HomeMy WebLinkAboutPersonnel Action Request - Central ServicesSON EL ACTION REQUEST (PAR)
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Section t, Co e Employee Data (Current Data Required)
EMPl#: 3810 Legal Name: Gaines, Thomas Effective Date: of/ oi/23
ns o an
Section 2 — Employee Data (Required for New Wre s Separatio rif Ch :'gmg
Item Current Data New Data
Name 0 L"ga' <Enter>
ID Preferred
Address <Enter>
Telephone (ooa) 000-0000 ext. C - ext.
SS# -Birthdate 000-1001-0000 — 00/00/00 000-00-0000 — 00/00/0:0
SectiOR 3 — Requested Action
Action(s) Leave Data Separation, Data
Wage Change - Step Increase A Type Reason
Start Date oo/oo/oo .A A
A �`'
Stop Date oo/oo/oo Eligiblefor Rehire
P ide Details ofSeparsation,Below
rom
Se (in
4— C6W
inents
Revised 09/23/19
Section 5 - Corelte-nLs urrent Data Required)
Item
CurrentDate
New Data
Dept# -Dept
Fac�944es-Ma, m''t.
A
Job#-JobTitl,e
112 -04 -Director- Central Services
Hire—Position
07/22/13- 01/01/21
Grp #-Name
NO2-Department Head
A
Employee Type
Full Time Regular
A
Scction 6 - ! Second Items Reir d only if Chang��O. !g qu e
Item
Scurre1 LL Data
Net Data
Base Wage
$10r76",- 3, Monthly
$11,077.73 MO,nt ly
Band / Step
22/05
22/o6
Stipend
$oo.0000 <Select Type>
$00.0000 <Select 'Type>
_PayType/FLSA
Exempt (SALRYE)
Exempt (SAIS RYE)
FTE
1.0 (4o hrs/wt)
1.0 (4o hrs/wk)
FTE—GrIS Only
<Enter>
<Enter>
Workweek
Standard Sun -Sat
Standard Sum Sat
SecdOn 7 -AuthorimigSAgnAtures��-,
Department:
Human Resources:Date:
Board ApIrReprov ReqUi red
alNot equired
R
Chair:
Vice -Chair � �k µ ��A
Member:
Date*
0 t�� I I Ioprd�
Date.:
Revised 09/23/19