HomeMy WebLinkAboutPersonnel Action Request - Public WorksPERSONNEL ACTION REQUEST (PAR)
Section 3 - Core Employee Data (current Data Required)
Empl#: 38_
Legal Name: ELEFSON, KEITH MICHAEL
Effective Date: 05/11/20
Section 2 - Employee Data (Required for New Hires, Separations, or if changing)
Item
Current Data
New Data
Name
Keith Michael Elefsonorm
<Enter>
Address
<Enter>
Telephone
( ) - ext.
SS# - Birthdate
-
000-00-0000 — 00/00/00
` Section g - Regested Action
Action(s)
Leave Data
Separation Data
New Hire
A
^
Start Date oo/oo/oo
Stop Date oo/oo/oo
Type
A
Reason
Eligible for Rehire
Provide Details o Se oration Below
Section '4 - Continents -
Section g - Core Renis (Current Data Required)
)
Item
Current Data
New Data
Dept# -Dept
^ Public Works -101050
^ ^
Job# -Job Title
189 -45 -County Engineer
000 -00 -<Enter Title>
Hire - Position
05/11/20 - 05/11/20
00/00/00 - 00/00/00
Grp# -Name
Noe -Department Head
^
Employee Type
Full Time Regular
^
Section 6 - Secondary Items 6W ifChan&W
Item
Current Data
New Data
Base Wage
$114,004.8o Yearly
$oo.00 <Select Cycle>
Band / Step
23/04
/
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
^
Section 7 - Authon=g Signatures
Department: Date:
Human Resources: Date:
Board Approval Required ❑Not Require
Chair: �---� i
Vice -Chair: Date:
Member: A" RECEIVED
MAY12
Revised 07/10/19