Personnel Action Form
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1PERSONNEL ACTION FORM
GOVERNMENT OF THE REPUBLIC OF PALAU
1. Name: (Last, First, Middle Initial)
2. Birth Date:
3. Service Computation Date:
4. Employment Status:
5. Type of Action:
6. Authority:
7.Requested Effective Date:
8. Effective date:
9.
From Code #
To Code #
Title
Pay Grade/Step & BW Salary
Department
Duty Station
Ministry
10. Requested by:
11. Social Security Number:
Non-Lapsing
12. Account Number:
1. Requesting Official
Date
Lapsing
13. Certification of Availability & Type of Funds:
2. Bureau Head
Date
Date
Casmir Remengesau
3. Appropriate Management Official
Date
Director, Bureau of Budget & Planning
14: Remarks:
15. Approved By:
1. Director, Bureau of Public Service System
Umerang A. Imetengel
Date
2. Minister of Finance
Elbuchel Sadang
Date
3. President, Republic of Palau
Tommy E. Remengesau, Jr.
Date
16. Resignation (to be completed by employee)
I resign for the following reason(s):
The effective date of my resignation will be:
Signature
Form Revised 02/2016
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Parent category: Business