HomeMy WebLinkAboutPersonnel Action Request - Human Resources (003)PERSONNEL ACTION REQUEST (PAR
Section x — Core Employee
Empl #' 3 839
Legal Name: Anderson, Decorah, J', E e ctive Date.- /01/21
ectioll 2 - lE #3 'le Data Q .e( iced for New' .1res, Separations, or if Changing
- ------------- --
Item
Current Data New Data
Name 0 Legal
D Prey reed
<Enter>
Address
<Enter>
Telephone (000) 000-0000 ext, - � .t.
SS# - Birthdate foo- - — / 000-00-0000 —00/00/00
Action(s) Leave Data Separation Data
Type
Ramon
Start Date oo/oo/oo
A
A
Stop Date oo/oo/oo
.eligible `or Rehire A
Provide Detai
Rs of Sepai-ation Below
section.4,. -. Comments
Successful end to first montesploymen . At time of mire potential, for movement to steP
et
r 6
months ss '%h Board.
er n 5 - Com lees rent D. a Hitt.
to
Oirrent Data
New Data
Dept# -Dept
Fluman R s urces- O. .24
Job# -Job Title
124 -05 -1 -IR Consultant i
000 ~00 -<En r Ti b
Hire Position
09/28/20 - 28
00/00/00 - 00/00/00
Grp # -Name N04-ExemPt A
F4 U1 I A
quir .... Changing)
item
.. .
New, Data
$5427�07
Bande
p
13/4 13
Stipend
8 r <Se e t T p $ <Select T
Pay
� T e FLSA
��py
Ex (SALRYE) A
FrE
hrs/iyt) A
1. (4o
Workweek
Standard Sun -Sat A
Section 7 -uthC nzIi ;� Signatures
Department: Date:y
1 -t ..,.
� y
Human Resources: � k�'`a � # sJ...:_��:zw.cv�-�.r',."z.'.,.�.n^„"��.rs.�.'"rn."'.
Dat
e16
Board Approval ' IS Require, Re i 6d
j
Cb ai .i. 8
4
Vice -Choi -,
tAF'9r !
Herber.
Revised 08/24/2020