HomeMy WebLinkAboutPersonnel Action Request - Human Resources (003)PERSONNEL ACTION REQUEST (PAR)
Section i - Core Employee Data (All sections reqwired to be fiUed out)
El-npl#: 6319 Legal Name: Ko�-, Blair Landon Effeethre Date: ar-, 11 -t,71 1.6
Section 2 - Employee Data (Onty required for new/separated eMR10yee.5 & address changes) -
Rein
Current Data
ArewlChanging Data
Nanie C N-eferred
Aa.dress
Telephone ---
- -------ext.
- - -
(000) 000-0000 ext.
SS# - Birthdrate
------------- - -----
000-00-0000 - 00/00/00
Section 3 - Requestsed Action Ts w — ------- .......... ..........
Action(s) (tw to -9)
Attendance - Leave Dal-a-__1
Separation Data
Wage Change - Step Increase
A
Type
Reason
S tart Date oo/oo/oo
A
A
Efigiblefor Rehire -Dept A
A
Stop Date oo/oo/oo
SVCHO' 4 - CAMunn nts (ror Separations, 16t the last dp)jdate of pay)
One Year Step Increase.
Section 5 - Core Items - Current Data
Section. 6 - Core Its - 0-tanging Data
Item
All'Current Data is Required
On�y Changth-j Data is Required
Dept#-Dept
Comm issioners' Office-00joj A
IN,
Job #-Job Title
101-23 -Risk & Safety Coordinator
000-00- <Enter Title> - - ----- ------ — -----
Hire - Position
02/10/25 - 02/10/25
00/00/00 - 00/00/00
Grp# Nt Nme
N04-Exempt
A
Employee I�Erpe
Full Time Regular , G-b
A
Base Wage
007
0'
$ Monthly 58r-0056
$9,50r%-5-07 MonthlY $ 56 .55
L Band/ Step
19/3
19"/ 4
Stipend
$oo.00 <SelectTy-pe>
Soo.00 <Select Type>
Pay IkNTe/FLSA
Exempt (SALRYE)
A
FrE 1.0 (4o hrs/vvk-) A
-- -- --------
Work -week Standard Sun -Sat A
Section Authorlizing Signature:%
Department: Date. ?.,-
T- <
Human 'Resources: Datev
Eligiblefor Rehire -Q)uu1y A
Board Approval Required Not Recluired
Chair:
Vice -Chair: Date:
T. . .........
Meniber:
HR use t)nlv
0 LNG T-r PAR _tVPN,1T C, LAPS 1-9 N axTDRY
! F I S Fl INT 11 7--] H EQ
C1 ACC 0 D1-7,�,PFF TT
Revised 10/08/25