Career to Per Diem by 285p3Vw


									E-Mail to: “Nursing Resources”

                            Career to Per Diem
                            PERSONNEL ACTION REQUEST

TO                Patient Care Resources             FROM

Employee Name:
Classification /Payroll Title:
Employee Number:                               Unit /Cost Center:

Employee must make an appointment with Resources.
All competencies must be current to prevent delay in processing of PAR.

Career to Per Diem

Approximate Break in Service Date:

Approximate Effective Date:

Percentage of Time:

Hours base work week:                 8 Hour or       12 hour


To be filled out by resources.
                                  User Fields: If applicable.
     License #
     License not expired.
     BCLS not expired.

                                      Personnel Module
Need date in all fields.                             Not Expired
     1. Hospital OT                                      1.   TB
     2. Nursing OT                                       2.   Annual Competency
     3. Abuse                                            3.   JD Evaluation
     4. Confidentiality                                  4.   Annual Unit Competency
     5. Initial Unit Competency                          5.   OSHA
     6. DON Part I                                       6.   Handbook
     7. DON Part II
     8. Initial Competency
     12. Job Description
     13. D Job Specific

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