<p> UAS PERSONNEL PAYROLL CHANGE REQUEST FORM</p><p>Use this form to request any changes to a payroll record. Select which part(s) of the form to complete according to your required change. You must complete Section 1 in full. You must also ensure that the Head of Department has approved this request (an electronic signature or scanned form). Use the text box in section 1 to provide any other relevant information. Once completed please email it to: [email protected] Please DO NOT copy this to any other member of staff.</p><p>SECTION 1: Employee details (All fields in Section 1 to be completed in full by department) NAME: JOB TITLE: DEPARTMENT: LOCATION: CLASSIFICATION: Support Academic Related Senior Staff (ALC6)</p><p>1 2 3 4 5 APPROVAL CODE: CURRENT GRADE: 6 7 8 9 10 (if applicable)</p><p>DOES THE EMPLOYEE COST CENTRE: Yes No HOLD A TIER 2/5 VISA? ANY OTHER INFORMATION: (inc. DFC comments/ approval where necessary)</p><p>SECTION 2: Hours INCREASE TO (STATE IN HRS) REDUCE TO (STATE IN HRS) TERM TIME ONLY AMEND HOURS:</p><p>EFFECTIVE DATES: permanent change temporary change</p><p>From: From: To: (dd/mm/yyyy) (dd/mm/yyyy) (dd/mm/yyyy)</p><p>SECTION 3: Grade change CHANGE GRADE/POINT: CURRENT GRADE/POINT: (x.x) NEW GRADE /POINT: (x.x) EFFECTIVE DATES: permanent change temporary change From: (dd/mm/yyyy) From: To: Allowance to carry over: Yes No (dd/mm/yyyy) (dd/mm/yyyy) Probation period: Yes No If yes, probation length REASON FOR CHANGE New acting up (TEMP) (STATE): Extension to existing acting up (TEMP) Additional Responsibility (TEMP or PERM) Re-grading (PERM)</p><p>PLEASE NOTE: Automatic increments will only apply if this change is more than 3 months in advance of the next yearly increment date (1 august for support staff or 1 october for academic related staff)</p><p>SECTION 4: Allowances EFFECTIVE DATE: FROM: END (if applicable): (dd/mm/yyyy) (dd/mm/yyyy)</p><p>Version 3 UAS Payroll Change form June14 Page 1 of 4 TYPE OF ALLOWANCE: Market pay supplement Hours greater than standard Clothing allowance Standby & call-out pay cash Boot allowance Standby & call-out % payment Flexible shift premium % basic Other (please state) </p><p>AMOUNT: Value £ per Percentage (%) </p><p>SECTION 5: Additional recurrent increment for retention CHANGE GRADE/POINT: CURRENT GRADE/POINT: (x.x) NEW GRADE /POINT: (x.x) EFFECTIVE DATE: FROM: (dd/mm/yyyy) PLEASE NOTE: An increment business case approved by your divisional accountant and the registrar must accompany this form.</p><p>SECTION 6: Move from fixed term to permanent EFFECTIVE DATE: FROM: (dd/mm/yyyy) Allowance to carry over: Yes No Probation period: Yes No If yes, probation length PLEASE NOTE: A permanent contract must be approved via the recruitment panel</p><p>SECTION 7: Change in funding details/funding end date COST CENTRE/ ACTIVITY/TASK SOURCES OF % SPLIT FUNDING FUNDING PROJECT CODE FUNDING START DATE END DATE OR AWARD (dd/mm/yyyy) (dd/mm/yyyy)</p><p>PLEASE NOTE: Cost centre percentage must add up to 100%</p><p>SECTION 8: Extending fixed term contract EFFECTIVE END Current Termination Date: (dd/mm/yyyy) Revised Termination Date: (dd/mm/yyyy) DATE: REASON Allowance to carry over: Yes No </p><p>PLEASE NOTE: An extension to a fixed term contract must be approved by the recruitment panel</p><p>SECTION 9: Family Leave: Maternity/ Paternity/ Adoption REASON: Maternity Ordinary Paternity Adoption Maternity Early Return Additional Paternity Adoption Early Return Maternity Extension Paternity Extension Adoption Extension KIT day</p><p>EFFECTIVE DATE: START: (dd/mm/yyyy) RETURN: (dd/mm/yyyy) For ordinary paternity Week 1 Start Week 2 Start leave only: Week 1 End (dd/mm/yyyy) Week 2 End (dd/mm/yyyy) PLEASE NOTE: This form must be accompanied by the appropriate leave plan and certification (Original MatB1 for maternity and SC3 for paternity). If employee is returning at different hours to when they started their maternity please complete section 2 in addition to section 9.</p><p>Version 3 UAS Payroll Change form June14 Page 2 of 4 SECTION 10: Unpaid Leave REASON: Parental Leave Annual Leave Other (please state) </p><p>EFFECTIVE DATE: START: (dd/mm/yyyy) RETURN: (dd/mm/yyyy) NO. OF DAYS/HOURS DO THEY HAVE AN ALLOWANCE? YES NO</p><p>PLEASE NOTE: If part time please state the amount in hours</p><p>SECTION 11: One off payment EFFECTIVE DATE: FROM: (dd/mm/yyyy) AMOUNT: COST CENTRE (if different from post) REASON:</p><p>SECTION 12: Stipends EFFECTIVE DATES OF FROM: TO: STIPEND: (dd/mm/yyyy) (dd/mm/yyyy) ANNUAL VALUE OF £ STIPEND: CURRENT DEPARTMENT/ COLLEGE: PLEASE NOTE: If the stipend is for someone who is not an existing UAS member of staff please submit this form with a completed data collection form, which can be found at: http://www.admin.ox.ac.uk/personneluas/formsandguidance/#d.en.52928 </p><p>SECTION 13: Secondment TYPE OF MOVE: SECONDMENT IN SECONDMENT OUT SECONDMENT RETURN</p><p>EFFECTIVE DATES OF FROM: TO: SECONDMENT: (dd/mm/yyyy) (dd/mm/yyyy) SECONDMENT IN Job title ADDITIONAL DETAILS: Grade FTE/Hours Line Manager Line Manager’s position Location Cost Centre SECONDMENT OUT Holiday pay (state no. of days/hours) No Holiday pay owed ANNUAL LEAVE OWED: (If part time you must input the amount in hours) Holiday to be carried over </p><p>PLEASE NOTE: Employee to be returned from secondment at substantive hours unless otherwise stated in section 2.</p><p>SECTION 14: Leavers/Internal transfers TYPE OF MOVE: TRANSFER OUT LEAVER</p><p>TRANSFERING WITHIN Yes State where UNIVERSITY? No </p><p>EFFECTIVE DATE OF TERMINATION: For resignations please attach a copy of the resignation letter ANY OTHER PAYMENTS None Holiday pay (state no of days/hours) DUE: Other (please state) (If part time the amount must be input in hours)</p><p>COST CENTRE FOR // (If different from Section 1) PAYMENTS: ANY SUMS TO BE None DEDUCTED: Holiday (state no of days) exceeding entitlement </p><p>Version 3 UAS Payroll Change form June14 Page 3 of 4 Loans (state amount) Other (please state) </p><p>Have these figures been agreed with employee? Yes No</p><p>REASON FOR LEAVING Dismissal: retirement Resignation: ISAP Probation: dismissal UNVERSITY: Dismissal: ill health Resignation: Probation: resignation (not for internal transfers) Dismissal: other capability personal/family Secondment End Dismissal: conduct Resignation: career Secondment externally paid Dismissal: redundancy/ reasons Sabbatical externally Paid end of Fixed Term Contract Resignation: further study Trial period end Dismissal: SOSR Resignation: pay/conditions Candidate withdrew Resignation: early retirement Resignation: vol. Offer withdrawn Resignation: normal severance Candidate no show Resignation: OMIS retirement Death TUPE Resignation: ill health retire Other (please state) </p><p>DESTINATION UPON Another HEI in UK (please state) Private Industry in the UK LEAVING: Another HEI Overseas Self-employed in the UK Other Education Institute in the UK Not in Regular employment Other Education Institute Overseas Retirement Student in the UK Death Student Overseas Other (please state) NHS, General Medical or Dental in the UK Decline to Specify Working in research institute (public) Working in voluntary sector Working in research institute (private) Not Known Other Public Sector in the UK</p><p>LOCATION AFTER England Other EU LEAVING Wales Non EU Scotland Information refused Northern Ireland N/A continuing as University employee UK (Not otherwise specified)</p><p>ADDRESS FOR P45 & FINAL PAYSLIP to be sent to:</p><p>APPROVAL: SIGNED: Click here to enter text. DATE: HEAD OF DEPARTMENT</p><p>FOR OFFICE USE ONLY</p><p>Completed by: Approved by: </p><p>FOR UAS PAYROLL CUT OFF DATES PLEASE SEE http://www.admin.ox.ac.uk/personneluas/reward/payrolladministration/</p><p>Version 3 UAS Payroll Change form June14 Page 4 of 4</p>