Personnel Action Form-Starpoint
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1STARPOINT
PERSONNEL ACTION FORM
EFFECTIVE DATE:
Employee Number:
JOB TITLE:
EHS POLICY COUNCIL APPROVAL
DATE ______________________________
HOURLY RATE/SALARY:
NAME:
Exempt
Non-Exempt
ADDRESS: _________________________
WORK SCHEDULE:
_________________________________________________
PHONE:
___________________________
CLASSIFICATION:
SSN:
____________________________
HOURS PER WEEK:
DATE OF BIRTH: ____________________
PROGRAM/GRANT:
SEX:
Male
Female
MARITAL STATUS:
S
M
LOCATION:
PERSON TO BE NOTIFIED IN CASE
OF EMERGENCY:
ACKNOWLEDGEMENT
NAME: ____________________________
ADDRESS:
________________________
___________________________
___________
________________________________________________
EMPLOYEE SIGNATURE
DATE
PHONE:
_________________________
APPROVED
ACTION
Employment
___________________________
___________
Promotion
SUPERVISOR
DATE
Personal Data Update
___________________________
___________
SECOND LEVEL SUPERVISOR
DATE
End of Introductory Period
___________________________
___________
Termination –
HR DEPARTMENT
DATE
Voluntary
Involuntary
___________________________
___________
OTHER:
CHIEF EXECUTIVE OFFICER/
DATE
CHIEF ADMINISTRATIVE OFFICER
Interim: From__________ to ________
FOR OFFICE USE ONLY:
COBRA: __________________________________
Department ______________
Job Title
________________
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Parent category: Business