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