Change Form for Student, Work Study and Temporary Employees s at

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Change Form for Student, Work Study and Temporary Employees
Send to Payroll Services at [email protected]
PLEASE NOTE: Changes to work study records need to be approved by the Student Employment Office
before form submission, please include their approval with your email submission. Please use this form
only for all student employees and temporary employee record changes or terminations.
Person requesting change:
Employee Info
Employee Name:
PS Employee ID:
PS Employee Record #:
*(required )
*(required )
* (required)
* (required)
Pay Rate Change Effective Date:
Current Pay Rate:
New Pay Rate:
Retro $$ owed:
Date From:
Date To:
Combo Code Effective Date:
Current Combo Code(s):
New Combo Code(s):
Additional New Combo Code(s):
Remove Combo Code(s) (use only if codes need to be removed, not replaced):
Supervisor Change Effective Date:
Current Supervisor:
Current Supervisor ID:
New Supervisor:
New Supervisor ID:
Only complete when employee terminates:
Termination Effective Date (last day worked):
COMMENTS:
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