Name _______________________________________________ Department/Division _________________________________________ Reports to: _____________________________
Type of Change
______ New Hire
______ Transfer
______ Reclassification
Termination:
______ Retirement
______ Rehire
______ Temporary (From ___________ to ___________)
______ Resignation
______ Salary Change
______ FMLA
______ Promotion
______ Other ______________________________
______ Title Change
______ Suspension ____ PAID ____ UNPAID
______ PAID Leave of Absence
Type ________________________________________ Beginning ___________________ Ending ____________________
______ UNPAID Leave of Absence Type ________________________________________ Beginning ___________________ Ending ____________________
Administration & Finance _________________________ Date _____________
President's Office
__________________________________________ Date _________________ Human Resources:___ ______
__
___________________ ate _____________
D
Form date: 12/12/14
MASSACHUSETTS COLLEGE OF LIBERAL ARTS
Effective Date:
____________
Employee ID#: _________________
EMPLOYEE ACTION FORM
Ending Date (if applicable):
____________
Record #: ______________________
Name _______________________________________________ Department/Division _________________________________________ Reports to: _____________________________
Type of Change
______ New Hire
______ Transfer
______ Reclassification
Termination:
______ Retirement
______ Rehire
______ Temporary (From ___________ to ___________)
______ Resignation
______ Salary Change
______ FMLA
______ Promotion
______ Other ______________________________
______ Title Change
______ Suspension ____ PAID ____ UNPAID
______ PAID Leave of Absence
Type ________________________________________ Beginning ___________________ Ending ____________________
______ UNPAID Leave of Absence Type ________________________________________ Beginning ___________________ Ending ____________________
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