Personnel Action Form
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1COLLEGE OF COASTAL GEORGIA
PERSONNEL ACTION FORM
Employee Name _________________________________ Employee ID (ADP) _________________ Banner ID __________________
Last, First
Job Title ___________________________Department _______________________________ Effective Date __________________
☐ New Hire (Section A, B, E)
☐ Change Funding (Section A, E)
☐ Other Change (Section B, E)
☐ Re-hire (Section A, B, E)
☐ Pay Rate Change (Section A, B, E)
☐ Reclassification (Section B, E)
☐ Leave of Absence (Section C, E)
☐ Promotion (Section A, B, E)
☐ Termination (Section D, E)
Section A – Position Funding Data (all changes in position funding must be approved by Budget/Grants)
Funding Distribution: ☐ 100% from Home Department listed above
☐ Split Funding or Other Funding (detail below)
Position Number ___________________Funding Comments __________________________________________________________
Job Code_________ Current Job Title _______________________________ New Job Title __________________________________
☐Full-Time (40 hours a week)
☐ Permanent
☐ Faculty Fiscal (12 month)
☐Part-Time- if so, indicate standard hours per week__________
☐Temporary
☐ Faculty Academic (10 month)
Benefits Eligible: ☐ Full benefits package
☐ Partially benefitted
☐Not eligible
Section B – Job Data/Position Data Changes
New Manager
________________________________________________________
(Responsible for Hiring/Performance Evaluations/Time Off Requests)
New Pay Rate:
Hourly/Non-exempt_____________
Salaried/Exempt_____________
Per Credit Hour_____________
Other Changes/Comments*_____________________________________________________________________________________
*Please give specific reason for change. For example- pay rate change-equity
Section C – Leave of Absence (different from time-off submitted electronically in ADP- sick, vacation, jury duty, etc.)
From: _______________________ To: _______________________
☐ Paid (until exhausted)
☐ Unpaid
Type of Leave:
☐ Personal
☐ Medical
☐ Military
☐ Worker’s Comp
☐ Other____________________
Additional documentation required to be sent to Human Resources. Do not attach.
Section D – Terminations
Last day worked: ______________________________
All terminations require a reason code. Please select one from the options below:
☐ Resignation
☐ Retire
☐ Job Abandonment
☐ Violation of Rules
(please attach letter)
(please attach letter)
☐ Insubordination
☐ Attendance
☐ Failure to Return from Leave
☐ Unsatisfactory Performance
☐ No Show
☐ Payroll Inactivity
☐ End of Temporary Employment
☐ Other______________________
Comments ___________________________________________________________________________________________________
Section E – Approvals –
To avoid a delay in processing, any action requested in Section A, B, or d will require VP for Business Affairs’ approval prior to
submission to Human Resources. Sections C does not require approval from Business Affairs.
Print Name
Signature
Date
Department Head/Budget Manager
Cabinet Member
Vice President for Business Affairs
Jeffrey H. Preston
Director of Human Resources
Phyllis Broadwell
Gregory F. Aloia, PhD
President
HR USE ONLY: Position # __________________ Entered by _________________ Date Entered ___________________
Georgia Defined Eligible: Yes
No
Entered in:
☐Georgia New Hire
☐ EVerify
☐ Skillsoft
February 2015
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Parent category: Business