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WY ©F <br /> I 0 NDS <br /> PERSONNEL ACTION NOTICE <br /> [JEW Employee Identification <br /> Name: /t// //1,`S X 0ta t e-�. Home Phone: 57k'- 1D‘3 <br /> Soc. Sec. <br /> Address: 7►4O 72 /2 ,eTi`e, fl ..#2.0 Cf Number 4/7 9 78'— '18`Z <br /> F4 t ' <br /> ' 2- inti✓ Date Appointed <br /> Position: Se..,san",./ /0444- y--ke to Current Position -9 <br /> Department: PSI ki.-,,4ee /114.0, - WevtkS X Date of Hir-. 5 <br /> cv- •ate <br /> Date of Form: 4/0— `7l X of Action: 5-- --i9 1 <br /> PURPOSE OF ACTION: Employee Identification Change❑ Step Change❑ <br /> Job Classification Change ❑ Resignation ❑ Layoff❑ Dismissal❑ Other, <br /> COMMENTS: to /,,,,/ <br /> , , <br /> EMPLOYMENT STATUS RETIREMENT EXEMPTIONS <br /> - X Temporary/Seasonal Employment: " ig Check if: <br /> Estimate end date 5e/44.41.01,2.- ) \991 Appointment is not to exceed six <br /> Part-Timeconsecutive months. Sr. <br /> Estimate Hours/Week H0 I (),) Employee's annual compensation will <br /> Regular 0 not exceed $5100 in a calendar year l2' <br /> Employee is a full-time student enrolled in and <br /> attending classes at an accredited school 0 <br /> WAGE INFORMATION UNION WAGE/BENEFIT-EXEMPTION <br /> AiiHourly Monthly Step Other Check if employee is in a union shop <br /> (j- 44 n and will work less than: <br /> X old -( <br /> 67 days in a calendar year, or ❑ <br /> y New (i,, .D 10D3 <br /> 100 days in a calendar year, is under the age <br /> XDate of last wage change -' -- 1 of 22 and a full-time student who will be <br /> 5 enrolled in a public or private institution. ❑ <br /> X Code Employment Cosi \ON 360 Q2D0 J <br /> SIGNATURES: Employee 1(2—_ - City Manage <br /> �C2o� ta <br /> X Department Head -72_x4 � Finance Director J <br /> 1 <br /> OFFICE USE ONLY <br /> DRIVER'S LICENSE NUMBER Si\ aQO QS j 3() 6 SI Application Complete ❑ <br /> EMPLOYEE NUMBER '?00 Immigration Form J <br /> WHITE-FINANCE YELLOW-CITY MANAGER PINK DEPARTMENT HEAD GOLDEN ROD-EMPLOYEE <br />