HomeMy WebLinkAboutPersonnel Action Request - GRISPERSONNEL ACTION REQUEST (PAR)
Section i - Core Employee Data (Current Data Required)
Empl#: 3683
Legal Name: Anderson, Dell
I Effective Date: 01/01/20
Section 2 - Employee Data (Required for New Hires, Separations, or if Changing)
Item
Current Data
New Data
Name ° Preferred
<Enter>
<Enter>
Address
<Enter>
<Enter>
Telephone
(000) 000-0000 ext.
(000) 000-0000 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
Position Change - Promotion
^
AType
Start Date 00/00/00
Stop Date 00/00/00
A
Reason
A
Eligible for Rehire n
Provide Details of Separation Below
Section 4 - Comments
Appointment from interim to ongoing Director effective 01/01/20.
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 - Clinical Services
150 -01 -Executive Director
Hire — Position
07/01/19 - 07/01/19
01/01/20 - 01/01/20
Grp# -Name
Noe -Department Head
Noe -Department Head
Employee Type
Full Time Regular
Full Time Regular
Section 6 - Secondary Items (Required only if Changing)
Item
Current Data
New Data
Base Wage
$oo.0000 <Select Cycle>
$10,791.73 <Select Cycle>
Band / Step
00/00
5 /7
Stipend
$oo.0000 <Select Type>
$oo.0000 <Select Type>
Pay Type/FLSA
A
A
FTE
A
A
Workweek
A
A
Section 7 - Authorizing Signatures
Department: y Date:
Human Resources: �,� Date:(eL tv
Board Approval RMCI Not R qu' d
siL
Chair:
Vice -Chair: Date: I ?.I
Member:
Revised 03/29/17