Transcription of (PAF) - Leech Lake Indian Reservation
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(PAF) - Leech Lake Indian Reservation
Employee ID# Today's Date: NEW HIRE JOB STATUS CHANGE PERSONAL CHANGEDate received:By: TRANSFER RETURN FROM LAYOFF REINSTATEMENTSent to Payroll:By: LAYOFF WAGE LINE ITEM CHANGE LEAVE OF ABSENCETD: TT: 90 DAY EVAL SEPARATION OF EMPLOYMENT OTHER PT FT Last NameSr., Jr., Maiden Name Social Security #Birth Date:Tribal Affiliation: Mailing Address:City:State:Zipcode: Physical Address:City:State:Zipcode: Phone 1:Phone 2:Emergency Contact:Phone: HIRE STATUS:RegularReinstatementSeasonalEduca tion program to RegularOn Call/SubstituteTransferPromotionDemotion Temp to Regular Retro back pay to: (If applicable)Temporary Hire, not to exceed:daysEmergency Hire, not to exceed:days*Employment requisition is required for Emergency Hire WORK STATUS:Full-time (30 hours or more per week)Part-time (less than 29 hours per week)Less than 52 weeks END PROBATIONARY PERIOD:Accrue Annual Leave back to: PAYROLL STATUS: INCREASE DECREASE SAMEC urrent:$per hourHourlySalaried Change to: $per hourHourlySalaried WAGE LINE ITEM STATUS:Budgeted from*Grant FundedDirect FundedIn-Direct FundedProgram Fees*Must total NEW/ADD %,%,%100% TYPE OF LEAVE: EXTEND LOA:(RTW -Return To Work) RETURN FROM LEAVE OF ABSENCE:Actual first day back to work: *ACTUAL LAST DATE WORKED.
Tribal Council Member's Signature / Date; Supervisor Signature / Date Executive Director Signature / Date Tribal Council Member's Signature / Date
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