Personnel Action Form
For LOAs, Suspensions, or Terminations (Voluntary or Involuntary)
Store Number
*
Enter TM's current 4 digit store # (Office/Support: use 9999)
DM Area:
*
Please Select
Almeida
Armas
Castro
Downey
Hartzo
Holditch
Lohse
M_Bouvier
Mejia
Messick
Moore
Ontiveros
Place
Powers
Ratanapan
R_Bouvier
Steadham
Stevens
Office/Support
EE ID: (HR Use)
Team Member's Name
*
TM First Name
TM Last Name
Last 4 digits of SSN:
*
TM's Current Position: (as listed in HR system)
*
Please Select
BIKE (Bike Delivery Expert)
CSR
DVR (Delivery Driver)
SM (Shift Mgr)
AM (Asst Mgr)
GMIT (Gen Mgr in Training)
GM (General Mgr)
DM (District Mgr)
Office/Support
Change Type:
*
LOA (Start)
Suspension
Termination
Effective Date:
*
-
Month
-
Day
Year
Date
LOA Reason:
Please Select
Another Job
Bereavement
Disability
Expired Docs
Maternity
Medical
Military
Paternity
Personal Reason
School or Semester Break
Vacation
Vehicle Issues
Other-List details in explanation
Expected LOA Return Date:
-
Month
-
Day
Year
Date
Termination Reason:
Please Select
Deceased
Fired-Policy Violation(s)
Quit-Job Abandonment-Reason Unknown
Quit-Another/Other Job
Quit-Medical Reasons
Quit-Military Service
Quit-Moved
Quit-No call/No show 2+ last consecutive shifts
Quit-No notice (TM informed Mgmt)
Quit-Other (provide details in reason)
Quit-Did not return before LOA Expired
List Policy Violation(s) resulting in Involuntary Termination:
Unprofessional Conduct, Theft, Attendance/Scheduling, Drivosity, etc
Did you receive HR approval for Involuntary Termination?
Yes
No
List the last 2+ consecutive dates of no call/no shows:
Rehire Status:
Please Select
Eligible
Not Recommended
Not Eligible
Termination Details and/or Reason for Rehire Status selected:
Explanation/Reason for requested LOA or Suspension:
Supporting Doc Upload (optional):
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Submitted By:
*
Mgmt First Name
Mgmt Last Name
Mgmt Position:
*
Please Select
AM/GMIT
GM
DM
RD
HR
Off/Sup(not HR)
Enter your MAC Pizza email (for confirmation of form submission)
*
mac1234@macpizza.net
Date/Time Submitted
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Submit
Should be Empty: