PERSONNEL DATA ON TRANSFERRED EMPLOYEE - …

[Pages:2]The City Of New York

PERSONNEL DATA ON TRANSFERRED EMPLOYEE

NAME OF EMPLOYEE

ADDRESS OF EMPLOYEE

Instructions: Upon the movement (by transfer, promotion or appointment) of an employee from one city department or agency to another, the following information should be supplied as soon as possible to the appointing officer of the agency to which the employee is being assigned.

RELEASING AGENCY

LAST TITLE IN RELEASING AGENCY

APPOINTMENT DATA

DATE OF ORIG. ENTRY INTO CITY SERVICE

DATE APPT'D. IN RELEASING AGENCY

LAST DATE ON PAYROLL

LAST DATE FOR WHICH EMPLOYEE WAS PAID

RATE OF ACCRUAL 20 DAYS 27 DAYS 25 DAYS OTHER

REGISTRY NO.

DATE ELIGIBLE FOR HIGHER LEAVE ACCRUAL

LEAVE DATA

A.L. BALANCE ON DATE RELEASED

S.L. BALANCE ON DATE RELEASED

OVERTIME CREDITS

LEAVE WITHOUT PAY SINCE LAST INCREMENT APP'T .. REINSTATEMENT OR PROMOTION

SALARY WHEN RELEASED

PAYROLL DATA

SALARY INFORMATION

LAST INCREMENT DATE

NEXT INCREMENT DATE

AMOUNT OF INCREMENT

NO. OF INCOME TAX EXEMPTIONS

BONDS

PENSION INFORMATION

PENSION RATE REGULAR ADJUSTED

PENSION NO.

HEALTH INSURANCE

CONTRACT NO. NOT ENROLLED TYPE

PENSION ARREARS: NO PAYMENTS DUE

RATE:

PENSION LOAN: NO. PAYMENTS DUE:

AMT. EACH PAYMENT

AMOUNT

ORGANIZATION DATA

NAME OF UNION

SOCIAL SECURITY

SOCIAL SECURITY NO.

FICA CLASS AC

BD E

UNION DUES

Important: please supply the additional information called for on the reverse side. (Over)

DATE

RECORD OF EMPLOYMENT

ACTION

TITLE

GRADE

SALARY

MISCELLANEOUS (INDICATE TEMP OR PERMANENT & NO. OF DAYS IN WORK WEEK IF

OTHER THAN 5)

CERTIFICATION OF RELEASING DEPARTMENT OF AGENCY I CERTIFY THAT THE DATA CONCERNING THE ACCRUED LEAVE, PAYROLL

DEDUCTIONS AND OTHER INFORMATION PERTAINING TO THE ABOVE EMPLOYEE IS ACCURATE, BASED UPON THE RECORDS MAINTAINED BY THIS DEPARTMENT OR AGENCY.

Signature

Date

Title

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