This is a request for transfer/reassignment from one location/department to another. This request is subject to availability of a position at the new location/department as well as the business and staffing needs of the organization. The transfer request date is subject to change to meet business and staffing needs.
Employees must complete Sections 1 and 2 and submit the form to Human Resources.
SECTION 1: EMPLOYEE'S CURRENT INFORMATION
Current base salary:
Current work schedule (include hours and days per week):
Days available Hours available
M, T, W, TH, F, SAT, SUN AM PM
SECTION 2: REQUESTED TRANSFER/REASSIGNMENT
Requested work schedule (include hours and days per week):
Reason for request:
Requested transfer date:
Employee's signature: Date:
SECTION 3: TRANSFER/REASSIGNMENT POSITION INFORMATION
(To be completed by supervisor in the department/location the employee is requesting)
New position title:
New position number:
New work schedule (include hours and days per week):
Requested effective date (must be prospective and at the beginning of a pay period):
Reason for reassignment:
SECTION 4: TRANSFER/REASSIGNMENT APPROVAL
Print current supervisor's name:
Print new supervisor's name:
New department/division head's signature: Date:
HR approved salary: Effective date
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