Personnel Payroll Data Sheet



**COMPLETE THIS FORM IN CONSULTATION WITH YOUR ASSIGNED HUMAN RESOURCE BUSINESS PARTNER.**ACTIONAgency Name: FORMDROPDOWN or FORMDROPDOWN Effective Date: FORMTEXT ????? (If: LOA use 1st day on leave; separation use last day in pay status)Recruitment #: FORMTEXT ????? Offer Accepted Date: FORMTEXT ????? Action Type: FORMDROPDOWN Action Reason: -or-Separation Reason: FORMDROPDOWN FORMTEXT ????? FORMDROPDOWN FORMTEXT ?????TASK MONITORING:Task: FORMDROPDOWN Expected end date: FORMTEXT ?????Review Period: FORMCHECKBOX YES FORMCHECKBOX NO If yes, length: FORMTEXT ????? monthsEMPLOYEE *****If this employee is new to your agency with this action, submit a completed Employee Information Form with the PPDS*****Last Name: FORMTEXT ?????First Name: FORMTEXT ?????M/I: FORMTEXT ?????Personnel #: FORMTEXT ?????(if no personnel #, call with SSN)Prior State Service FORMCHECKBOX YES FORMCHECKBOX NO ADDRESS & PHONE:Permanent Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????Zip: FORMTEXT ?????Mailing Address (if different): FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????Zip: FORMTEXT ?????Primary Phone: FORMTEXT ?????Alternate Phone: FORMTEXT ?????Type: FORMDROPDOWN Work Email: FORMTEXT ?????PERSONAL DATA:Gender Designation for Health Ins: FORMCHECKBOX Male FORMCHECKBOX FemaleDate of Birth: FORMTEXT ?????Marital Status: FORMDROPDOWN since: FORMTEXT ?????POSITION & ORGANIZATIONAL ASSIGNMENT FORMCHECKBOX No ChangeJob Class Title: FORMTEXT ?????Job Class Code: FORMTEXT ?????Working Title (if different than Job Class Title): FORMTEXT ????? 8-Digit Position #: FORMTEXT ?????4-Digit Position #: FORMTEXT ?????Status in Position: FORMDROPDOWN Overtime Eligible FORMCHECKBOX YES FORMCHECKBOX NO L&I Code: FORMDROPDOWN Duty Station: FORMDROPDOWN FORMTEXT ?????Org Key (optional): FORMTEXT ?????MyPortal: Agency uses MyPortal: FORMCHECKBOX YES FORMCHECKBOX NO This employee is a MyPortal leave approver: FORMCHECKBOX YES FORMCHECKBOX NOSupervisor Name: FORMTEXT ?????Supervisor Position #: FORMTEXT ?????BASIC PAY FORMCHECKBOX No ChangeReason: FORMDROPDOWN Salary: $ FORMTEXT ????? Per: FORMCHECKBOX Year FORMCHECKBOX Month FORMCHECKBOX Day FORMCHECKBOX HourBand/Range: FORMTEXT ?????Step: FORMTEXT ?????Eligible for Assignment Pay/PremiumIs a premium added to base salary to recognize specialized skills and assigned duties? FORMCHECKBOX YES FORMCHECKBOX NO Type: FORMDROPDOWN Eligible for Shift DifferentialDoes employee’s regular or temporary scheduled work shift include hours after 6:00pm and before 6:00am? FORMCHECKBOX YES FORMCHECKBOX NOWORK SCHEDULE FORMCHECKBOX No ChangeWork Schedule: FORMDROPDOWN Other: FORMTEXT ????? Shift Hours: Start Time: FORMTEXT ????? am FORMCHECKBOX pm FORMCHECKBOX End Time: FORMTEXT ????? am FORMCHECKBOX pm FORMCHECKBOX FORMCHECKBOX Full Time (100%) FORMCHECKBOX Part Time FORMTEXT ?????%Teleworking: Is/will employee be working from home or another alternative location closer to home? FORMDROPDOWN BENEFITS FORMCHECKBOX No Change Insurance Eligible Is the employee expected to work an average of 80 hrs/month (at least 8 hrs/month) for more than 6 months? FORMCHECKBOX YES FORMCHECKBOX NO Eligible for Personal HolidayIs the employee scheduled to be, or has been, continuously employed 4 months? FORMCHECKBOX YES FORMCHECKBOX NO Retirement EligibleNote: Eligibility is based on the position. Use the Retirement Eligibility Worksheet to make determination. FORMCHECKBOX YES FORMCHECKBOX NO Eligible for Personal Leave Day (Represented Only)Is the employee scheduled to be, or has been, continuously employed 4 months. (6 months if Coalition or Teamsters) FORMCHECKBOX YES FORMCHECKBOX NO BUDGET FORMCHECKBOX No Change Percentage: FORMTEXT ?????Fund: FORMTEXT ?????Appropriation Index: FORMTEXT ?????Program Index: FORMTEXT ?????Project: FORMTEXT ?????Percentage: FORMTEXT ?????Fund: FORMTEXT ?????Appropriation Index: FORMTEXT ?????Program Index: FORMTEXT ?????Project: FORMTEXT ?????Percentage: FORMTEXT ?????Fund: FORMTEXT ?????Appropriation Index: FORMTEXT ?????Program Index: FORMTEXT ?????Project: FORMTEXT ?????AUTHORIZATION & COMMENTS/NOTESPrepared By: FORMTEXT ?????Date: FORMTEXT ?????Comments: FORMTEXT ?????Approved By: FORMTEXT ?????Date: FORMTEXT ?????HR/PAYROLL USE ONLYHRMS Processor: FORMDROPDOWN Represented Position: FORMCHECKBOX YES FORMCHECKBOX NOEligible for Leave Accruals: FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX S/L Only Date Received: FORMTEXT ?????Union: FORMDROPDOWN Periodic Increment: FORMTEXT ?????Date Processed: FORMTEXT ?????Change in CBA: FORMCHECKBOX YES FORMCHECKBOX NOLetter Received: FORMCHECKBOX YES FORMCHECKBOX NOSent to Payroll: FORMTEXT ?????Received by Payroll: FORMTEXT ?????Processed by Payroll: FORMTEXT ?????**Send completed PPDS to the Small Agency Inbox at saa@des.**Form Revised 9.21.21ACTION INFORMATIONAgency Name:Use the drop-downs to choose your agency name.Effective Date:The effective date of the action – the first day the employee is in the status. If the action is for a Leave of Absence (i.e. FMLA), enter the first day the employee is considered to be on leave. If the action is a separation, enter the employee’s last day in pay status.Recruitment #:If this appointment is resulting from a recruitment, enter the recruitment number. If applicable, provide the date the candidate accepted the job offer.Action Type:The type of action you are requesting. If you need help identifying which action to use, contact your HR consultant.Action Reason or Separation Reason:The reason for the action you are requesting. If the action type is separation, choose from the bottom drop-down. If you need help identifying which action type to use contact your HR consultant.Task:Select from the drop-down – if there is no task associated with this action, select Not Applicable from the drop-down. If there is a task, indicate the expected end date of the task chosen in the space provided.Review Period:Indicate if there is a review period associated with this action. If yes, indicate the length of the review period.EMPLOYEE INFORMATIONLast Name:Employee’s last name.First Name:Employee’s first name.M/I:Employee’s middle initial.Employee ID #:Employee’s personnel number, if employee currently works for the state or has in the past. If this is a new hire action, enter the employee’s social security number.Prior State Service:If the employee associated with this action is new to the agency, indicate whether this employee has prior state service.Permanent Address:Employee’s permanent address, to include City, State, and Zip Code.Mailing Address:Employee’s mailing address, to include City, State, and Zip Code. This field only needs to be completed if mailing address is different than permanent address.Primary Phone:Employee’s primary contact number.Alternate Phone:Alternate number the employee can be reached at, if provided, and type of contact number (i.e. cell).Work Email:Employee’s work email address.Gender:Indicate employee’s gender.Date of Birth:Indicate employee’s date of birth.Marital Status:Indicate employee’s marital status, and the effective date of this status.POSITION & ORGANIZATIONAL ASSIGNMENT INFORMATIONJob Class Title:Employee’s assigned Job Class Title.Job Class Code:Indicate the job class code associated with the employee’s assigned job class.Working Title:Indicate the position’s working title, if it is different.8-Digit Position #:Indicate the 8-digit position number this employee is assigned to.4-Digit Position #:Indicate the 4-digit position number this employee is assigned to.Status in Position: The employee’s appointment status in the position.Overtime Eligible:Indicate if the employee is overtime eligible.L&I Code:Indicate the risk code of the employee’s position.Duty Station:Indicate the address where the employee is assigned to work. Use MyPortal:Indicate whether your agency utilizes MyPortal for leave.MyPortal Leave Approver:Indicate whether the employee will be a MyPortal Leave Approver in this position. This field is required if your agency utilizes MyPortal.Supervisor Name:Indicate who this position reports to.Supervisor Position #:Indicate the supervisor’s 8-digit position number.BASIC PAY INFORMATIONReason:Select from drop-down - indicate the reason for the salary change associated with this action.Salary:Indicate the employee’s new salary, to include whether the amount is per year, month, day, or hour.Band/Range:Indicate what Band (WMS/EMS) or Pay Range the employee is in based on their job classification.Step:Indicate what Step within the range the employee is being assigned to. This field does not apply if the job classification is EMS or WMS.Assignment Pay:Indicate if the employee is eligible for assignment pay or King County premium pay. Indicate the type of assignment pay if applicable. Shift Differential:Indicate if the employee is eligible for shift differential pay. WORK SCHEDULE INFORMATIONWork Schedule:Choose from the drop-down list what schedule the employee will be working (5/8s, 4/10s, 9/80s, etc). If the employee is hourly, choose 24/7. If the employee’s schedule is not listed, select Other, and then specify what the schedule will be.Shift Hours:Indicate the employee’s hours of work.Full-Time/Part-Time:Indicate whether the employee will be working full-time or part-time. If the employee will be working anything less than 40 hours/week, select part-time. If employee is part-time, fill in part-time percentage.Teleworking:Indicate if the employee will be participating in teleworking. BENEFITSInsurance Eligible:Indicate if the employee is insurance eligible.Retirement Eligible:Indicate if the employee is retirement eligible.Eligible for Personal Holiday:Indicate if the employee is eligible for a personal holiday.Eligible for Personal Leave Day:Indicate if the employee is eligible for a personal leave day.BUDGET INFORMATIONComplete all fields that apply. If unsure, work with your assigned budget analyst.AUTHORIZATION & COMMENTS/NOTES:Prepared By:Complete this section with every action. Indicate who completed the PPDS.Approved By:Complete this section with every action. Indicate who approved the ments/Notes:Use the Comments/Notes to indicate any additional information necessary to process the action. ................
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