Document jgx8r171GGNzzYb5920RR3paZ
To
1ft RC-ll__________
NAME -rTc
EMPLOYE JOB & STATUS CHANGE NOTICE
T~
Dept;
Date
t.c.# a*/
$/(&
REGULAR TRANSFER (Job Ownership)
Award Notice Only
Ja^Bid Job
, `
Bumped
' (
. ...
Assigned
O Returning (Expansion)
Relief Work
..
. . *
UTILITY TRANSFER .
.
No Choice
' .
. .
Q Day Choice
' 'V
Shift Choice .
*
Q 5-Year Selection : .
.
BgLOYMENT
;
New Bnploye
Ret. from Lay Off
O Ret. from L.O.A. :
Ret . from Absenc
Effective Date
FROM /a'?'. OP- fi`r,L/ry) JDEPT.
caI/2
____
f Address
I''T UCU* c 0 01 { a^rnone
sA>M/T7/ .
S'Me#//?. //Z.
Replacing A) > Ty
&
TEMPORARY SEPARATION
Lay Off Off W/0 Pay Q Military Service O Leave of Absence Other (Specify)
Remarks : :
Authorization
. ,
.
PERMANENT SEPARATION
Retire Resign T. & P.D. 0 Dropped Discharged Deceased
n X
PCB-ARCH-EXT0375561
PCB-ARCH-EXT0375562