"Employee Action Form - Massachusetts College of Liberal Arts"

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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 ____________________

_______________________________________________________________________________________________________________________________________________________

FOR NEW HIRES/REHIRE OR CURRENT EMPLOYEE STATUS:

TO (NOT APPLICABLE FOR NEW HIRES):

Title _______________________________________________________________

Title _________________________________________________________________

Status ____ Full-time ____ Part-time Pos. #_________________ Job Code________________ Status ___ Full-time ___ Part-time Pos. #______________ Job Code_________________

AFSCME

APA

MSCA

Non-Union

AFSCME

APA

MSCA

Non-Union

Exempt

Non-Exempt Salary ____________________ Hourly _______________

Exempt

Non-Exempt Salary ____________________ Hourly _______________

Grade/Step ____ ________________________________________

Account # ___________________________________ Amount ____ _____________________

Standard # Hours/week (ACA compliance) _____________________________

*Part-time- No more than 960 hours

*Temporary – No more than academic year

*Part-time- No more than 960 hours

*Temporary – No more than academic year

Additional Information with Regard to Change: (Include justification for position and if applicable, include calculations for salary change):

Initiated by: ______________________

Date: ________________

APPROVALS:

Appropriate VP: __________________________________________ Date: __

______________

Administration & Finance _________________________ Date _____________

President's Office

__________________________________________ Date _________________ Human Resources:___ ______

___________________ ate _____________

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 ____________________

_______________________________________________________________________________________________________________________________________________________

FOR NEW HIRES/REHIRE OR CURRENT EMPLOYEE STATUS:

TO (NOT APPLICABLE FOR NEW HIRES):

Title _______________________________________________________________

Title _________________________________________________________________

Status ____ Full-time ____ Part-time Pos. #_________________ Job Code________________ Status ___ Full-time ___ Part-time Pos. #______________ Job Code_________________

AFSCME

APA

MSCA

Non-Union

AFSCME

APA

MSCA

Non-Union

Exempt

Non-Exempt Salary ____________________ Hourly _______________

Exempt

Non-Exempt Salary ____________________ Hourly _______________