Personnel Action Form (Paf)
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1PERSONNEL ACTION FORM
(PAF)
Employee ID#
Today's Date:
Mark all boxes that apply
(
)
PERSONNEL ACTIONS
HR USE ONLY
Date received:
NEW HIRE
JOB STATUS CHANGE
By:
PERSONAL CHANGE
Sent to Payroll:
TRANSFER
RETURN FROM LAYOFF
REINSTATEMENT
By:
LAYOFF
WAGE LINE ITEM CHANGE
LEAVE OF ABSENCE
TD:
TT:
90 DAY EVAL
OTHER
PT
FT
SEPARATION OF EMPLOYMENT
PERSONAL INFORMATION
Sr., Jr., III…
First Name
Full Middle Name
Last Name
Maiden Name
Social Security #
Birth Date:
Tribal Affiliation:
Mailing Address:
City:
State:
Zipcode:
Physical Address:
City:
State:
Zipcode:
Phone 1:
Phone 2:
Emergency Contact:
Phone:
JOB STATUS INFORMATION
Hire / Effective Date
Division/Program
Job Title
CHANGE TO:
Division/Program
Job Title
HIRE STATUS:
Regular
Reinstatement
Seasonal
Education program to Regular
On Call/Substitute
Transfer
Promotion
Demotion
Temp to Regular
Retro back pay to:
(If applicable)
Temporary Hire, not to exceed:
days
Emergency Hire, not to exceed:
days
*Employment requisition is required for Emergency Hire
WORK STATUS:
Full-time
)
Part-time
Less than 52 weeks
(30 hours or more per week
(less than 29 hours per week)
END PROBATIONARY PERIOD:
Accrue Annual Leave back to:
PAYROLL STATUS:
INCREASE
DECREASE
SAME
Current:
$
per hour
Hourly
Salaried
per hour
Hourly
Salaried
Change to: $
Budgeted from*
WAGE LINE ITEM STATUS:
Grant Funded
Direct Funded
In-Direct Funded
Program Fees
%
NEW/ADD
%,
%,
*Must total
100%
LEAVE OF ABSENCE
Actual last day worked:
Anticipated RTW date:
TYPE OF LEAVE:
(RTW -Return To Work)
Previous RTW Date:
New Anticipated RTW date:
EXTEND LOA:
RETURN FROM LEAVE OF ABSENCE:
Actual first day back to work:
SEPARATION OF EMPLOYMENT
*Documentation must be attached.
*ACTUAL LAST DATE WORKED:
RESIGNATION
Written
Verbal
*If subject to recall, note the Return To Work date:
LAYOFF
Permanent
Temporary/Seasonal
TEMPORARY HIRE / INTERIM ASSIGNMENT ENDED.
PAY OUT ANNUAL LEAVE HOURS
SEPARATION OF EMPLOYMENT
Policy Violations Codes:
AUTHORIZING SIGNATURES
Employee Signature / Date
Human Resources Director Signature / Date
Tribal Council Member's Signature / Date
Supervisor Signature / Date
Executive Director Signature / Date
Tribal Council Member's Signature / Date
Division Director Signature / Date
Deputy Director Signature / Date
Tribal Council Member's Signature / Date
HR/Personnel
Benefits
Div/Dept File
Employee
LLHR 2/06-009
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Parent category: Business