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2. General
3. Please Print, Completing Known Information
5. 
   
7. Name:
8. Employee #:
10. Dept. Name
    -- Select One --Parks and Rec Aquatics- 7240Stormwater- 3800Maintenance/Parks- 7210
11. Job Classification*
    -- Select One --Deputy City Clerk- 132Building Official- 141Airport Manager- 137
13. Present Salary:
14. Present Status:

    1. Regular
    2. Seasonal/Temp
    3. Full-Time
    4. Part-Time
16. Effective Date:
18. Action Requested
20. 1. New Hire Request
    2. Promotion
    3. Salary Adjustment
    4. Transfer
    5. Demotion
    6. Rehire/Recall
    7. Suspension
    8. Reclassification
22. 1. Merit Increase (Amount: %)
25. 1. Other
27. 
    
29. Provide Applicable Information
31. New Salary:
33. -- Select One --HourlyBi-weeklyAnnual
35. 1. New Position
    2. Budgeted Position
    3. Yes
    4. No
37. 1. Replacement for
40. New Department
    -- Select One --Parks and Rec Aquatics- 7240
41. New Job Classification
    -- Select One --Camp Leader- 117
43. 1. Exempt
    2. Nonexempt
45. New Status:
47. 1. Regular
    2. Season/Temp
    3. Full-Time
    4. Part-Time
49. Remarks:
51. Separation
53. 1. Voluntary Resignation
    2. Retirement
    3. Discharge
    4. Layoff
55. 
    
57. __________________________________________________
59. Employee Signature for Resignation/Retirement
61. 
    
63. _________________________
65. Date:
67. 
    
69. Eligible for Rehire:
71. 1. Yes
    2. No
73. Exit Interview:
75. 1. Yes
    2. No
77. Reason Given for Resignation:
79. Last Day Worked:
81. Remarks:
83. Approvals:
85. 
    __________________________________________________
87. Supervisor Signature and Date
89. 
    
91. 
    __________________________________________________
93. Department Director and Date
95. 
    
97. 
    __________________________________________________
99. Human Resources Director and Date
101. 
     
103. __________________________________________________
105. Controller and Date
107. 
     
109. __________________________________________________
111. City Manager and Date
113. 
     
115. 
     
117. Posted to IMS _____

     Posted to PeopleTrak _____
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119. 1. Receive an email copy of this form.
120. Email address

     This field is not part of the form submission.

121. Submit

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