Regular Classified Intent Form

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L
R
C
C
D
OS
IOS
OMMUNITY
OLLEGE
ISTRICT
Please Print / Type
Worksheet Location
Please mark below the appropriate action(s)
ARC
FM
1 -
Approval of Applicant for Regular Classified Employment (New Hire Only)
CRC
FLC
2 -
Temporary Second Assignment
SCC
EWC
 /
3
-
Shift Differential: Add
Remove
A
DO
Other
 /
 /
 /
3
-
Work Schedule Adjustment:
Change to Work Hours
Extension
Reduction
Field Training
B
 /
4
-
Request for Reassignment/Promotion/Transfer: Temporary
Permanent
A
 /
4
-
Authorization for Reclassification: Temporary
Permanent
B
Name
Employee ID #
_
(Last)
(First)
(M.I.)
Job Code#
Sub Job Code (if applicable)#
___
________
___
________
For 1, 2 , 3
& 3
:
A
B
Title ____
________________
__ ___
____
__________
1 - A
A
R
C
E
PPROVAL OF
PPLICANT FOR
EGULAR
LASSIFIED
MPLOYMENT
New Position
Replace for _________
____________________
Req # ___
________ Range/Step(+ sd)___
__ ______
2 – T
S
A
(
1)
EMPORARY
ECOND
SSIGNMENT
PAID AT STEP
Range/Step (+ sd and/or Lng) ______
___ Hourly Rate $ ________
____
3
-
S
D
– A
R
/ 3
– W
S
A
– H
/ E
/ R
/ FTO
A
HIFT
IFFERENTIAL
DD OR
EMOVE
B
ORK
CHEDULE
DJUSTMENT
OURS CHANGE
XTENSION
EDUCTION
Hours/Days New Shift:
_
Range/Step (+ sd and/or Lng) _______
_____ Hourly Rate $_______ ____
Hours/Days Current Shift: __
___________
Range/Step (+ sd and/or Lng) ____
________ Hourly Rate $_
________
Amount Differential Rate (if applicable): $_____
_____
Work Schedule Adjustment: Extension: _ _________
OR
Reduction*: __ ________
=
Total Hours: _ _________
No. of Hours
No. of Hours
4
– R
/P
/T
/ 4
- R
A
EASSIGNMENT
ROMOTION
RANSFER
B
ECLASSIFICATION
New Job Code # ______
____ Title _____
______
__
Sub Job Code (if applicable)# _
Range/Step (+ sd and/or Lng) ___
__
__ Hourly Rate (temp change only) $_
______
Current Job Code # __ __
___ Title ________________
___
Sub Job Code (if applicable)# _
Range/Step (+ sd and/or Lng) ____
__
_ Hourly Rate (temp change only) $__ _
__
Replacement for ____________________________________________ Req # __
_________
Difference (temp change only) $_ _____
_
E
D
: From ___________________________ To ____________________________
FFECTIVE
ATES
B
#(
)
UDGET
S
:
Budget #: _____ _______
_______ _
_________ _________________
__ ____________
__ ______
___ ______
Account
Fund
Org/GL Dept ID
Program
Proj/Grant
%
Budget #: _________ ___
_____ ___
________________________ __
________ ______
____ ____
_____ ____
Account
Fund
Org/GL Dept ID
Program
Proj/Grant
%
W
S
:
ORK
CHEDULE
8:00 am – 4:30 pm, M-F
OR
Other: __________________
__________________________________
12-Month
11-Month
10-Month
9-Month
Number of Hours per Week _____
__ ______
OR Time sheets will not be submitted:
Time sheets will be submitted:
Supervisor ______
_______________
____
S
P
N
:____________________________________
____ D
:
_______________
IGNATURE AND
RINTED
AME
ATE
Vice President of Administration or DO/FM Manager
To be completed by District Human Resources:
:
Board Approval Date: ___
______
Temp assignment - MQ
Range/Step(+sd/Lng):_______
__ _
Salary Rate: _
_____ ______
_
Percentage: _____ ___
FTE: _
_
Req#:_____ _______/Position#:_____ _______ Date Processed: _
__
Record #: ____
__
Initials:
_
* Reduction of hours must be voluntary or treated as a layoff. If this is a voluntary reduction of hours, a Leave of Absence form must be submitted.
*Reduction of hours must be voluntary or treated as a layoff. If this is a voluntary reduction of hours, a Leave of Absence form must be submitted.
Original – Human Resources
Copy– Vice President of Administration
Copy – Requestor
:forms\classified intent (P103A)
Rev: 10/14

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