Student/Temp Status Change and Termination Authorization
Fill out form ONLY after candidate has applied for, and accepted a posted position OR employee has resigned their position.
Personnel Action *
First Name (Legal) *
Your answer
Last Name (Legal) *
Your answer
Date of Hire or Rehire *
MM
/
DD
/
YYYY
End Date
Provide date when terminating students
MM
/
DD
/
YYYY
Job Title *
Your answer
Employee Type *
Department *
Your answer
Account number *
If position is funded by department/grant use Acct Number, and if Work Study, enter '0' Financial Aid with provide the Account Number
Your answer
Pay Rate *
Your answer
Submitted By: *
Please enter supervisor name
Your answer
Special Instructions
Your answer
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