Employee Action Form
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1MASSACHUSETTS COLLEGE OF LIBERAL ARTS
Effective Date:
____________
Employee ID#: _________________
EMPLOYEE ACTION FORM
Ending Date (if applicable):
____________
Record #: ______________________
Name _______________________________________________ Department/Division _________________________________________ Reports to: _____________________________
Type of Change
______ New Hire
______ Transfer
______ Reclassification
Termination:
______ Retirement
______ Rehire
______ Temporary (From ___________ to ___________)
______ Resignation
______ Salary Change
______ FMLA
______ Promotion
______ Other ______________________________
______ Title Change
______ Suspension ____ PAID ____ UNPAID
______ PAID Leave of Absence
Type ________________________________________ Beginning ___________________ Ending ____________________
______ UNPAID Leave of Absence Type ________________________________________ Beginning ___________________ Ending ____________________
_______________________________________________________________________________________________________________________________________________________
FOR NEW HIRES/REHIRE OR CURRENT EMPLOYEE STATUS:
TO (NOT APPLICABLE FOR NEW HIRES):
Title _______________________________________________________________
Title _________________________________________________________________
Status ____ Full-time ____ Part-time Pos. #_________________ Job Code________________ Status ___ Full-time ___ Part-time Pos. #______________ Job Code_________________
AFSCME
APA
MSCA
Non-Union
AFSCME
APA
MSCA
Non-Union
Exempt
Non-Exempt Salary ____________________ Hourly _______________
Exempt
Non-Exempt Salary ____________________ Hourly _______________
Grade/Step ____ ________________________________________
Grade/Step ____ ________________________________________
Account # ___________________________________ Amount ____ _____________________
Standard # Hours/week (ACA compliance) _____________________________
Standard # Hours/week (ACA compliance) _____________________________
*Part-time- No more than 960 hours
*Temporary – No more than academic year
*Part-time- No more than 960 hours
*Temporary – No more than academic year
Additional Information with Regard to Change: (Include justification for position and if applicable, include calculations for salary change):
Initiated by: ______________________
Date: ________________
APPROVALS:
Appropriate VP: __________________________________________ Date: __
______________
Administration & Finance _________________________ Date _____________
President's Office
__________________________________________ Date _________________ Human Resources:___ ______
__
___________________ ate _____________
D
Form date: 12/12/14
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Parent category: Business