HR MACD Request Form

HR MACD REQUEST FORM

Purpose: Use this form to request Moves, Adds, Changes, or Deletes (MACD) affecting employee records, system access, hardware/software issuance, payroll adjustments, or organizational assignments. Complete all applicable sections and obtain required approvals. Incomplete requests may be delayed.

Requestor & Employee Identification

Date of Request:    Request Type: Move Add Change Delete

Employee / Subject Information

Current Job Title:    Proposed Job Title:

Current Department:    Proposed Department:

Reporting Manager:    Effective Date of Change:

Full-Time    Part-Time    Contingent/Temporary    Salary / Hourly Rate:

Detailed Change Description

1) Field: Current: Requested:

2) Field: Current: Requested:

Systems & Access Requirements

Required system access (check all that apply). For each checked item, indicate access level and justification below.

Corporate Email    Active Directory / Account Provisioning    VPN / Remote Access

HRIS / Employee Records    Payroll System    Timekeeping System

Hardware / Software Issuance

Issue or retrieve equipment (check all that apply): Laptop Monitor Mobile Phone Access Badge Other

Termination / Offboarding (if applicable)

Is this request related to termination or separation? Yes

Last Day of Work:    Exit Checklist Required:

Payroll Adjustments (if applicable)

Approvals & Processing Instructions

Manager Decision: Approve Reject    Date:

HR Action Required: Update Employee Records Notify Payroll Initiate Background Check

IT Completed By (printed name):    Completion Date:

Employment History (for background / verification)

Title: Dates Employed:

Title: Dates Employed:

Education

References (Professional)

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Legal Disclosures & Applicant Certifications

At-Will Employment: Nothing in this request shall be construed as an employment contract. Employment with the organization is at-will and may be terminated by either the employee or the organization at any time, with or without cause, unless otherwise provided in a written agreement signed by an authorized representative.

Equal Opportunity: The organization maintains and enforces an equal opportunity policy. Decisions related to hiring, assignment, promotion, compensation, and separation will be made without unlawful discrimination on the basis of protected characteristics.

Applicant / Requestor Certification: I certify that the information provided on this form is true, complete, and accurate to the best of my knowledge. I understand that false statements or omissions may be grounds for disciplinary action consistent with company policy.

Authorization to Verify: By submitting this request, I authorize the organization and its representatives to contact prior employers, educational institutions, listed references, and other parties as necessary to verify the information provided and to perform background checks as permitted by applicable law. I agree to cooperate with necessary verification and clearance procedures.

Consent: I consent to background verification and reference checks as described above.

Final HR Notes

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