Hire/Change Form – Human Resources

Will this person be on the College's payroll? *

Please indicate the nature of the change to be made. *

Description of "other" change

Employee Name *

First Last

Department *

Effective Date of hire/change

Account number (##-#-#####-50005) *

Position title *

Is this a new position? *

Status *

Anticipated Term Date

Is this a full-time or part-time position? *

Please indicate the number of hours per year.

Is this an hourly (bi-weekly) or a salaried (monthly) position? *

Please indicate the annualized salary. *

Please indicate hourly pay rate. *

Stipend amount

Frequency of stipend payment

Reason for stipend payment

Person's Name *

First Last

Department *

Account Number

For payroll approvals only ##-#-#####-50005 format

Effective Date *

Title

Will this person be leaving on or before the end of the academic year? *

Please note that a new hire request will need to be submitted if this person returns in a future academic year.

Supervisor's name

First Last

Authorized by *