PPM 5210 610 PA FORM V0

C

ClTY OF RALEIGH PERSONNEL ACTION FORM

Use rhfafor111for tmy employee action or clumge. Use the New Hire PAform to establish a new employee.

SECTION I

*COMPLETE TIOS SECTION FOR ALL PERSONNEL ACTIONS (current information)*

Se lect the appropriate action from the drop down menu in each section below. T f , . Change Account Code ypc O ACt1on: --------------- Leave Actions: Employee Number: ____ Pay Group: _ P _ u _ s ____ Position Control # : _ o _ o _ o _ o _ 3 _ 6

_ 7 _ 8 __ J ob Co d e ff i1 1eP1 2419 Utilities Specialist, Se11 i or

N Vacant as11 rune: _____________ _

L

First Name: ______________ Middle initial:

----

. 7000-PU rut:______ Dept. ID :_ 5 _ 2 _ 8

_ 0 ___ \Vork L oca t io n: 000197

08

/ 04

/ 2018

.

.

f

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Err

B a1e o Acuon:__ __ __ usmess

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(l)o not u5e CL)

•forarlions involYine mn· adiustmcnt�. oleases:usnre the Pcrfornuwcr Evaluation is curn:111 iHHI uroc:essrd SECTION II

*COMPLETE TfilS SECTION FOR CHANGES TO EMPLOYEE CNFORMATION*

New Salary:$ _____ Grade: ___ Hourly Rate:S ______ % ofChange: ____ Position Control #:. ________ J ob Code /Title:__--'________ Business Unit:______ Dept. JD: ______ Employee Type: ___ _ Work Schedule: ________ Pay Period Hours: ______ Clocker: _ _ _ _Work Location: ____ Overtime: ___ _ C 310-5280-600010-634 Account ode: ________________ Pay G ro u p: ___ _ Step: ___ Anniversa,y Date: __ / __ ! ___ (P&R Only) Change Other: __________________ FLSA: ____ Check Locmion: _____________ Employee Type: _________ Social Security Number: ___ - ___ - ___ New Address: ____________ Ci ty: ________ Stat e : Zip: ____ Phone: I lire Daic: _______ Last Physical Day Wo rked: __ / ___ / ___ Last Date on Payroll: __ / __ / ___ •Anach the Scp:irariou Checklist SECTION IV *COMPLETE THIS SECTION FOR EMPLOYEE MERIT INCREASES* Overall Rating: __________ Merit Quartile: ___ Grade: ____ Anniversary Date: ___ / ___ __ _ Currclll Salary: $ ______ % oflncrease: ____ _ New Salary : $ _______ Hourly Rat e: $ _____ _ Comments: Change Account code from 618 to 634 •(New Salary and llourly Rale entered by Payroll) Date of Birth: SECTION ID *COMPLETE THIS SECTION FOR SEPARATING EMPLOYEES* Tvpe of Separation: Reason for Separation: (P&R Only)

000034 8 9

Joanie Hartley ame: ___________

Employee#: ____ Employee # _____

Position Control#:

upervisor

Position Control#: 0000348 9

Time Approver's Name: Joanie Hartley

DepartmenI Director Namc/Siguature: e�lif �:.......!::..:::..i,.c:::��:::::..-,,L�:..L - Oate:

2018

Phone: -� 996

2743

Christine Alston

13

0 8

Date Prepared __

Prepared hy

I ___ I __ _

48