HR Requirements or Form
Employees must complete Sections 1 and 2 and submit the form to Human Resources.
SECTION 1: EMPLOYEE'S CURRENT INFORMATION
Employee's name:
Current department:
Current position:
Current base salary:
Current work schedule (include hours and days per week):
Days available Hours available
M, T, W, TH, F, SAT, SUN AM PM
(Circle days)
SECTION 2: REQUESTED TRANSFER/REASSIGNMENT
Requested department:
Requested position:
Requested work schedule (include hours and days per week):
Reason for request:
Requested transfer date:
Employee's signature: Date:
SECTION 3: TRANSFER/REASSIGNMENT POSITION INFORMATION
(To be completed by supervisor in the department/location the employee is requesting)
New position title:
New position number:
Department:
New work schedule (include hours and days per week):
Requested base salary:
Requested effective date (must be prospective and at the beginning of a pay period):
Reason for reassignment:
SECTION 4: TRANSFER/REASSIGNMENT APPROVAL
Print current supervisor's name:
Signature: Date:
Print new supervisor's name:
Signature: Date:
New department/division head's signature: Date:
HR approved salary: Effective date
