Student/Temp Status Change and Termination Authorization
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 an employee whose employment is ending.

Personnel Action *
First Name (Legal) *
Your answer
Last Name (Legal) *
Your answer
Employee Email Address
Your answer
Employee Phone Number
Your answer
Start Date of Change or Rehire *
Provide start date of employee action (Change or Rehire)
MM
/
DD
/
YYYY
End Date of Change or Termination *
Provide end date of employee action (Change or Termination)
MM
/
DD
/
YYYY
Job Title *
Your answer
Employee Type *
Department Name *
Your answer
Budget Account Number (Enter account wages will be charged to - if Work Study, enter 0) *
Your answer
Pay Rate *
Your answer
Submitted By: *
Please enter supervisor name
Your answer
Special Instructions/Information Regarding Personnel Action
Your answer
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