Change To Employee Terms and Conditions
HR 102
Page 1
Section1. Employee Details
Surname First Name
Grade
Personnel
Number
Location PPS No
Section 2. Reason for Contract Change Place () in appropriate box
Promotion
Renewal of Contract
Return from Career Break
Transfer
Section 4. Organisation Details
Cost Centre: Care Group: Personnel Area
Position Name
Employee Group Permanent Temporary Officer Non Officer
If on a Temporary Contract please confirm contract expiry date
Employee Sub Group
Casual
Fees/Sessions
Flexible Working
Whole time
Contract type
Indefinite Duration Indefinite Duration Std T&Cs Fixed Term Fixed Term Std T&Cs
Indefinite Duration Std
T&Cs 06/2014
Fixed Term Std T&Cs 06/2014 Specified Purpose
Std T&Cs 06/2014
Cessation of Temporary Appointment
Grade Change
Temporary to Permanent Contract
Reference Number:
Location Code :
Position Number to
be assigned
If Faxing please ensure Employee’s Name and Personnel Number are included for each page of form
Employee Name ____________________________ Personnel Number:
Change of Contract Hours NCHD Extension of Contract
Internal Secondmentt
External Secondment
HR 102 V8 Dec 2020
Revised 09/12/2020
Date Change Effective to (If appropriate)
Date Change Effective from
Section 3: Effective Dates
This Form is to be used when there is a change to employee’s contractual terms and conditions due to one of the reasons listed in
Section 2. This form should be completed by the line manager in conjunction with the employee, and must be approved by the
appropriate authorised/delegated officer and forwarded to Personnel Administration, Human Resources. Please complete form in
Block Capitals/Tick appropriate boxes.
HR 102 V8 Dec 2020 Page 2 Revised 09/12/2020
Section 5. Working Week
Standard Full Time hours for this grade
Weekly Contracted hours (use decimals)
.
Work Schedule rule details (SAP Phase II Sites Only)
Working Week Mon Fri 5/5 Mon Sun 5 / 7
Note if an employee works a Monday to Friday roster they are classed as 5/5. These employees will never be paid
Saturday allowance, Sunday premiums or Public Holiday premiums. Alternatively if an employee may work on a
Saturday or Sunday they are classed as 5/7, this will allow them to be paid the relevant allowances and premiums
Work Schedule Rule* Start week of Rotational Roster
* (If employee is casual, enter HRPD)
Section 6. Pay Details
Work Location
Annual Salary Level (point on Scale)
Pay Scale Type Pay Scale Area
Grade Code
Next Increment due
D D M M Y Y Y Y
Payroll Area / Group: Pay slip distribution Internal External
Section 7. Allowances
Complete this section if the contract change results in the payment / cessation of an allowance
Attach supporting documentation if appropriate
Allowance
Amount/Unit Effective Date Pay Allowance
Cease allowance
pay
ment
Wage type/
Pay Code
Section 8. Employee Declaration
I declare that the above information is accurate and correct on the date indicated below.
Signature: Date:
DDDDD
D M M Y Y Y Y
Name: Grade:
Email Address: Mobile Number:
Section 9. Line Managers Declaration
I declare that the above information is accurate and correct on the date indicated below.
Name: Grade:
Signature: Date:
D D M M Y Y Y Y
Contact Phone Number: Mobile Phone Number:
E-mail Address:
Section 10. Delegated Officer Approval Regional HR
Name: Signature:
Contact Phone Number: Date:
D D M M Y Y Y Y