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Personnel Action Form Template

This personnel action form is used to document employee changes including new hires, promotions, transfers, leaves of absence, terminations, and annual reviews. It requests information such as the employee and department name, effective date of change, reason for change, type of change being made, and terms of any incentive plans for new employees. The human resources representative signs and dates the completed form.

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Herbert Bactong
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468 views1 page

Personnel Action Form Template

This personnel action form is used to document employee changes including new hires, promotions, transfers, leaves of absence, terminations, and annual reviews. It requests information such as the employee and department name, effective date of change, reason for change, type of change being made, and terms of any incentive plans for new employees. The human resources representative signs and dates the completed form.

Uploaded by

Herbert Bactong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Personnel Action Form

Employee Name _____________________________ Date of Request _______________


Department _______________ Position _______________ Effective Date __________

Reason for Change:


New Employee  Annual Review  Promotion 
Dept./Job Transfer  Leave of Absence  Termination 
Other  (Please indicate reason: _________________________________________________

If Leave of Absence, please indicate reason:


FMLA  Military  Jury Duty 
Bereavement  Personal  Workers Compensation 
Other  (Please indicate reason: _________________________________________________

Type of Change From (Current Status) To (Changed Status)


Salary
Bonus
Position
Department
Manager
Location
Full-time/Part-time
Classification
(Exempt vs. non-exempt)

If New Employee, please complete the following:


Incentive plan Yes  No  If yes, please indicate terms: ____________________________
New Position  Replacement  If replacement, indicate preceding employee: ___________

Comments: ___________________________________________________________________
_____________________________________________________________________________

___________________________________ _______________________
Human Resources signature Date

This form is provided as an example and is for informational purposes only. If utilized, the form should be adapted to reflect the
company's own policies and procedures. Please consult with a legal or tax professional as appropriate.

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