actual Salary: Enter Actual Salary
Enter FTB: Enter FTB
☐ Annual: Choose start date to Choose end date
Annual: FTE: Enter FTE
FTE Change: Select FTE action
FTB Change: Enter FTB
Enter Actual Salary: Enter Actual Salary
FTE % change: Enter % change %
Enter FTB: Enter FTB
FTE % after change: Enter new FTE %
Actual salary: Enter actual salary
Comments:
Funding Information
Fund (3)
IBAC/Program (2)
☐ Grad Studies Allocation: $ Enter amount
UDDS/Department (6)
☐ Diversity: $ Enter amount
% (must sum to 100%)
☐ Other-Specify: $ Enter amount
Approval/Review
Reviewer/Approver
Printed Name
Signature
Date
N/A
N/A
N/A
Dean/Director (or designee)
Division Authorization
Budget Planner/Director
Min/Max
Scan
Human Resources (Initial & Date)
HRS Entry
HR Audit
Payroll Audit
Updated 5/20/15