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Payroll Change Form for Student Employees
PLEASE NOTE: This form is ONLY applicable for undergraduate student employee hires (work study or non-work study jobs) and graduate student employee hires (work study jobs only).
1. Your Name
2. Your Email Address

Employee Info

3. Employee Name:
4. JobX Job ID#
5. PeopleSoft Employee ID:
6. PeopleSoft Employee Record #:
7. Pay Rate Change Effective Date:
8. Current Pay Rate:
9. New Pay Rate:
10. Retro $$ owed:
11. Date From:
12. Date To:
13. Combo Code Effective Date:
14. Current Combo Code(s):
15. New Combo Code(s):
16. Additional New Combo Code(s):
17. Remove Combo Code(s) (use only if codes need to be removed, not replaced):
18. Supervisor Change Effective Date:
19. Current Supervisor:
20. Current Supervisor ID:
21. New Supervisor:
22. New Supervisor ID:
Only complete when employee terminates:
23. Termination Effective Date (last day worked):