HomeMy WebLinkAboutPersonnel Action Request - BOCC (005)PERSONNEL ACTION REQUEST (PAR)
Section 1— Core Employee Data (Current Data Required)
Empl#: 5578
Legal Name: THOMAS TAYLOR
Effective Date: 12/31/20
Section 2 — Employee Data (Required for New Hires, Separations, or if Changing)
Item
Current Data
New Data
Name ❑ Preferred
THOMAS TAYLOR
<Enter>
Address
<Enter>
Telephone
( ) -0000 ext.
( ) - ext.
SS# - Birthdate
000-00-0000 — 00/00/00
000-00-0000 — 00/00/00
Section 3 — Requested Action
Action(s)
Leave Data
Separation Data
Separation (Provide Data)
^
Start Date oo/oo/oo
Stop Date 00/00/00
Type
Other
Reason
Personal
Eligible for Rehire Yes
Provide Details of Separation Below
Section 4 — Comments
Section 5 — Core Items (Current Data Required)
Item
Current Data
New Data
Dept# -Dept
Commissioners' Office-oo11o1 ^
Job# -Job Title
101 -02 -County Commissioner District 2
000 -00 -<Enter Title>
Hire — Position
01/01/17 - 01/01/17
00/00/00 - 00/00/00
Grp# -Name
Not -Elected Official
Employee Type
Full Time Regular
Section 6 — Secondary Items (Required only if Changing)
Item
Current Data
New Data
Base Wage
$oo.00 <Select Cycle>
$oo.00 <Select Cycle>
Band / Step
Stipend
$oo.0000 <Select Type>
$oo.0000 <Select Type>
Pay Type/FLSA
A
A
FTE
A
A
FTE—GrIS Only
<Enter>
<Enter>
Workweek
^
Section 7 — Authorizing Signatures
Department: Date:
Human Resources: f 4 Date: 12/01/20
Board Approval [Required ❑ No "Requi d
Chair:
Vice -Chair: �--� Date: I 2_ _ZZ
Member:C�S�D
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