Hr Processing Unit Change Form printable pdf download

Hr Processing Unit Change Form

HR Processing Unit Change Form

Agency Name _________________________

Action

Agency Code __ __ __

Check one:

r New HR Processing Unit

r Change to Existing HR Processing Unit

r Inactivate Existing HR Processing Unit

HR PROCESSING UNIT

__ __ __ __ __ __ __

EFFECTIVE DATE

____/____/____

DESCRIPTION

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

__ __ __ __ __ __ __ __ __ __ __ (30 Characters Maximum)

COUNTRY

USA

STREET (Line 1)

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

__ __ __ __ __ __ __ __ __ __ __ (30 Characters Maximum)

STREET (Line 2)

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

__ __ __ __ __ __ __ __ __ __ __ (30 Characters Maximum)

STATE

__ __

CITY

__ __ __ __ __ __ __ __ __ __ __

ZIP (Suffix optional)

__ __ __ __ __ - __ __ __ __

Name of person completing this

form (If not Table Administrator)

________________________________________________

Phone

________________________________________________

Table Administrator Signature

(Mandatory)

________________________________________________

Return form to MMB, 658 Cedar Street, Centennial Building, St. Paul, MN 55155-1689 or fax to (651)

797-1341.

Call (651) 259-3634 if you have questions completing this form.

For MMB Use Only: Notify HR Proc Unit Contacts q

admserv/sema4/general/hr processing unit change (04/09)

Hr Processing Unit Change Form