CIVIL SERVICE APPOINTMENT CHANGE FORM

Office of Human Resources

SOUTHERN ILLINOIS UNIVERSITY Edwardsville
Employee Name	Banner ID
Supervisor’s Name

Phone

CURRENT STATUS	CHANGED TO (NEW) STATUS
Class (Title)	Class (Title)
Appointment type

Continuing

Temporary (not to exceed 3 mos.)

Extra Help (intermittent work)

AND

Full-time OR	Effective Date	End Date
Appointment type

Continuing

Temporary (not to exceed 3 mos.)

Extra Help (intermittent work)

AND

Full-time OR
Part-time at	% (e.g., .3333=33.33)	Part-time at	% (e.g., 3333=33.33)
Temp Assign Pay: $_____________________________	Temp Assign Pay: $_____________________________
SM salary	$	OR BW Hrly rate	$	SM salary	$	OR BW Hrly rate	$
NBAJOBS position no:	NBAJOBS position no:
Dept. Organization Code:	Dept. Organization Code:
1. AIS Acct Title:	1. AIS Acct Title:
Budget Purpose:	Labor Dist %:	Budget Purpose:	Labor Dist %:
2. AIS Acct Title:	2. AIS Acct Title:
Budget Purpose:	Labor Dist %:	Budget Purpose:	Labor Dist %:
3. AIS Acct Title:	3. AIS Acct Title:
Budget Purpose:	Labor Dist %:	Budget Purpose:	Labor Dist %:
OVERTIME ONLY	OVERTIME ONLY
4. AIS Acct Title:
4. AIS Acct Title:
Budget Purpose:	Labor Dist %:	Budget Purpose:	Labor Dist %:
5. AIS Acct Title:
5. AIS Acct Title:
Budget Purpose:	Labor Dist %:	Budget Purpose:	Labor Dist %:

REASON FOR CHANGE:

Signature of Fiscal Officer
Date:
Signature of Dean or Director
Date:
Signature of Chancellor or Vice Chancellor
Date:
HUMAN RESOURCES OFFICER:
CS Sys ID (also CS Posn Tr No.): N
CS Appt Type
CS Occ Code
Posn Class Code:
E-Class
Job Progression
Banner Position No – Employee Reassignment
Leave Category
9/10/15 – previous versions obsolete

jchura

2015-09-16

Chura, Joyree

SIUE