Office personnel action Request Form "*" indicates required fields Requestor Email* Select your Action Type* Resignation/Retirement Termination Change of Address Retro Pay Leave of Absence Pay Rate Change Transfer Effective Date* MM slash DD slash YYYY Section 1: Employee Information Employee Name* First Last Employee ID#*Home Dept*Human ResourcesAccountingOperationsJob Title* Section 2: Assignment Information Action Type* Resignation Retirement Future Eligibility* Eligible for Re-Hire Do Not Re-Hire Proof of Resignation*Max. file size: 50 MB. Proof of TerminationMax. file size: 50 MB. W4 Upload*Max. file size: 50 MB. Date & Hours*DateAmount of Hours Add Remove*if multiple days are being requested, please select the "+" sign for more entries. To* MM slash DD slash YYYY From* MM slash DD slash YYYY Previous Pay Rate*New Pay Rate*From Position*To Position*Pay RateNotes Δ
