Uwsa Personnel Action Form (Paf)
UWSA PERSONNEL ACTION FORM (PAF)
Employee Name: Not necessary for recruitments/ Empl ID:
Not necessary for recruitments
Name of Supervisor: / Department Name
Person Submitting Form: / Date form completed:
APPROVAL TO FILL
Previous Employee Name:
Previous Employee’s Title: / *Attach previous employees PD
Previous Employee’s FTE%:
Previous Employee’s Salary:
Previous Funding Source(s)[see below*]:
Previous Employee’s Type of Employment: ☐Academic Staff ☐Limited ☐Univ. Staff ☐US Proj.☐USTemp ☐Student
Requested Job Title: / *Attach updated PD
Requested Working Title:
Requested FTE (%):
Requested Salary Range:
Requested Funding Source(s):
Type of Employment: ☐Academic Staff ☐Limited ☐University Staff ☐Univ. StaffProj. ☐Univ. Staff Temp. ☐Student
For HR Use Only:
Title Verified: ______Reviewed for ACA: ______☐WRS Eligible ☐Needs Further Review (See attached)
APPROVALS:
President or Vice President: *Send to HR when complete
Date:
HIRE
(Completethe original PAF form used to begin the recruitment process)
Hire’s Name (Last, First, MI):
Type of Hire: ☐Internal – from w/in UW ☐From other State agency ☐New/Original
Job Title: / Job Code:
Date Job Offer Made to Employee:
Start Date: / Expected End Date, if applicable:
Salary:
Email Address:
Rehired Annuitant (check one): ☐Yes ☐No
Funding Source(s)*:
Work Address: / Room#:
Work Phone:
APPROVALS:
PrintSupervisor Name:
Supervisor Signature/Date: *Send to HR& Controller when complete
Controller/Date:
HRS ENTRY by/date:
*[Funding format: Business Unit – Fund – Department – Program Code – Project ID – i.e., W 350 451000 1
Employee Name:/ Empl ID:
Name of Supervisor: / Department Name:
Person Submitting Form: / Date form completed:
TERMINATION *Include copy of resignation letter
Last Day in Pay Status:
Reason:
☐ Retirement(Has applied for ETF annuity) ☐Transfer within UW To:
☐ Transfer to other state agency: Enter text. ☐Resignation ☐Other:
APPROVALS:
Supervisor Signature/Date: *Send to HR& Controller when complete
Controller/Date:
JOB CHANGE *Include supporting documentation
Effective Date of Change:
Written explanation of change(s):
Check all applicable boxes:
☐ Title Change (Note: If different job, complete HIRE section on reverse instead):
☐ New Salary:
☐ Supervisor Change:
☐ New Funding:
☐ New FTE%:
Is FTE Change Permanent?: ☐Yes ☐No (If no, new PAF needed to readjust FTE%)
☐ Change Job End Date:
☐ Leave Without Pay Begin:
☐ Leave Without Pay End:
APPROVALS:
Department Head or Supervisor:
Department Head or Supervisor Signature/Date: *Send to HR& Controller when complete
Controller/Date:
OVERLOAD/LUMP SUM PAYMENT *Include supporting documentation
Type of Employment: ☐Unclassified ☐Classified
Total of overload/lump sum payment(s):
Amount of each payment (if not one-time):
Number of payments:
Payment Start Date (enter first day of applicable pay period):
Payment End Date (enter last day of applicable pay period):
Funding:
OVERLOAD/LUMP SUM PAYMENT APPROVALS:
Department Head or Supervisor:
Department Head or Supervisor Signature/Date: *Send to HR& Controller when complete
Controller/Date:
HRS ENTRY by/date:
PAYROLL ENTRY by/date: