Feedback/ Request Forms : choiceshr.com

Personnel Action Form (PAF)

*Your Email Address:

   * Name

   * Job Title

   * Program

   * Manager Name

   * HR use only: Social Security#

   * Current title

   * New Title

   *

Effective Date

   * Voluntary
   * Involuntary
   * Rehire status

   * Effective Date

   * Change Employment status to: full-time
   * Part-time
   * Effective Date

   * Current Benefit Eligibillity: Full time
   * Part-time: 17 more hours scheduled per week
   *

Non Benefit Eligable: Part Time 16 hours or less schduled per week

   * Schedule Sub
   * No. of 24/Hr shifts per week

   * scheduled hours per week

   * Merit Increase
   * Adjustment
   * Promotion
   * Current Annual Salary$ or Current Hourly Rate $

   * Pay Retro

   * Proposed Increase/%change

   *

New annual Salary or New hourly Rate

   * Effective Date

   *

From: Full or Part time

   * To: Full or Part time

   * Program/New program

   * New Manager

   * Efeective date