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Personnel Transaction Report PTR Employment Employee Changes All changes in employee status must be completed in every case where there is an employee change in job classification salary rate job status or termination. This form must be received by Human Resources-Auxiliary Services Corporation ASC PRIOR to the effective date. If you have any questions regarding this form please contact Human EMPLOYEE INFORMATION S.S.N. CWID Last Name First Name Middle Initial Address City Zip Code Phone number Email Emergency Contact Current ASC Employee CSUF Faculty/Staff All employees are required to meet federally mandated I-9 work eligibility and authorization procedures. Personnel Transaction Report PTR Employment Employee Changes All changes in employee status must be completed in every case where there is an employee change in job classification salary rate job status or termination* This form must be received by Human Resources-Auxiliary Services Corporation ASC PRIOR to the effective date. If you have any questions regarding this form please contact Human EMPLOYEE INFORMATION S*S*N* CWID Last Name First Name Middle Initial Address City Zip Code Phone number Email Emergency Contact Current ASC Employee CSUF Faculty/Staff All employees are required to meet federally mandated I-9 work eligibility and authorization procedures. All employees therefore must present acceptable work authorization documents in person to Human Resources-ASC PRIOR to their first day of work as a new hire or rehire. EMPLOYMENT ACTION AND CLASSIFICATION Effective Date Account Number Action Type New Hire Rehire Change Employee Classification Full-time Part-time benefited Part-time Rate Change Reason if app Merit attach evaluation Promotion HR must approve Other Job Title Position Change Reason Promotion-HR approval Req Reclassification Other Specify Comments Leave of Absence HR approval req Pay Rate Change Termination From FLSA Temporary Exempt Student up to 20/hr wk Salary Pay Rate To Non-Exempt Hourly JOB INFORMATION Rate Diff Proposed New Rate if app HR must approve current vs. proposed new rate Bi-weekly Work Location On-campus Location Hours/Week HR must approve ALL pay rates This position Has supervisory authority AB1825 Training required Works with Children LiveScan required YES Has cash handling responsibilities DEPARTMENT AND CONTACT INFORMATION Director/PI please print Budget Period Not to exceed one year Contact Person please print NO Dept/Project Name REASON FOR SEPARATION Professional Development End Temporary Appt Better Job Better Pay Personal Reasons Dissatisfaction with Job Eligible for Rehire Yes No AUTHORIZATION SIGNATURES Phone Requires HR Approval Job Abandonment Layoff Dismissal Fail Rtn from Leave Separation by Agency TRANSACTION IS NOT OFFICIAL WITHOUT ALL REQUIRED SIGNATURES AND FINAL HR APPROVAL Employee Date Human Resources Initiating Supervisor Executive Director Approving Supervisor OSP/Agency FICA Exempt International Student Pay Class WC Code Copy Payroll Distribution Original HR Copy Employee Rev 04/18/12 Department to retain own copy.

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