Feonix - Mobility Rising
Personnel Action Notice Form (PAN)
Employee Name
First Name
Last Name
Job Title
Title
Supervisor's Name
Supervisor
Department
Work LocationRe
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Email
Feonix Email
Personnel Email
example@example.com
Phone Number
-
Area Code
Phone Number
Employment
Start Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Change
New Hire
Rehire
Intern
Other
Employee Status
Rows
Exempt
Non-Exempt
Full Time
1
2
Part Time
3
4
Change in Salary or Status:
Rows
Change
From
To
Title Change
5
# of Hours Working
6
Salary
7
Rate of Pay
8
Per Diem
9
Stipend
10
Holiday
11
Other
12
Comments
Effective Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Termination
Type a question
Discharged
Resignations
Laid Off
Quit Without Notice
Effective Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Approved by:
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: