HomeMy WebLinkAboutKemp, Bailey PO Intro Form {""'s Employee Status Change Request Form
Gt.
Status Change
Date Submitted* Submitted by*
09/21/2021 Gretchen Scott
What type of employee is this change for?*(?)
Regular Full Time or Regular Part Time Employee
Department* Sub-department*
Police Patrol
Employee's Current Status
Employee Name* Employee Number*
Bailey Kemp 50003
Employee First Name Employee Last Name
Bailey Kemp
Current Department Current Sub-department
Police Patrol
Current Job Title
Police Officer
Current Labor GL Distribution Current Dept Head
101-21-12-410-11 Craig Kingsbury
Current Supervisor Date of Hire
Chuck Garner 12/21/2020
Current Exempt Status
Non-Exempt
Selected Changes to Employee's Status
Which information would you like to update?*
Employment Status(Introductory, Full Time, Part Time, Seasonal, Retirement,Termination, Military Deployment)
Personnel Status(Transfer, Promotion, Demotion,Admin Leave, Reinstatement)
Department
Job Title
✓ A Change in Hourly Rate/Salary(Demotion, Promotion, Pay Increase)
A Change in Other Compensation(Assignment,Certification, Clothing, Extra Duty, Specialty,Out of Class)
Shift Assignment(Fire)
Patrol Assignment(Police)
Work Schedule(9/80,4/10,5/8,etc.)
New Supervisor(for this employee)
New/Update Supervisory Access this Employee has to other Employees(Includes Mass Shift Changes)
City Phone Number(s)
Access to Finance Software, City Credit Card, Fuel PIN
Select Job Title
If requesting a change in pay, select the employee's current job title.
Otherwise, select employee's new job title.
New Job Title* New Job Employment Status
Police Officer Regular Full Time
New Job Exempt Status New Job Labor Distribution
Non-Exempt 101-21-12-410-11
Grade or Salary Level
Current Grade or Salary Level(?)
PO Recruit
New Grade or Salary Level(?)
PO Intro
Change to Hourly Rate / Salary
Reason for Request to Change Hourly Rate/Salary*
Mark all that apply
Demotion
Promotion
✓ Pay Increase
Other
If you are not sure of the current or new grade or salary level, please leave blank and Human Resources will complete this
section.
Requested Pay Change Amount
...............................................................................................................................................................................................................................................................................................................................................................................................
Requested Pay Change Amount
$22.00
Does Employee already have Assignment Pay?*
Assignment pay can change with rate changes
Yes
• No
Don't know
Effective Date
Effective Date of Payroll Change*
09/12/2021
Changes may only be effective at the beginning of a pay period
Select the first date of the time card for which the change is effective.
Submitter Comments
Submitter Comments
Submitted By