HUMAN RESOURCES
PERSONNEL ACTION REQUEST
EMPLOYEE INFORMATION
Name
Employee ID
Daytime Phone
Date
Message Phone
TYPE OF ACTION REQUESTED (APPLIES TO ALL POLICY GROUPS UNLESS INDICATED)
New Employment
Regular hire
New Specially Funded Hire
Temporary reassignment
SPF Renewals/Changes
Short Term Hire (OSO)
Athletic Specialist Hire
Transfer
Return to Reg. Assign
Short Term Hire (OYO)
Administrative reassignment
Separation
Other
Employee Selected
through Posting
Voluntary
Management Initiated
Supervisor change:
Complete Department Table Change Form
http://www.maricopa.edu/employees/divisions/hr/forms/salary/DeptT
ableChange.pdf
POSITION INFORMATION
Position Title
Requisition #
Calendar
Grade
FTE
12 Mos. 10.5 Mos. 10 Mos. 9.5 Mos. 9.0 Mos. Irreg.
1.00
.75
.50
.25
Other
College/Division
Phone #
Days
Department ID
Hours
SPECIALLY FUNDED INFORMATION
End Date
Grade
Funding Start Date
Funding Source/Grant Name
Internally Funded
Last Day Worked
Reallocation
End Date
Supervisor
Department/Office
New
Recommended start date
Externally Funded
SEPARATION INFORMATION
Step
Salary
Reason
Separation Date
BUDGET INFORMATION
Replacement
If replacement, give name/reason:
Non-Budgeted
CFS#1
%
Budget Code(s)/Percentage:
If Funding & FTE coming from different accounts, please identify:
FUNDING/FTE
DIFFERENTIAL/PAY PERIOD
CFS#1
%
Earnings Code
Total Hours
CFS#2
%
CFS#2
CFS#3
%
POS#1
POS#2
Position charge to:
%
%
%
SIGNATURE/BUDGET APPROVAL
___________________________________________________
Supervisor/Committee Chair
Date
___________________________________________________
College President/Vice-Chancellor or designee
Date
___________________________________________________
Vice President/Administrator
Date
___________________________________________________
Budget Department
Date
___________________________________________________
College Budget Approval
Date
___________________________________________________
District Human Resources
Date
Maricopa Community Colleges
02/08/12
2411 W. 14th Street
Tempe, AZ 85281-6942
Fax 480 731-8599/8704
Human Resources Division