Employee Hire Change Termination Form printable pdf download

Business Office

Employee Hire, Change,

Termination Form

2500 E. Nutwood Ave.

Fullerton, CA 92831 USA

(714) 879-3901

FAX (714) 681-7512

❑ Hire

❑ Cost of Living Adjustment

❑ Termination (must supply reason)

❑ Formal Leave

❑ Staff

❑ Rehire

❑ Classification Change

________________________________

Reason: _________________________________________

❑ Admin.

❑ Merit Increase

________________________________

________________________________________________

❑ Faculty

❑ Other

____________________________

________________________________

Anticipated return date: _____________________________

❑ HIU Student

Name: _____________________________________________________________________ ID #: _____________________________ Effective Date: _________________

Comments

Ledger Acct #: __________________________________

HR Use Only

Job Title: ______________________________________

______________________________________

Benefits: Start date ______________ End date ___________

❑ Medical

❑ Full Time

❑ Part Time*

❑ Seasonal*

______________________________________

❑ Exempt

❑ Non-Exempt

❑ Dental

*Average hours per week: ________________________

❑ Life/Disability

______________________________________

Hourly

Semi Monthly Rate

W/C Classification Code

__________________________________________

______________________________________

Base Rate

Signatures/Approvals

Supervisor: _________________________________________________________________________________________ Date: _____________________________________

Human Resources: ___________________________________________________________________________________ Date: _____________________________________

Administrator: _______________________________________________________________________________________ Date: _____________________________________

41203112

Business Office

Employee Hire, Change,

Termination Form

2500 E. Nutwood Ave.

Fullerton, CA 92831 USA

(714) 879-3901

FAX (714) 681-7512

❑ Hire

❑ Cost of Living Adjustment

❑ Termination (must supply reason)

❑ Formal Leave

❑ Staff

❑ Rehire

❑ Classification Change

________________________________

Reason: _________________________________________

❑ Admin.

❑ Merit Increase

________________________________

________________________________________________

❑ Faculty

❑ Other

____________________________

________________________________

Anticipated return date: _____________________________

❑ HIU Student

Name: _____________________________________________________________________ ID #: _____________________________ Effective Date: _________________

Comments

Ledger Acct #: __________________________________

HR Use Only

Job Title: ______________________________________

______________________________________

Benefits: Start date ______________ End date ___________

❑ Medical

❑ Full Time

❑ Part Time*

❑ Seasonal*

______________________________________

❑ Exempt

❑ Non-Exempt

❑ Dental

*Average hours per week: ________________________

❑ Life/Disability

______________________________________

Hourly

Semi Monthly Rate

W/C Classification Code

__________________________________________

______________________________________

Base Rate

Signatures/Approvals

Supervisor: _________________________________________________________________________________________ Date: _____________________________________

Human Resources: ___________________________________________________________________________________ Date: _____________________________________

Administrator: _______________________________________________________________________________________ Date: _____________________________________

41203112

Employee Hire Change Termination Form

Related Articles

Related forms

Related Categories