GEORGIA DEPARTMENT OF JUVENILE JUSTICE POSITION/PERSONNEL ACTION REQUEST
TO: Department HR Director                                                                                           DATE:

Location:                                                                           Initiator:                                                Phone:                              E-mail:

Add New Hire or Employee Address or Personal Information Changes                                 Supporting Papers:                                                                         COMMENTS:
in the Comments Section. Use Comments also for other explanations.                                       Letter of Resignation, Dismissal or Layoff                                         New Hire Info and Address or
                                                                                                         Suspension Notice                                                                  Employee Info and Address
Employee ID:                    Employee Email Address:
                                                                                                         PMF or other performance info                                                      Change:
                                                                                                         Certification Statement
                                                                                                         DOL 800 Separation Notice
Name:                                                                                                    Donated Leave (specify effective date      )                                       (use “comments” to explain any
                                                                                                                                                                                            processing action requiring clarification
                                                                                                         Does this action impact a pay supplement? Yes                      No              such as: Advanced Hire Salary info;
      Action     Reason                  *Description of Action/Reason                                   Other (Specify)                                                                    hours to pay for LWOP/Termination;
                                                                                                                                                                                            Annual Leave Payout/ Donated Leave;
1.                                                                                                                                                                                          Suspensions; Military Leave; Start or
                                                                                                                                                                                            Stop Supplements; Position Actions;
2.                                                                                               Check here if rehire is not recommended                                                    Hourly Rate Revision requests; etc.)
3.                                                                                               *If checked, attach supporting documentation.
     Effective Date of Action          Mail Drop ID – If new, check here:                        Terminal Leave Hours To Be Paid                        Last Date in Pay Status
                                       461-                                                                     *Please attach verification

                                           FROM                                                                                               TO
Position                                    Classified                                           Position                                Classified
                                                                       U                                                                                        U
Number                                      Indicator                                            Number                                  Indicator
Job                                         Job                                                  Job                                     Job
Number                                      Title                                                Number                                  Title
Department                                  Dept ID                                              Department                              Dept ID
                    461                                                                                             461
ID                                          Name                                                 ID                                      Name
County Code/                                                                                     County Code/
                                            Zip Code:                                                                                    Zip Code:
Name:                                                                                            Name:
                                                                                                                                         Hourly Rate or Semi-                               Central HR Use Only:
                                            Hourly Rate or Semi-                                                                         Monthly Salary
                                                                                                                                                                $      .
Paygrade                                    Monthly Salary
                                                                       $        .                Paygrade
                                                                                                                                         Percentage                     %
Check the boxes to indicate scheduled days off in second row and indicate                        Reports To: (supervisor position number mandatory)                                         FLSA Code:
                                                                                                                                                                                            Change? Yes                 No
number of Hours to Pay here:                What are regular pay period hours?
                                                                                                                                                                                            Field Notification:
1st Pay Period         1           2       3         4       5        6        7       8      9        10      11      12       13      14       15
2nd Pay Period        16          17      18        19      20       21       22      23     24        25      26      27       28      29       30    31
COMPLETED BY:                                                               Date:                BUDGET APPROVAL BY:                                                 Date:
                                                                                                                                                                                            DTI Code:
                                                                                                                                                                                            Change?       Yes           No
APPOINTING AUTHORITY:                                                       Date:                ADDITIONAL SIGNATURE BLOCK:                                         Date:
                                                                                                                                                                                            Initial:            Date:

Class0627                                                                                                   Central Office HR Use These Blocks Only
*See Action Reason Codes Descriptions Next Page (central office HR does not need other pages below, please select “File,” then “Print,” then “Current Page,” and then “OK.”)

Record retention: Retain permanently in the official and local personnel files.                                                                                                                                           Rev. 3/12
                             PeopleSoft Codes for Personnel Actions
Action                      Reason Meaning
HIR                         APP            New hire appointment
                            ATL            Hourly employees (appointment time limited)

REH                         REH            Rehiring a former state employee

TER                         TMP            End temporary employment
Termination                 PRE            Presumptive resignation is used after an employee has been on ULWOP for 5 days
                            RES            Resignation
                            DIS            Dismissal
                            RLS            Did not complete probationary period
                            CER            Changing from PT to FT or vice versa
                            RTM            Retirement
                            DEA            Death
                            DRG            Failed Drug test
                            LVE            Failure to Return from leave
                            RHA            Repeal Incorrect Hire Action
                            RIF            Reduction In Force
                            NPR            No position return from leave
                            FOR            Forfeiture of position

PRO                         PRO            Promotion
DEM                         DEM            Demotion
Demotion                    VDM            Voluntary demotion

RFL                         RFL            Use this code when an employee returns from leave to be placed back in pay status
Return from leave
Note: Use when approval has been given to return an employee due to donated leave or approval of family leave
XFR                        LAT   Lateral transfer within DJJ
Transfers                  OUT   Employee leaving DJJ and going to another state agency
                                 **Please include the agency employee is transferring

                           IN    Employee transferring to DJJ from another state agency

                           PRO   Employee transferring to DJJ from another state agency and will be on a higher pay grade
                                 which results in it being a promotion
                                 Employee transferring to DJJ from another state agency and will be on a lower pay grade
                           DEM   which results in it being a demotion

PAY                        CBI   Criteria Based Increases (POST increases)
Pay rate changes           INC   Pay increase
                           ACT   Acting pay supplement
                           END   Ending pay supplement
                           RTE   Hourly rate change
                           TCH   Teacher salary adjustment

LOA                        FML   Family medical leave without pay
Leave of absence w/o pay   CON   Contingency leave without pay
                           AUT   Authorized leave without pay
                           UNA   Unauthorized leave without pay
                           MIL   Military leave without pay
                           SUS   Suspension without pay

LOA                        FML   Family medical leave with pay
Leave of absence w/pay     SUS   Suspension with pay
                           MIL   Military leave with pay

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