Directions: Submit to Human Resources to effect
a change to the employee’s record. Use this form for all
employees on the contractual
file (Contingent I and II, student assistants, college work-study, graduate
assistants and Adjuncts. Adjuncts can also be processed as a cancellation
on another form.
| Employee: | Soc. Sec. No.: |
| Department: | Account #
(only used for College Work Study appointments): |
| Effective Date of Change: |
Changes:
1. Terminate from Payroll as of ____________________________________(date)
Reason for termination:___________________________________________________
2. Continuation of College Work Study Assignment:
Contract Begin Date:_______________ Contract End Date:___________________
3. Name Change From:______________________________ To:_______________________________
4. Rate of Pay From:________________________________ To:_____________________
5. Change Total Contract Amount: From:________________ To:_____________________
7. Account Number Change: From: _______________
- _______ To:_____________ - ______________
(10 digits)
(10 digits)
8. Other (describe) _____________________________________________________________________
Approved by: ____________________________________
Date: __________________________
Department Head
Grants Accountant (if grant funded position) ______________________________
Date: ________________
|
Job Code__________ Contract Maximum: $___________________ Class Code:__ __ __ __ __ __ Assigned End Date-____/_____/_____ |