PS03

Name:        |||||||| Employee ID (six digits):        |||| Dept./School: RC Number:    ||  POSITION CHANGE // (rc mgr headmaster //  //  principal   //  // signature) required)  //     ||||||       Position Change within Department/School     ||    ||||       Designation/Teacher in      Charge        Job Reclassification  ||    ||||||   Proposed     Effective Date:          To Position    Number:        ||   Title:        ||   LEAVE OF ABSENCE/     RETURN FROM LEAVE // (rc mgr/headmaster/principal signature required) // |||||| Following Adoption Family & Medical Leave Act Maternity/Paternity //  (application required)  // ||   ||||       Education/Study Military Service Personal Reasons Personal Illness Return from Leave || ||||||  Effective Date: Position Number:       || Return Date: Title:       || TERMINATION/ RETIREMENT  |||||| AWOL Discharge for Cause Dismissal Non-R/A Layoff ||   ||||   Retirement Death Failed Probationary Period Resignation // (letter from employee required)  // ||   ||||||   Effective Date:        || ||  PAY  ADJUSTMENT  //(employee signature required) //  |||||| Adjusted Payroll Date // (Civil Service – original //    //  documentation required) // Salary Step (//Specify)//  Outside Service // ( //// original documentation required) //  || ||||      Career Award //(Specify)//  Salary Lane //(Specify)// // (original transcripts required) // Tuition Reimbursement // (original transcripts, documentation of payment and signed affidavit required) //  || |||||| // For HR Use Only // Effective Date: Old Salary: ||  New Salary:        ||  PERSONAL  DATA  CHANGE // (employee signature required) // |||||| Name Change Telephone Change || ||||      Home Address Change //  (W-4 and M-4 required)  // Mailing Address Change Change in Federal/State Withholdings // (W-4 and M-4 // //  required //// ) //  || ||||||||  New Name: New Address: New Phone:       || Originator’s Signature:        |||||||||||| ||||||  Date: || // For HR Use Only:  // ||      Approved Not Approved |||||||||||| HR Signature:       |||||| Date:       || PLEASE NOTE: All hiring of staff new to the department/school should be completed through the BPS Recruiting Center in Kenexa. The PS03 form will no longer be used for hiring. Please contact the Office of Human Resources with any questions.
 * == ACTION  == |||||||||||||| ==  REASON  == |||||||| ==  REQUIRED INFORMATION  == ||
 * Additional Explanation (if necessary): ** ||
 * Additional Explanation (if necessary): ** ||