Personnel Status Change

Personnel Status Change
Payroll:
Employee Name:

First NameLast Name
Current Job Title:
Current Job Title:
Current Location:
Department:
Changes to employee status may be noted below:
New Payroll:
New Job Title:
New Job Title:
New Location:
Employment Status:
Department:
Change in Status (check all that apply)

Other
ACTS New Salary
New Union dues:
Retrieve all LCCAP belongings i.e. laptop,cellphone, key/badges, etc
Resignation - Retrieve all LCCAP belongings i.e. laptop,cellphone, key/badges, etc
Employee has access to the following databases:

Other
Employee has the following items:

Other
Date Change Effective:

MonthDayYear
Change anticipated to be :
Temporary- Effective until:

AyGünYıl
Remarks (use this space to provide a reason for the change and any specific information except SALARY)
Salary Information
Where will the employee be charged ?
Project Number
If applicable, Policy Council Approval Date
Approval Date
Attach new job description/credential:

Cancelof
Attachment

Cancelof
Submit to:
Please submit to your Director.

To be completed by HR:

Rows
Date Rec’d Paycor Approval Notice
Approved in Paycor:
New employment letter issued:
Letter to Supervisor:
Benefits Updated:
Other:
Pertinent info sent to payroll Ee:
Job Description :
Childcare Balance :