PERSONNEL ACTION OR CHANGE NOTIC

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					                                 PERSONNEL ACTION OR CHANGE NOTICE
                                           INSTRUCTIONS


I have read these instructions

Important: To ensure timely processing, please verify accuracy of all data fields, especially
funding codes, prior to submitting this form to the Bureau of Personnel Services. Forms
submitted with incorrect data will not be processed and will be returned to the originating office.


This form is used to:
     Establish or effect changes to OPS positions
     Name change, social security number correction, and/or birth date correction for CS/SES/SMS/OPS
        positions


Section 1:     This section must be completed to process any of the above actions.

Section 2:     This section must be completed to establish a new OPS position or to effect changes to an
               existing OPS position.

               a)     Check the box next to the type of action to be processed.
               b)     Complete the appropriate data fields (numbers 1-20) that are indicated next to the type
                      of action that has been checked. For example, to change the supervisor of an existing
                      OPS position, check the box “Supervisory Change”, complete (5) Supervisor’s Pos. #.
               c)     NOTE: If this position is paid for by one division/district and reporting to
                      another, check YES and then complete (3) PF Org Code. This information must
                      be reflective of the division/district the position reports to so that accurate
                      organizational structure is maintained.

Section 3:     Complete this section if any actions listed need to be updated. Proper documentation (if
               applicable) must be attached before change will be processed.

PLEASE NOTE:

      If you are completing Sections 1 and 2, you have the option of submitting the form via email, Fax OR
       by mailing the original. PLEASE CHOOSE ONLY ONE METHOD OF SUBMISSION. If you email or
       Fax the form, please do NOT send the original to Bureau of Personnel Services. Please submit to the
       attention of the Org Management/Classification Section, MS-70.

               Forms can be sent to:

               Email to:                   Jennifer.Grantham@dep.state.fl.us
               Fax to:                     850-412-0747

               Email to:                   Brenda.Stubbs@dep.state.fl.us
               Fax to:                     850-412-0748


      If you are completing Sections 1 and 3, an approval signature is required, therefore you must
       submit the original by mail to the attention of the Payroll Processing Section, MS-70.

             Do not include this sheet with your submittal. This is an instruction page only.

If you have questions regarding the completion of this form, please contact the Bureau of Personnel Services
at (850) 245-2511.



DEP 54-701 (10-09)
                                           PERSONNEL ACTION OR CHANGE NOTICE
                                       Section 1 - Complete this section for all actions or changes


Employee Information:
Last:                                                         First:                                                    MI:
PF ID#:                            Pos#:                       Effective Date:
Division/District:                                                      Bureau/Park District:
Section:


CONTACT INFORMATION (Name of person submitting form-please PRINT OR TYPE)                Phone Number:


    Section 2 – Complete this section to establish a new OPS position or to effect changes to an established OPS position


NOTE:      Is this position paid for by one division/district and reporting to another? Yes       No
           If yes, PF Org Code (3), must be reflective of the division/district the position reports to so that accurate
           organizational structure is maintained.

        Establish New OPS Position (complete 1 - 20)
        Class Title Change (complete 1 - 20)
        Supervisory Change (complete 5)
        Security Role Code Change (complete 6)
        Change Funding Codes (complete 3, 7, 8, 9 & 10)
        FTE/Status Change (complete 11, 12 & 13)
        Work Location Information Change (complete 14, 15, 16, 17, 18, 19 & 20)
        Delete OPS Position
 (1)    Class Title:
 (2)    Class Code: (4 digit)
 (3)    People First Org Code: (24 digit)
 (4)    Broadband Code: (7 digit)
 (5)    Supervisor’s Pos. #: (8 digit)
 (6)    Security Role Code:
 (7)    FLAIR Account Code:(29 digit)
 (8)    FLAIR Org Code: (11 digit)
 (9)    Program Component: (10 digit)
(10)    Budget Entity: (8 digit)
(11)    FTE:
(12)    Shared:            Yes                No
(13)    Temporary           Seasonal           Student     (provide completed student verification: Form DEP 54-605)
(14)    Work Address:
(15)    City:
(16)    Zip:
(17)    County:
(18)    Phone #:
(19)    Extension:
(20)    Mail Station


                                           Section 3 - This section applies to OPS/CS/SES/SMS


Type of Action: (Check all that apply. Form will not be processed without required documentation.)

        Name Change (Must submit copy of new Social Security Card to BoPS, MS - 70)
        Social Security Number Correction (Must submit copy of Social Security Card to BoPS, MS – 70)
        Birth date Correction: Corrected Birth date


 Signature of Employee or Other Designee                  Print Name of Employee or Other Designee               Date

DEP 54-701 (10-09)

				
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