Personnel Action Notice Form

Personnel Action Form (PAF)
Employee Name*

First NameLast Name
Team*
Requestor Name*
Requestor Email*
Reason for Change*

New HireChange in Salary and/or Position/TeamAddress ChangeTerminationBonusName Change (Update Federal Tax Form & I9)Leave of AbsenceReturn from LOA
Former Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthdate

MonthDayYear
Date
Work Email
Personal Email*
Cell Phone Number*

Area CodePhone Number
Employee Status:*

Full Time SalaryPart Time SalaryFull Time HourlyPart Time Hourly
Position Hours*

Part Time 30hrs/wk (eligible for health insurance)Part Time 25hrs/wkPart Time 20hrs/wkPart Time less than 20hrs/wkSubstitute (PSCC)Seasonal EmployeeIntern (DB)
Approximately 10-15 hours/week
Position Title*
Title
New Hire Hourly Rate*
Per Hour
New Hire Salary Rate*
Per Year

Personnel Action Form (PAF)