Personnel Action Form - Apache County
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1PERSONNEL ACTION FORM
APACHE COUNTY
The following action will take effect on ______________________________________
Date and Time
Employee Name
SS# _ _____________
Address ______________________________________________________________
P.O.
City
State
Zip
Check One
New Employee
Hired Temporary / No. of days approved __________ / No. hours per week __________
Hired Permanent Full Time (20 hours or more a week) / No. hours per week __________
Hired Permanent Part Time (less than 20 hours a week) / No. hours per week __________
New Hire: Replaces
whose position was ____________________
Job Title
________________________________________________________________________
Range
Salary $ _________ _
Code ___ ___ ___ —___ ___ ___ ___
Fund
Dept. /Grant
Current Employee
Job Title Change
Transfer
Pay Change
Probation End
FROM
TO
Terminating Employee
Resignation
Retirement
Layoff
Discharge/Explain Below
End of Temporary Employment
Reorganization
Eligible for rehire
Not eligible for rehire
Other ___________________________________________________________________________
__________________________________________________________________________________
Change Authorized by _______________________________________ Date ___________________ _
Elected Official/
Department Head
Change Authorized by _______________________________________ Date ________________
__ _
Human Resources
Change Authorized by _______________________________________ Date _
_________________ _
Payroll
Date of Board Approval ________________________
___
___
___
For Human Resources Use Only:
Position No: ___________________
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Parent category: Business