REGULAR and CONTINGENT CATEGORY II STAFF – COMPENSATION ACTION REQUEST
EXEMPT AND NONEXEMPT EMPLOYEE CLASS 20, 22, 33, or 35
After obtaining appropriate approvals, please submit the completed form and required documents to:
HRComp@umaryland.edu (410) 706-6338 [P]
This form should be utilized to request a change to an employee’s compensation/assignment as outlined in Policy VII 9.11(B).
Requested Staff Action:
Acting Capacity (ACT) ☐
Reclassification (REV) ☐
Reassignment (REA) ☐
Requesting Department Information
Initiator Name:
School/Unit:
Current Employee Information
Phone:
Department name:
Email:
Department code:
Employee name:
Employee ID:
Position number:
UMB Date of hire:
Job title:
Job code:
Dept name:
Dept code:
Building code:
Exempt ☐ Nonexempt ☐
Current salary:
Classification:
Weekly hours:
Supervisor/ Principal investigator:
Supervisor’s job title:
Currently on a VISA?
If yes, please contact the International Office at 410 706 7488
Requested New Employee Information (Complete only sections that will be changing and leave those sections not changing blank)
New department name:
New department code:
New job title:
New job code:
New supervisor name:
New supervisor title:
Does this position supervise? If so, please list position titles being supervised:
Proposed effective/start date (must coincide with pay period begin date ):
Acting Capacity end date:
Requested New Job Funding Information
State ☐:
Grant: ☐
Revolving: ☐
Other: ☐
Funding source (mark all that apply):
PCBU number(s) and % funded:
Project ID:
Requested New Job Information
Select agents ☐
Radioactive Materials ☐
Hazardous Materials ☐
Does this position require working with:
Yes ☐ No ☐
Out of country assignment:
Percentage of travel:
Percentage of time off campus
Location of where work will be done:
Building code:
Yes ☐ No ☐
Does this position require Financial Disclosure per State Ethics Standards of Conduct Law?
Required Attachments
Yes:
Yes:
Yes:
Yes:
Yes:
Yes:
Current job description:
Proposed job description with assigned %’s attached:
Employee’s resume attached:
Summary of duties and examples attached:
Business need justification for action attached:
Organizational chart attached:
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All required documents below must be attached
before Compensation will begin analysis.
The effective date will be the pay period after
Compensation received all required documents.
Signatures/Approvals
By signing in the designated areas below, I am verifying that I have identified and approved funding source(s) for this position. I
understand that should this approved funding source become unavailable that the Department identified above will be charged
for any portion of the unavailable funding source(s). I also attest that this action is needed to fulfill the Department’s and
University’s function.
Department 1 approver:
Printed name:
Date:
Department 2 approver:
VP/Dean:
Printed name:
Date:
Printed name:
Date:
Human Resources Services Use Only
Date action received:
ACT ☐ REV ☐ REA ☐ EQT ☐ WIP ☐
Action Number:
Job title:
Exempt ☐ Nonexempt ☐
FLSA:
Job code:
Salary:
Salary Increase:
Effective start date:
Acting End Date:
$
%
If increase greater than 10%, please list reason:
Action result:
Compensation signature:
Approved ☐ Cancelled ☐ Denied ☐
Position number (C, U, N/C):
Date:
New July 2015
REGULAR and CONTINGENT CATEGORY II STAFF – COMPENSATION ACTION REQUEST
EXEMPT AND NONEXEMPT EMPLOYEE CLASS 20, 22, 33, or 35
After obtaining appropriate approvals, please submit the completed form and required documents to:
HRComp@umaryland.edu (410) 706-6338 [P]
New July 2015