HR Change Request

Manager Email Address(Required)

This will be used to send you a copy of this form.

Please specify:(Required)

Please elaborate on the reason for the change(s):(Required)

Upload the resignation letter here.(Required)

No file chosen

Employee's New Hours(Required)

Employee's New Title(Required)

Employee's New Salary/Wages(Required)

Please describe your employee's weekly schedule:(Required)

Effective Date of Change(Required)

Date that these changes (hire or adjustment) should take effect.

New Hire/Rehire — Employee Information

Employee Date of Birth

If the employee is under 18, a work permit will be required.

Employee's Updated Resume (If Applicable)

No file chosen

Please upload your employee's complete job description.(Required)

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Mobile(Required)

Home Phone (If Applicable)

Personal Email Address(Required)

Work Location(Required)

Where will your employee be based?(Required)

Department(Required)

Office Location (Room Number)

Office Phone Number

If yes, is there an extension that should be assigned?

Job Title(Required)

Please upload a clear photo that includes your employee's head and shoulders.(Required)

No file chosen

This can also be emailed to salleyne@jccgb.org if a photo is not readily available.

Please list any equipment needs:

Please note: Your department may be required to cover the budget.

Hire Type:(Required)

Please describe your employee's weekly schedule:(Required)

Hourly Rate(Required)

If the rate varies, please provide the rate that will be used most often.

Hours/Week(Required)

A rough estimate is fine. This is necessary because there is a difference in how employees who work 1–2 hours/week are entered into the system compared to those who work 20 hours/week.

Annual Salary(Required)

GL/Payroll Code(s)(Required)

Direct Supervisor(Required)

Please list any scheduling details for your employee's offer letter:

Please let us know why your employee requires access to each of these specific locations:(Required)

Do you have any other comments or information?

New Hire/Rehire — Employee Information

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