Personnel Action Form - City Of Milpitas
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1PERSONNEL ACTION FORM
LAST NAME
FIRST NAME, MIDDLE INITIAL
EMPLOYEE NO.
EFFECTIVE DATE
POSITION CONTROL #
(H.R. USE ONLY)
FUNCTION (SUBDEPT)
OCC CODE
JOB CLASSIFICATION/TITLE
CURRENT
PROPOSED
ACTUAL (H.R. USE ONLY)
STEP/RANG
BASE HOURLY
INCREMENT
BI-WEEKLY
I-WEEKLY BASE
CURRENT
PROPOSED
% (100) GEN
% (250) HCD
% (390) RDA
% (400) WATER
% (450) SEWER
% (500) EQUIP
% (000) OTHER
FUNDING
ACTIONS
SAME ADD
DELETE
MISCELLANEOUS PAYS
HL - HOLIDAY-IN-LIEU PAY 6%
NEW HIRE
RE-HIRE
CD – CAREER DEVELOPMENT 6%
END OF PROBATION
E5 – INTERMEDIATE POST 5%
MERIT (PAR REQUIRED)
E7 – ADVANCED POST 7.5%
PROMOTION
DEMOTION
K9 – CANINE 5%
TRANSFER
SW – SWAT 5%
ACTING APPOINTMENT
END ACTING APPOINTMENT
MC – MOTORCYCLES 5%
ADMINISTRATIVE LEAVE
HM – HAZ MAT SPECIALIST 6%
LEAVE WITHOUT PAY
LEAVE OF ABSENCE
BL – BI-LINGUAL 2.5%
REINSTATEMENT FROM LEAVE
S5 – SPECIAL ASSIGNMENT 5%
WORK SCHEDULE CHANGE
SA – SPECIAL ASSIGNMENT 10%
15 – SPECIAL ASSIGNMENT 15%
STATUS
S2 – SHIFT DIFFERENTIAL 2.5%
FULL TIME REGULAR
SD – SHIFT DIFFERENTIAL 5%
PART TIME REGULAR – HRS PER WK
C4 – CERTIFICATIONS 4%
FULL TIME TEMPORARY
CC – CA WATER CERTIFICATE 4%
PART TIME TEMPORARY – HRS PER WK
LG – LONGEVITY 0.5%
TEMPORARY (BENEFITTED)
LH – LONGEVITY 1%
LI – LONGEVITY 1.5%
SEPARATION
LA – LONGEVITY 3%
LB – LONGEVITY 5%
RETIREMENT
LC – LONGEVITY 7%
RELEASE FROM PROBATION
LD – LONGEVITY 8.2%
TERMINATION
LE – LONGEVITY 10.5%
RESIGNATION W/NOTICE (attach notice)
LF – LONGEVITY 15.1%
RESIGNATION W/O NOTICE
C2 – CONFIDENTIAL 2%
LAST DAY OF WORK
C5 – CONFIDENTIAL 5%
ELIGIBLE FOR REHIRE: YES
NO
943-UNIFORM ALLOWANCE
NO? :
OTHER:
COMMENTS:
APPROVALS
SUPERVISOR:
DATE:
DEPARTMENT HEAD:
DATE:
HUMAN RESOURCES DIRECTOR:
DATE:
CITY MANAGER:
DATE:
HR USE ONLY
POS CONTROL
PERSON #
1000 HOURS
CANINE
DISTRIBUTION
POSITION #
TERMINATION
UNIFORM
TIME BANKS
EMPLOYEE REQUEST #
FLOATING HOLIDAY
FINGERPRINTS / WORK PERMIT
EMERGENCY CONTACT
TRANSFER REQUEST #
TEMP TO PERM
PULL I-9 FORM
DEPENDENTS
NEW HIRE REQUEST #
STATUS CHANGE
REMOVE FROM DOJ
WORK PERMIT
TERMINATION REQUEST #
PARS TO PERS
REMOVE FROM DMV
DRIVER’S LICENSE
OTHER:
RETRO
PERS:
YES
NO
PAR REPORT
HEADCOUNT & VACANCY REPORTS
PSCR #
DOT:
YES
NO
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Parent category: Business