Personnel Action Form (PAF)

To be completed by Administrator/Director -complete only sections that apply.

Section I- Employee Information

Name*
Director Name*

Section II- Title/Position Change/Salary Increases

Driving Classification
Effective Date
Salary Increase
Effective Date

Section III- Leave of Absence

Paid Leave of Absence
Unpaid Leave of Absence
(paid leave of absence will automatically become unpaid after all accrued Paid Leave and Vacation time has been depleted)
Start Date of Leave of Absence
Return To Work Date if Known
(I.e., Medical, Personal, Military)

Section IV- Benefit Eligibility

Current Benefit Eligibility

New Benefit Eligibility

Benefit Eligible
Benefit Eligible

Section VI- Transfers

(Directors must approve all transfers of employees out of each program)

From:
To:
Program
Program
Effective Date

Section VII- Signatures/Approvals

Use your mouse or finger to draw your signature above
Date
Benefit Impact Termination

Choices In Community Living, Inc.

Schedule Change

Please note ANY schedule changes for the employee greater than 30 days.

New Schedule: List the scheduled time and program for each day and if the hours are paid sleep or non-paid sleep.

Paid Sleep Hours

Non-Paid Sleep Hours

Does this schedule change create open hours at the program?
If yes, please complete the information below.

Job Posting Request (JPR)

Date Position became available

Please list open hours (and program if different from above):

Use your mouse or finger to draw your signature above
Date*

Choices In Community Living, Inc.

Section V- Salary Information

$
$

HR Approval

HR Approving Employee*
Use your mouse or finger to draw your signature above
Date*

Fiscal Approval

Fiscal Approving Employee*
Use your mouse or finger to draw your signature above
Date*
Powered by Formstack Create your own form