PERSONNEL ACTION FORM Date Effective MM slash DD slash YYYY Personnel Action FormDate(Required) MM slash DD slash YYYY Name(Required) First Last Employment Status(Required) New Hire Re-Hire Transfer Lay-Off Separation Pay rate per hourPay rate per yearType Exempt Non-Exempt Program(Required) Form Purpose(Required) Employment Status Change Job Information Change Pay Rate Change Leave of Absence Employment Status ChangeChange From Full-Time Exempt Salaried Temporary Lay-Off Schedule Change Part-Time Non-Exempt Hourly Regular Re-Hire Change To Full-Time Exempt Salaried Temporary Lay-Off Schedule Change Part-Time Non-Exempt Hourly Regular Re-Hire Job Information ChangeChange FromTitle Supervisor Department Change ToTitle Supervisor Department Pay Rate ChangeChange FromPer HourPer YearChange ToPer HourPer YearLeave of AbsenceLeave Starts on: MM slash DD slash YYYY Expected Return Date: MM slash DD slash YYYY Leave Paid Leave Unpaid Leave Workers Compensation Leave Type of Leave Additional SectionComments Δ