Rehire / EE Name* / Empl. ID*

Reminder: Employee’s name in PeopleSoft must match the name on the employee’s Social Security card.

Work Location / OOG ONLY: / ADJUST Job Date? YesNo Asset Date? YesNo
Effective Date* / Company*
Business Unit* / OXYCCOXYOGOXYPC / Dept. ID & Name*
Loc. Code & Name* / Supvr. ID & Name*
Job Information
Job Code & Title* / Regular/Temp. / RegularTemporary
Full/Part-Time / Full-TimePart-Time / Empl. Class / (Blank)Co-opExpatriateInpatriateInternSold and Closed Locations / Officer Code / NoneMANFOfficerSGA
Regular Shift / N/A123410Hr NR12Hr 218412Hr - 1st12Hr - 2nd12Hr 20809/80 Blue9/80 RedR 8 (2080)R 8 (2184) / Standard Hours / Work Period / W
Job Labor (Union Only) / Labor Agreement Entry Date
Labor Agreement / Union Code
Union Seniority Date / Bargaining Unit
Payroll / Pay Group* / Employee Type* / S - SalariedH - Hourly
Tax Location Code*
Salary Plan / Salary Administration Plan (4 digits)* / Grade (3 digits)*
Compensation – Pay Components / Rate Code* / NAANNLNAHRLY / Comp. Rate* / Frequency* / A - AnnualH - Hourly
Compensation – Compensation Rate / Compensation Rate* / Frequency* / B - BiweeklyH - HourlyM - MonthlyQ - QuarterlyS - SemimonthlyW - Weekly
Employment Data / Original Hire Date
Business Title / Work Phone
Co. Seniority Date / Service Date / Vac. Service Date
Earnings Distribution
Account Code / Distribution %
A. C. / D. % / A. C. / D. %
A. C. / D. % / A. C. / D. %
Benefits Program Participation / Annual Benefits Base Rate
Is Employee Returning from LTD? / NoYes / Annual Vacation (Hours)
Mail Drop ID / Time Administrator
Additional Information
Approved By: / Date:
Submitted By: / Telephone Number:

Use Excel Seniority Calculation Worksheet to calculate Company Seniority/Service Date.

NOTE: PLEASE ALSO ATTACH/SEND TAX FORM(S) AND PERSONAL DATA SHEET

Procedures for Workflow: Yellow highlight and * indicate the (minimum) information required to key a Rehire into PeopleSoft. Please submit this information to your Data Administration Team member 5–8 days prior to the employee’s Rehire Date, then provide the completed form as soon as possible.

For Data Administration Team Use:

Keyed By: / Date Keyed: / Sent to Payroll

Form Revised 04/23/2004