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CITY OF HIALEAH, FLORIDA

- \

PAYROLL AUTHORIZATION

-
J .., Z~l~
NAME: - - - -- - - - - - -- - -- - -- DATE:
JCXX-X mp.:D · 6.L
ADDRESS : - - -- - - - - - - -- - - - - SOCIAL SECURITY NO,: ~ .. •'-''-

CITY: _ __ _ __ _ _ __ __ _ _ _ _ _ __ :!'C.lr.t
POSITION:
'[; ll.t: c.
DATE OF BIRTH: _ _ _ _ _ _ _ __ _ _ _ __ DEPARTMENT:
REDACTED .:.cc' ( l:i .:
F.S. 119.071(5)(a)5.
PLACING - REMOVING

EFFECTIVE DATE:_ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ __ RATE: _ _ _ _ _ _ _ _ _ _ _ _ _ __

CHECK ONE : NEW EMPLOYEE □ REMOVING □ AUTHORIZED HOURS: _ _ _ _ __

REASON FOR TERMINATION:

CHANGE IN STATUS
BASE
-- .
SPEC. nn. t\1111
i?cl.:.-
- , '
FROM :_ _ _ _ _ _ _ _ _ __ _ _ _ _ __ LONG .
POSITION ·•.
DEPARTMENT INCT.
LJ. "e • J.
T >

TOTAL Bl -WEEKLY .lJ Li • k 'I.A

.:,2. 7 2u
BASE - ::-
SPEC. -
DEPARTMENT LONG .
INCT.

1..1.:.. ·26, 115 TOTAL Bl -W EEKLY -


EFFECTIVE PAYROLL DATE: _ _ __ __ _ _ _ _ __ _ _ _ _ _ _ __ __

2/31201
REASON FOR CHANGE IN STATUS:
n.ciJ•1::·t.:1cnt~ ,:-::: ~ ':l':I.J.- on te-qu.1.ar uu"t;y, ~ue on "t;nc
t°'.iyd ... y ... •.1nc 1 , .. 1):(.

SIGNATURE OF EMPLOYEE _ _ __ _ _ _ _ _ _ _ _ _ _ __ _ __

SIGNED :_ _ _ __ _ =------ - - - - - - - - - SIGNED : _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __


APPOINTING AUTHOR ITY OR DESIGNEE DEPARTMENT HEAD

+ TO BE USED BY PERSONNEL DEPARTMENT ONLY +

VACATION DAYS: _ _ _ _ _ _ _ _ __ _ __ _ __ COMPENSATORY TIME: _ __ _ _ _ _ _ _ _ _ _ _ __

OTHER : _ _ _ __ _ _ _ _ _ _ _ _ __ _ _ __ UNUSED SICK LEAVE: _ _ _ _ _ _ _ _ __ _ _ _ _ __

SALARY PAYROLL
SCHEDULE- - - - - - -- CARDS AUTHORIZED- - - - - - - - - - - - - - -

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