Employee Department Change Form

EMPLOYEE DEPARTMENT CHANGE FORM

Personal Information

Employee Name:    Employee ID:

Phone:    Email:

Current Position Information

Current Job Title:

Current Department:    Current Manager:

Current FTE:    Current Location:

Proposed/New Position Information

Proposed Job Title:

Proposed Department:    Proposed Manager:

Proposed FTE:    Proposed Location:

Effective Date:    Position Number / Job Code:

Compensation and Employment Terms

Current Salary / Hourly Rate:    Proposed Salary / Hourly Rate:

Is this change a promotion, lateral transfer, demotion, or reclassification?    Promotion    Lateral Transfer    Demotion    Reclassification

Employment History (Most Recent)

Title:    Dates Employed (From - To):

Title:    Dates Employed (From - To):

Education

Highest Degree:    Institution:

Graduation Date:

Professional References

Phone:    Email:

Phone:    Email:

Phone:    Email:

Approvals and Notifications

Current Manager Approval:    Approve    Deny

Printed Name:    Date:

New Manager Approval:    Approve    Deny

Printed Name:    Date:

HR Representative Review:    Review Complete    Additional Info Required

HR Printed Name:    Date:

Payroll Notified: Yes    No    Payroll Notified By:    Date:

Legal and Administrative Statements

At-Will Employment: I acknowledge and understand that my employment with the organization is at-will and that this departmental change does not alter the at-will nature of my employment unless there is a separate written agreement signed by an authorized representative of the organization.

Equal Opportunity: The organization is an equal opportunity employer and makes employment decisions without unlawful discrimination. This change shall be administered consistent with applicable laws and organizational policies prohibiting discrimination and harassment.

Authorization: I authorize the organization and its designated agents to contact prior employers and references and to conduct employment-related background checks as necessary to administer this change. I understand that information obtained will be used solely for employment-related purposes.

Employee Certification

I certify that all information provided on this form is complete and accurate to the best of my knowledge. I acknowledge that misrepresentation or omission of material facts may result in disciplinary action, up to and including termination. By signing below I accept the terms of the proposed departmental change as described above and understand any changes to compensation, benefits, or classification will be effective on the date approved by HR and implemented in payroll.

Sign Now