Employee Transaction Form Requisition #

Employee Transaction Form
Requisition #
California State University, Los Angeles
2. PeopleSoft Employee ID No. 3. Legal Name (Last, First, Middle)
Faculty
Student
Staff
TA
MPP
GA
4. Job Code Description (Classification)
5. Department
6. Dept. Code
7. School Code
1.
9. Collective Bargaining Unit (check box)
10. Working Title
1
2
3
4
5
6
7
8
9
11
11. Supervisor & Extension 12. Other Current Employment
(including Cal State L.A.)
14. Institution where highest degree earned
16.
PS Position #
18.
Account:
20. Action/Reason
Position
Unit
Job Code
Grade
Degree
13
13. Any Previous CSU Employment?
15. Doctorate Expected
Date:
Institution:
17.
Concurrent Position
PS Position #
Unit
Job Code
19.
Program:
C99
E99
Teaching
Yes
Grade
M98
Non-Teaching
No
Time Base
Rec Hours Units
Concurrent Chart Fields
Fund:
Dept. ID:
Account:
M80
Program:
Retired Annuitant
12-Month
10-Month
21. Compensation Rate
Effective Date
Expires on or Before
Base
Actual
Month
F 20
W 20
OR
Sp 20
Su 20
Hire/Rehire (If faculty, check below)
FERP
Graduate Assistant
Part-Time
Full-time Temp.
Teaching
Probation
Contract
Promotion
Reassignment (Transfer)
Return from Reassignment
Change in Units/Hours
From:
To:
Extension of Temporary Appointment
Internal Position No. Change Only
Other (Indicate in "Remarks" box)
Selected for Announced Position
Change from temporary to permanent appointment
Eligible for benefits (Must enroll within 60 days)
Credit given toward probationary period
Remarks:
Year
Time Base
Rec Hours Units
Chart Fields
Fund:
Dept. ID:
Academic Year
Month
8. Work Location Abbreviation
Day
Year
Month
Day
Year
$
Concurrent Position
Suspension
Demotion
Reclassification
Reinstatement
Placing on Leave
$
Extension on Leave
Unit
Quarter
Month
Day
Hour
Step
22. Work Schedule
No Change
5/40
4/40
Other: __________________________
Work Days/Hours:
IDL
IDL w/ Supplementation
LWOP 23. Leave Conditions (Academic Only)
NDI
TD
TD w/ Supplementation
SSI Credit
Sabbatical Accrual
Military Leave
Family Medical Leave
Tenure Credit
Parental Leave
Administrative Leave
Sabbatical:
1 Qtr. - Full Pay
Return from Leave
2 Qtr. - 3/4 Pay
3 Qtr. - 1/2 Pay
Difference in Pay:
(Last Day Physically Worked)
(Payroll Return Date)
1 Qtr.
2 Qtr.
3 Qtr.
Other
Month
Day
Year
Month
Day
Year
Earliest date for Sabbatical Eligibility:
Month
Day
Year
Department Head
Date
Dean/Director
Date
Fiscal Officer
Date
Executive Officer
Date
Human Resources Management
Date
24. Tenure Status
Career Center
Financial Aid
Date
No Change
Tenure Credit
1 Yr.
2 Yrs.
25. Service-based Salary Increase 26. PeopleSoft Entry
(A)
1 Year (A)
2 Years
Tenure Not Applicable
Month
Year
On Probation, probationary in another class:
Not Eligible for Permanent Status:
Action:
(B)
1 Year (B)
2 Years
(N)
Temporary
On Probation, permanent/tenured in another class: (N)
Less than full-time
Reason:
Initials:
(C)
1 Year (C)
2 Years
(N)
Positive Attendance
No Change
Not Applicable 28. Professional License/Certificate
(D)
Probation, Partial Waiver
(N)
Management Personnel Plan
Expiration Date
27. Prob. Period Ending Date
(E)
On probation, following LWOP,
(P)
Probationary/tenure in another
Code
Month
Day
Year
Month
Day
Year
W/C, IDL or NDI
class, none this class
(I)
Permanent/Tenured
(Q)
Permanent/tenure in another
(J)
Permanent/Total Waiver
class, none this class
Payroll Use:
30. This Document Prepared By:
29.
FLSA Status:
Initial:
Date:
No Change
Not Applicable
Extension:
Exempt
Non-Exempt
On Probation, no probation or permanent status
in another class:
HRM-884-1 (08/30/2012)