Personal Information Form (Pif) - Change In Position - Gulfstream Goodwill Industries
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2GULFSTREAM GOODWILL INDUSTRIES - PERSONAL INFORMATION FORM (PIF)
New Hire / Rehire (Sections A & B)
Termination (Sections A & C)
Status Changes (Sections A & D)
SECTION A
1 Last Name: _____________________________
ALL GRAY AREAS FOR HR/PR USE ONLY
First Name: _________________________
Tab # 1, Employee #___________________________
3 Home Dept # _____________________ EWS Type: [ ] 1-Other
[ ] 2-Hrly
[ ] 3-Salary
Tab # 5, Senior Staff: [
] Yes [
] No
[
] CHECK HERE if requesting an Address Change (complete contact information only)
SECTION B
2 Street Address: __________________________________________________________________________
Apt/Unit #: __________________
2
City: ___________________________________ State: _______________
Zip: _______________ Residential County: ______________________
2
Home Tel #: ________________________________ Cell #: _________________________________ Email: ________________________________
1 Driver License #: ___________________________________
Class: ___________ State: ___________
Expiration Date: ___________________
1 DOB: ____________________________
Marital Status: ____________________________
Gender: [
] Male [
] Female
SS #:________________________________
# of W-4 Exemptions: _______________
W-4 Marital Status (S or M): _____________________
S = Withholding at Single, M = Withholding at Married, PER W-4
1 Citizenship: ________________
Ethnic Code: _____________
Employee Type: _____________
(HR / PR Use Only - Tab 3 & 5)
2 Emergency Contact Name: _______________________________________
Emergency Contact Tel #: _____________________________________
3 Job Title: ______________________________
Hire Date: ____________________
Hire Source: __________________________________
Dept: _____________________________
(HR/PR Use Only - Tab 3)
Benefits Eligibility:_________________________
5 Rate of Pay:
Hourly, Non-Exempt $
/ Hr
Salaried, Exempt $
/ Year
Processing Group #:
5 Effective Date of Pay Rate: ________________
Status: [ ] Full-Time
[ ] Part-Time
[ ] Per Diem
[ ] Temporary (90 days or less)
P/R Distrib Code
( Home Dept # if 100% of Wages are to be charged to Home Dept, OR Distrib as below ):
3 Seniority Date:
0.00%
0.00%
0.00%
0.00%
0.00%
6
P/R Distrib:
/
%,
/
%,
/
%,
/
%,
/
%
Enter above:
Dept #
%
Dept #
%
Dept #
%
Dept #
%
Dept #
%
3 Name of Employee's Immediate Supervisor: __________________________________________________
Title : ____________________________
3 Name of Employee's Secondary Supervisor: __________________________________________________
Title : ____________________________
3 Name of Employee's Time Manager/Approver: ________________________________________________
Title: ____________________________
***ATTACH TERMINATION REPORT & SUPPORTING DOCUMENTS***
SECTION C (Termination)
[ ] Voluntary (Employee)
[ ] Involuntary (Employer)
FOR HR / PR
USE ONLY
Last Day Worked: ______________________
Termination Date: ____________________________________
Reason:_____________________
Pay PTO: [ ] Yes [ ] No
Rehire in this position? [
] Yes
[
] No
Rehire in another position?
[
] Yes
[
] No
Stop Deductions: [ ] Yes [ ] No
SECTION D (Status Changes)
[ ] Promotion [ ] Demotion [ ] Lateral [ ] Annual Evaluation [ ] Adjustment [ ] Direct Deposit [ ] Benefits [ ] W-4 [ ] Other_______________
Pay Rate Changes
Previous Rate: __________________________
New Rate: _____________________
Effective Date: _______________
Deductions or Other
From: _________________________________
To: ___________________________
Effective Date: _______________
New Supervisor (PRINT): _______________________________________
New Location: ______________________________________________
Supervisor Signature: _______________________________________________________
Date: ______________________________________
Dir / AVP / VP Signature: ____________________________________________________
Date: ______________________________________
HR/PR Use:
WC Code:
HR Approval:
Date:
PR Approval:
Date:
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Parent category: Business