Personnel Action Form (PAF)

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

Section I- Employee Information

Name*

Section II- Title/Position Change

Driving Classification
Effective Date

Section III- Change in Employment Status/Rehire Information

Termination
Resignation
Rehire Status?
Effective Date

Change Employment Status To:

Must complete the Employee's scheduled hours on second page
Effective Date

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
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*
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