Change of Circumstances

To be completed by the Head of Unit and upload onto SharePoint.

Contact name or email address (for queries) / Ext. / Control №

Notification of… (Select appropriate box)

☐ / Extension to Fixed Term Contract * / ☐ / Extension of Secondment **
☐ / Change of Hours / ☐ / Part-Year Arrangement / ☐ / Temp to Perm*** (If this option is chosen additional information is required, please refer to the OU policy)
☐ / Extension of Change of Hours / ☐ / Extension of Placement
If other (please specify)
* Does this give the individual over 4 years service? If so please attach a Business Case. / Yes ☐ / No☐
** Has this been agreed with applicant’s original Head of Unit? / Yes ☐ / No☐
***Is theapproval from Head of Unit or authorised nominee attached? This should confirm an individual was competitively appointed and if there are other potential candidates on fixed term contracts within that unit that a competitive process has taken place (refer to procedure for converting fixed term to permanent) / ☐ /
*** Has a probationary period been served/completed
If no, probation balance outstanding? / Yes☐ / No☐
Are there any immigration restrictions that impact on the change of circumstances? / Yes☐ / No☐

Details of Employee

Faculty/Department/Division / Post ID
Subsection/Discipline / Grade
Name / Staff No if known
Existing Job Title
Line of responsibility

Change to Contract

Effective Date of Change / End Date of Change (if applicable)
Previous Hours / New Hours
Change of work pattern e.g. YYYYYNN
Change to weeks worked each year
Any Special Allowances
New Job Title (if applicable)

Please state actual hours worked (This section applies to Part Time Secretarial/Clerical staff only)

Day / Start am / Lunch Break / Finish pm
Monday
Tuesday
Wednesday
Thursday
Friday
If temporary please indicate appropriate code below:
☐ / CS / Cover for other staff absence
☐ / FI / Funding Issues
☐ / ML / Cover for Maternity Leave
☐ / SS / Cover for Short-Term Secondment
☐ / SW / Short-Term Increase in Work
Primary HESA cost centre / Primary source of salary
Secondary source of salary / % charged against general income / %

Conditions of Service

☐ / Academic / ☐ / Craftsperson / ☐ / Research / ☐ / Technical
☐ / Academic Related / ☐ / Print / ☐ / Secretarial/Clerical / ☐ / Other

Finance (Please enter the budget code(s) to which this is to be charged, if different from present, together with appropriate dates and hours.)

Budget Code(s) / From / To / % Hrs
1
2

Comments/further instructions

Accountant Signature (if applicable) / Print Name / Date
Signature Head of Unit or Authorised Signatory / Print Name / Date
Planning & Resource Office Signature (if applicable) / Print Name / Date
PVC (Research & Enterprise) (Applicable for research posts only) / Print Name / Date

Human Resources HRF019

March 2018

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