Transfer: Internal Transfer/Reassignment Request

This is a request for transfer/reassignment from one location/department to another. This request is subject to availability of a position at the new location/department as well as the business and staffing needs of the organization. The transfer request date is subject to change to meet business and staffing needs.

Employees must complete Sections 1 and 2 and submit the form to Human Resources.

SECTION 1: EMPLOYEE'S CURRENT INFORMATION

Employee's name:

Current department:

Current position:

Current base salary:

Current work schedule (include hours and days per week):

Days available                          Hours available

M, T, W, TH, F, SAT, SUN                       AM   PM

(Circle days)

SECTION 2: REQUESTED TRANSFER/REASSIGNMENT

Requested department:

Requested position:

Requested work schedule (include hours and days per week):

Reason for request:

Requested transfer date:

Employee's signature:                                                Date:

SECTION 3: TRANSFER/REASSIGNMENT POSITION INFORMATION

(To be completed by supervisor in the department/location the employee is requesting)

New position title:

New position number:

Department:

New work schedule (include hours and days per week):

Requested base salary:

Requested effective date (must be prospective and at the beginning of a pay period):

Reason for reassignment:

SECTION 4: TRANSFER/REASSIGNMENT APPROVAL

Print current supervisor's name:

Signature:                                                                    Date:

Print new supervisor's name:

Signature:                                                                    Date:

New department/division head's signature:             Date:

HR approved salary:                                                   Effective date

Express Requests

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