PERSONNEL ACTION SLIP
Step
1
of
4
25%
Date
*
MM slash DD slash YYYY
Employee Number
*
Project Name/Number
*
Change, complete sections
Re-Hire (Section 1, 2)
Promotion (Section 1, 2)
Warning (Section 1, 3)
Termination (Section 1, 3)
Section 1
Current Employee Information
Employee Name
*
First
Last
Current Job Title
*
Current Job Number
*
Current Wage
*
Section 2
New Employee Information (complete fields that have changed)
Type of Change
Job Reclassification
Promotion
Demotion
Merit Increase
Other
Type of Other Change
Employee Status
Regular Full-time
Regular Part-time
Salary Full-time
Salary Part-time
Job Status
Exempt
Non-Exempt
New Job Title
Supervisor
Department
Merit Increase
New Wage
Effective Date
MM slash DD slash YYYY
Section 3
Separation/Warning Information
Last Day Worked
MM slash DD slash YYYY
Eligible for Rehire
*
Yes
No
(1-5, 1-being lowest, 5 being highest)
Warning notice
*
Verbal Warning
Written Warning
Third Choice
Suspension Pending Investigation
Suspension Pending Termination
Reason for Warning
*
Personal Reasons
Quit w/o Notice
Employee Resignation
Unsatisfactory Performance
Violation of Safety Rules
Attendance
Failed Pre-Emp. Reqs.
Quit w/ Notice
Leave
Temporary Layoff (tentative return date)
Military Leave (expected return date)
return date tentative or expected
MM slash DD slash YYYY
HE/SHE returned
Keys
Laptop
Phone
Gas Card
Vehicle
Credit Card
(Indicate item returned, i.e. which keys, which credit cards, which vehicle)
Employee Signature
*
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