Student/Temp Status Change and Termination Authorization

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Supervisors will complete this form when they need to place a Student or Temp employee on Leave without Pay or Return them from Leave to Active Status; change the employee from Student to Temp or Temp to Student; Rehire a previously terminated employee, or Terminate a Student or Temp employee whose employment is ending.

Personnel Action *

Change - Student to Temp (Employee Currently Active Status)

Terminate

Change - Other (Provide explanation in Special Instructions Section below)

Rehire (Employee Previously Terminated Employment)

Change - Temp to Student (Employee Currently Active Status)

Hire (Temporary - One-time Event Support)

Change - Return to Active Status (Employee Currently on Leave without Pay Status)

Change - Place on Leave without Pay (Employee Currently Active Status)

First Name (Legal) *

Last Name (Legal) *

Employee Email Address

Employee Phone Number

Start Date of Change or Rehire *

Provide start date of employee action (Change or Rehire)

YYYY

End Date of Change or Termination *

Provide end date of employee action (Change or Termination)

YYYY

Job Title *

Employee Type *

Student

Work Study

Temp

Department Name *

Budget Account Number (Enter account wages will be charged to - if Work Study, enter 0) *

Pay Rate *

Submitted By: *

Please enter supervisor name

Special Instructions/Information Regarding Personnel Action

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.