HomeMy WebLinkAboutPersonnel Action Request - GRISPERSONNEL ACTION REQUEST (PAR)
Section 1- Core Employee Data (Current Data Required)
Empl#:
Legal Name: Anderson, Dell Alan
Effective Date: 07/01/19
Section 2. - Employee Data (Required for New Hires, Separations, or if Changing)
Item
Current Data
New Data
LegaName D Preferred
Anderson, Dell Alan
<Enter>
Address
314 Boylson RD
Moses Lake, WA 98837
<Enter>
Telephone
(509) 430-3768 ext.
( ) - ext.
SS# - Birthdate
215-86-0957 — 08/10/76
000-00-0000 — 00/00/00
Section 3 - Requested Action
Action(s)
Leave Data
Separation Data
New Hire
A
^
Start Date 00/00/00
Stop Date 00/00/00
Type
A
Reason
I A
Eligible for Rehire n
Provide Details of Separation Below
Section 4 - Comments
Hired for the Director of Clinical Services Position Band 25 Step 4; Mr. Anderson will get a sign on
bonus for the amount of $4, 2oo.00, plus one week of annual leave on the books.
`t. VC`'5 5��V,rt\ 10y
Section 5 - Core Items (Current Data Required)
Item
Current Data
New Data
Dept# -Dept
GrIS-Grant Mental Healthcare-lo8000
^ ^
Job# -Job Title
150 -32 -Director of Clinical Services
000 -00 -<Enter Title>
Hire — Position
07/01/19 - 07/01/19
00/00/00 - 00/00/00
Grp# -Name
NO2-Department Head
^
Employee Type
Full Time Regular
^
Section 6 - Secondary Items (Required only if Changing)
Item
Current Data
New Data
Base Wage
$9,763.8700 Monthly
$oo.0000 <Select Cycle>
Band / Step
25/4
ti /
Stipend
$oo.0000 <Select Type>
$oo.0000 <Select Type>
Pay Type/FLSA
Exempt (SALRYE)
^
FTE
1.0 (4o hrs/wk)
^
FI'E—GrIS Only
<Enter>
<Enter>
Work -week
Standard Sun -Sat
^
Section - Authorizing Signatures
Department: Date:
Date:
Human Resourc"quired
Board Approval Not Required
Chair:
Vice -Chair: Date:
Member:
Revised 01/09/19