HomeMy WebLinkAboutPersonnel Action Form (PAF) 2024-10-09 Cashout Exec Leave HoursCITY OF UKIAHPERSONNEL ACTION FORM
DATE____________________________
NAME (LAST NAME FIRST)
POSITION
DEPARTMENT
ADDRESS (NEW HIRE)
ACCOUNT NO.
EFFECTIVE DATE
SOCIAL SECURITY NO.
DATE OF BIRTH (NEW HIRE)
TELEPHONE NO.(NEW HIRE)
APPOINTMENT ABSENCE SEPARATION OTHER
PROBATIONARY
FULL TIME
TEMPORARY
PART-TIME/HOURLY
EMERGENCY
REINSTATEMENT
RETURN FROM LEAVE
PROMOTION
VOLUNTEER
OTHER
________________________
SICK LEAVE
VACATION
JURY DUTY
UNPAID LEAVE OF ABSENCE
WORKERS COMP
MATERNITY LEAVE
BEREAVEMENT
COMP TIME
SUSPENSION W/PAY
SUSPENSION W/O PAY
ADMINISTRATIVE W/PAY
ADMINISTRATIVE W/O PAY
PERSONAL LEAVE
OTHER
___________________________
RESIGNATION
RETIREMENT
DISMISSED
LAY OFF
LEFT JOB
TERM OF APPT.
DEATH
OTHER
__________________________
SALARY INCREASE
SALARY DECREASE
ACTING OUT OF CLASS.
TRANSFER
RECLASSIFICATION
OVERTIME
CERTIFICATE PAY
OTHER
__________________________
SALARY INFORMATION
FROM
TO
RANGE ____________________ STEP ____________________
RANGE ____________________ STEP ____________________
TEMPORARY/PART TIME HOURLY RATE _____________________
EXPLANATION OF ACTION/LEAVE JUSTIFICATION
THIS CHANGE IS IN ACCORDANCE WITH CLASSIFICATION AND PAY PLANS, BUDGET AND PERSONNEL RULES OF THE CITY OF UKIAH
EMPLOYEE SIGNATURE
PERSONNEL OFFICER SIGNATURE
DEPARTMENT HEAD SIGNATURE
CITY MANAGER SIGNATURE
(N/A - Same as City Manager)