HomeMy WebLinkAboutPersonnel Action Request - GRISPERSONNEL ACTION REQUEST (PAR)
Section 1— Core Employee Data (Current Data Required)
Empl#: 1017
Legal Name: Cordova, Lisa
Effective Date:
Section 2 — Employee Data (Required for New Hires, Separations, or if Changing)
Item
Current Data
New Data
Name °Up]
O Preferred
<Enter>
Address
<Enter>
Telephone
(000) 000-0000 ext.
( ) - ext.
SS# - Birthdate
000-00-0000 — 00/00/00
000-00-0000 — 00/00/00
Section g — Requested Action
Action(s)
Leave Data
Separation Data
Wage Change - Reclassification
A
Start Date oo/oo/oo
Stop Date oo/oo/oo
Type
A
Reason
Eligible for Rehire
Provide Details o Se aration Below
Section 4 — Comment -
The position of "Director - Clinical Services" has been assigned to Band 24.
Section g — Core Items (Current Data Required)
Item
Current Data
New Data
Dept# -Dept
GrIS-Grant Mental Healthcare- 1o8000
^ ^
Job# -Job Title
150 -32 -Director - Clinical Services
000-00-< Enter Title>
Hire — Position
09/14/87 - 01/28/16
00/00/00 - 00/00/00
Grp# -Name
Noe -Department Head
Employee Type
Full Time Regular
Section 6 - Secondary Items(Required only if Chan 'ng)
Item
Current Data
New Data
Base Wage
$8,328.2700 Monthly
$ 1, 70. v 7 Monthly
Band / Step
18/6
24/1-
4/1-
Stipend
Stipend
$oo.0000 <Select Type>
$oo.0000 <Select Type>
Pay Type/FLSA
Exempt (SALRYE)
FTE
1.0 (4o hrs/wk)
FTE—GrIS Only
<Enter>
<Enter>
Workweek
Standard Sun -Sat
A
_
Section 7 — Authorizing Signatures
Department: Date:
Human Resources: Date:
Board Approval Required [�] d
Chair:
Vice -Chair: Date: 5 - Zi
Member:
Revised 01/09/19