Empl ID or
SS# if New Hire:
HUMAN RESOURCES
Personnel Action Form
Hire/Rehire
Date Prepared:
Preparer’s Name:
PERSONAL DATA
Prefix
First Name
M.I.
Street Address
Last Name
Suffix
City
JOB DATA
Start Date
End Date (if temp)
Job Req #
Position # (reg)
Action
State
Reason
New or Indicate Previous Incumbent
Campus and Department
Temp/Reg
Postal Code
Fac Tenure Elig Date
Job Function
Job Family
Full Time/ Part Time
Standard Hours
Primary Title
Secondary Title(s)
COMPENSATION
Current information
Base Contract Rate
Contract Basis
Grade
Resource Analysis & Budgeting :
If applicable please indicate the additional funding
source(s) other than or in addition to originally
approved budget:
Account - %
Bargaining Unit
Admin stipends:
Amount:
Stipend Basis:
EMPLOYMENT DATA
Building/Room
Current information
Account/Position Number
Amount
Stipend
Account %:
Campus Phone
Campus Zip+4
First Level Supervisor
COMMENTS OR CONTINGENCIES
Note: Faculty hires please attach a copy of the JRF/SPRC Rationale, Candidate Interview Summary, signed letter of offer, resume, original transcripts, and (if applicable) Search Waiver.
SIGNATURE APPROVALS
Department Chair/Director
Vice President/Provost/President
Date
Dean
Date
Date
Appointing Authority
Date
HUMAN RESOURCES USE ONLY
In HR
BOT Date
Proc. By
Prob End
Fair Sh.
To RPBB
Ret Sys
Job Code
SPRC Approval
Budget Funds Available
Controller Funds Available
_________________________________________ Date______________
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HRF001 Revised 8/15/13