Division/Office/Unit Requesting Action - DBHDD
|Division/Office/Unit Requesting Action |DBHDD- WEST CENTRAL GEORGIA REGIONAL HOSPITAL |
|Contact Name | |Phone Number | |
|Effective Date | |Position Number | |
|Department ID Number | |Mail Drop ID Number | |
|County Name/Code/ZIP | |Reports To | |
|REQUESTED ACTION (Type an “X” in all that apply) |
| |New Position | |Lateral Job Change | |Job/Grade Change |
|MISCELLANEOUS ACTION (Type an “X” in all that apply and provide necessary information) |
| |Activate Psn | |Department ID Change |From | |To | |
| |Inactivate Psn | |County/ZIP Change |From | |To | |
| | | |Mail Drop ID Change |From | |To | |
|POSITION VACANT? | |YES | |NO (If No, complete the following Employee Data) |
|Employee Name | |Employee ID Number | |
|Current Hourly Rate | |New Hourly Rate | |
|CHANGE IN EXISTING POSITION |
|Current Job Title | |Current Job Code | |Hourly Rate | |
|New Job Title | |New Job Code | |Hourly Rate | |
|CREATE A NEW POSITION (Call OHRMD, 404-657-5682, to receive Control Number) |CONTROL NUMBER | |
|Requested Job Title | |Job Code | |PG | |
|DRUG TESTING REQUIRED? | |YES (If Yes, check one of the following) | |NO |
| |POST Certified | |CDL | |Discretion of Agency (Board) | |Pre-employment |
|SALARY PLAN | |CHW ($5.15 - $8.50) | |TPW ($8.51 - $30.00+) |
|COMMENTS |
| |
|Submitted By | |Date | |
|Approved By | |Date | |
| |
|FOR OHRMD USE ONLY |
|Decision |Action/Reason |FLSA |SCOA Type |Drug Test |Psn File? |Date Completed |Analyst |
| | | |Temporary | | | | |
Georgia Department of Behavioral Health & Developmental Disabilities (DBHDD)
Hourly Paid Program – Request for Position Action
Form HL001 (Revised March 2005)
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