Personnel Action Notice Form

Feonix - Mobility Rising
Personnel Action Notice Form (PAN)
Employee Name
First NameLast Name
Job Title
Title
Supervisor's Name
Supervisor
Department
Work LocationRe
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Work Email
Feonix Email
Personnel Email
example@example.com
Phone Number
Area CodePhone Number
Employment
Start Date
MonthDayYear
Date
Reason for Change
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
MonthDayYear
Date
Termination
Type a question
Effective Date
MonthDayYear
Date
Approved by:
Date
MonthDayYear
Date
Signature
Clear
Should be Empty:

Feonix - Mobility Rising