JOB CHANGE REQUEST FORM

Administrative & Professional Staff, Faculty, & Graduate Assistants

(For changes other than extensions of appointment periods)

“Acting” positions may not be given an appointment period which exceeds one year.
Legal Name:
Banner ID:
Campus: Alton ESL Edw Spfld	Box:	Bldg & Rm No.:	Phn w/Prefix:
POSITION/JOB INFORMATION	CURRENT STATUS:
**Please do not use the delete key or backspace key in the Hrs. Per Pay column or the Actual Assign Salary column.**
POSN TITLE/RANK	POSN No.	Full-Time Semi-Mo Salary

Base	Appt. Percent

(4 decimal places max, e.g., 33.33)	**Hrs. Per Pay (F9 to calc)	**Actual Assign Salary (F9 to calc)	Sal Hold (Y/N)	Account Title	Org/

DDU

AIS

Budget

Purpose

0.00	$ 0.00
0.00	$ 0.00
0.00	$ 0.00
0.00	$ 0.00
CHANGE STATUS TO:
0.00	$ 0.00
0.00	$ 0.00
0.00	$ 0.00
0.00	$ 0.00
0.00	$ 0.00
GRANTS OFFICE APPROVAL (Grant Accounts Only):	Approved by:
Date:

EFFECTIVE DATE(S) FOR CHANGE: Beginning	Ending	or Continuing
TYPE OF APPOINTMENT:	Academic:
Faculty Continuing
Faculty Term
Grad Asst (term only)
Fiscal:
Faculty Continuing
Faculty Term
Grad Asst (term only)
Admin/Professional Staff:
Administrative Staff Continuing
Administrative Staff Term
Professional Staff Regular (IEA/NEA)
Professional Staff Durational (IEA/NEA)
COMMENTS & JUSTIFICATION:

This extra service is over and above services required by the current budgeted contract. It will not affect performance under such contract.
READ BEFORE SIGNING: The applicant agrees that if appointed, his or her conditions of employment will include the laws of Illinois, including Board of Trustees legislation, and all policies and regulations, including those of SIUE, from time to time issued pursuant thereto, and any applicable collective bargaining agreement, all of which will be as much a part of the applicant's employment contract as if set out in full therein, and that such terms and conditions as from time to time amended will continue to govern in any change of assignment or renewal of the appointment.
Signature of Staff Member
Date
Please sign and make a file copy before forwarding.
As defined by the Office of the Secretary of State and based on the responsibilities assigned to this position, the employee will be required to complete a Statement of Economic Interest. URL for filing info., including criteria: http://ethics.siu.edu/
RECOMMENDATION:
Chair/Supervisor
Date
Dean/Dir./Fiscal Officer
Date
Vice Chancellor
Date
Chair/Supervisor
Date
Dean/Dir./Fiscal Officer
Date
Vice Chancellor
Date
ACCEPTED BY DIRECTOR OF HUMAN RESOURCES:
Date:
APPOINTMENT: Subject to the requirements of the Board of Trustees' Policy on Personnel Approval, you are hereby appointed to the position described above.
Chancellor
Date
Date approved/ratified by President
Date ratified by Board of Trustees
PAYROLL STAFF:	NBAJOBS: Job Labor Dist Changed
New Eff Dated Job Detail Record Created with Labor Dist Change Reason Code	PHAREDS:	Completed NA
FICA SURS Medicare	12/31/12

Joyree Chura

2013-02-11

Southern Illiniois University Edwardsville