ࡱ> qsp3 *bjbjKK -h)w)wA :6l`8F|l`%;(:Vllln}l:::::::$M< m>::  ::"ll:""" :pll:" :""s*h7|8l. ЯRxc`  N784:0%;7'?)"d'?8"( H Payroll #  FORMTEXT       From  FORMTEXT       to  FORMTEXT       EMPLOYEE NAME Last  FORMTEXT       First  FORMTEXT       MI  FORMTEXT   EMPLID  FORMTEXT      EMPL RECD  FORMTEXT       BENEFITS SVC DATE  FORMTEXT        AGENCY  FORMTEXT      DEPT  FORMTEXT      SALARY $  FORMTEXT      / HOUR ($  FORMTEXT       /YEAR)TITLE  FORMTEXT      POS. CTL #  FORMTEXT      UNION CODE  FORMTEXT       ACTION  FORMTEXT       REASON  FORMTEXT       EFFECTIVE DATE*  FORMTEXT       *The Effective Date of Termination is always the day AFTER the last day on payroll Will employee continue to be employed in another position?  FORMCHECKBOX  Yes TITLE  FORMTEXT      POS. CTL #  FORMTEXT        FORMCHECKBOX No  FORMCHECKBOX Unknown If employee is being rehired into same/another county agency, use the Action TER and the Reason JAC (JOB and AGENCY CHANGE) and provide the following information: NEW DEPARTMENT  FORMTEXT       NEW TITLE  FORMTEXT       EFFECTIVE DATE  FORMTEXT        ACCRUED LEAVE PAYABLE UPON TERMINATION (Not paid if employee is dismissed for cause) ** CONSULT APPROPRIATE COLLECTIVE BARGAINING AGREEMENT FOR PROVISIONS GOVERNING PAYMENT FOR ACCRUED LEAVE (E.G., ELIGIBILITY, LIMITS) VACATION** Annual Balance At Termination:  FORMTEXT       HRS Longevity Balance At Termination:  FORMTEXT       HRS TOTAL BALANCE PAYABLE**:  FORMTEXT       HRS Times $ FORMTEXT       Hourly Rate = VACATION TERMINAL LEAVE PAY $ FORMTEXT      HOLIDAY** Balance At Termination:  FORMTEXT       HRS BALANCE PAYABLE**:  FORMTEXT       HRS Times  FORMTEXT       Hourly Rate = HOLIDAY TERMINAL LEAVE PAY  FORMTEXT       COMPENSATORY** Balance At Termination:  FORMTEXT       HRS BALANCE PAYABLE**:  FORMTEXT       HRS Times $ FORMTEXT       Hourly Rate = COMP TERMINAL LEAVE PAY $ FORMTEXT      SICK LEAVE** Balance At Termination:  FORMTEXT      HRS BALANCE PAYABLE**:  FORMTEXT      HRS Times $ FORMTEXT       Hourly Rate = SICK TERMINAL LEAVE PAY $ FORMTEXT      DEPARTMENTAL APPROVAL: Name Title Date NOTES: Appointing Authority MUST ensure that any adjustments made to terminal leave pay are properly entered prior to close of payroll. Instructions: 1. Complete all information fields and attach required documentation. Any unusual situations or changes not reflected on accompanying documents must be explained below in the "Comments" area. Termination transactions must be received in personnel on Monday following payday to allow for review of terminal leave pay. Following personnel review, any adjustments will be recorded below and communicated to the department. Departments must ensure that adjustments are input into PeopleSoft. Finance will verify terminal leave amounts input into PeopleSoft. COMMENTS:  FORMTEXT       . ___________________________________________________________________________________________________________________________________________      V 1.3  DATE \@ "MM/dd/yy" 01/30/08 ATTACH: 1. Copy of resignation/retirement/termination letter 2. Copy of last quarter time/attendance record 3. Copy of Leave Balance Report from prior pay period DIS Disability To denote a Disability Retirement INC Incentive To denote a retirement under an approved Retirement Incentive Program VRE Voluntary To denote a regular Voluntary Retirement ACTION: RETIREMENT 1ST First Year Non-Comp/Labor To denote the termination of a non-competitive/labor employee during the first year of employment. ATW At Will To denote the termination of an individual without rights e.g. served at the pleasure of the County Executive. AWN Resignation Absence Without Notice To denote the deemed resignation of an individual who was absent without notice under the terms of the appropriate labor agreement. DEA Death To denote the death of an active employee. DFC Discharged for Cause To denote the discharge of an employee for disciplinary reasons. HEA Health Reasons To denote Resignation due to Health Reasons. JAC Job and Agency Change To be used when an employee terminates in one County agency to be appointed to a different position (i.e., title and/or position control number) in a different County agency. LAB Layoff Abolishment To denote Layoff due to the abolishment of an individuals position. LCS Layoff Civil Service Law To denote Layoff due to the operation of Civil Service Law e.g., failure to appear for exam/appear on eligible list; not reachable on eligible list, etc. LVE Failure to Return from Leave To denote a termination based on an individuals failure to return from an approved Leave of Absence. NVR Never Reported to Work To terminate an individual who was hired onto the payroll but never reported to work. OTH Resignation Other Reasons To denote a Resignation for reasons other than those listed within this action. PRB Terminated during Probation To denote the termination of an individual who failed to successfully complete his/her probationary period. REL Resignation Relocation To denote an individuals resignation in order to relocate from this area. S71 Section 71 Ordinary Disability To denote a termination for ordinary disability under Section 71 of NYS Civil Service Law. S73 Section 73 Ordinary Disability To denote a termination for ordinary disability under Section 73 of NYS Civil Service Law. S75 Section 75 Disciplinary To denote a termination for disciplinary reasons under Section 75 of NYS Civil Service Law. STE Still Employed in Another Position To denote the termination of an individual in one or more of multiple positions while remaining active in at least one. TMP End of Temporary Employment To denote the end of an approved period of temporary employment, including student employment. TOF Term of Office Expired To denote the termination of an individual when his or her term of office expires. TPV Provisional Services Terminated To denote the termination of the provisional services of an individual. TSV Temporary Services Terminated To denote the termination of the temporary services of an individual. WCL Workers Comp Leave To denote the termination of an individual from Workers Comp Leave. XFR Civil Service Transfer Out of County To terminate an individual from County service under the approved Civil Service definition of Transfer pursuant to RC Rule XVII. ACTION: TERMINATION ACTION: TERMINATION WITH PAY To be used where final pay may be effected in a payroll subsequent to actual termination date. 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A B C x { |  Lauren Boaz>G:\LB-Lauren\Personnel Forms for Joyce\PS TERMINATION FORM.doc Lauren BoazlC:\Documents and Settings\BoazL\Application Data\Microsoft\Word\AutoRecovery save of PS TERMINATION FORM.asd Lauren BoazlC:\Documents and Settings\BoazL\Application Data\Microsoft\Word\AutoRecovery save of PS TERMINATION FORM.asd Lauren BoazlC:\Documents and Settings\BoazL\Application Data\Microsoft\Word\AutoRecovery save of PS TERMINATION FORM.asd Lauren BoazlC:\Documents and Settings\BoazL\Application Data\Microsoft\Word\AutoRecovery save of PS TERMINATION FORM.asd Lauren BoazlC:\Documents and Settings\BoazL\Application Data\Microsoft\Word\AutoRecovery save of PS TERMINATION FORM.asdRockland County2H:\PEOPLESOFT FORMS\PS ONLINE TERMINATION FORM.docRockland CountyFC:\Documents and Settings\BoazL\Desktop\PS_ONLINE_TERMINATION_FORM.docRockland CountyFC:\Documents and Settings\BoazL\Desktop\PS_ONLINE_TERMINATION_FORM.docRockland CountyFC:\Documents and Settings\BoazL\Desktop\PS_ONLINE_TERMINATION_FORM.dotl= \x%A-2$K-}A`yThq@Xr_$ xvv^v`.FF^F`.L^`L.  ^ `.  ^ `.L^`L.VV^V`.&&^&`.L^`L.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.vv^v`o(.FF^F`.L^`L.  ^ `.  ^ `.L^`L.VV^V`.&&^&`.L^`L.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.}Ar_q@Xl= A-2yT                                                     p&'(C\,Fg h @Ĩ pppp p pppppp0@pp8@UnknownGz Times New Roman5Symbol3& z Arial5& zaTahoma;Wingdings"qhff۪ !20dj H2Q'ROCKLAND COUNTY DEPARTMENT OF PERSONNELPreferred CustomerRockland CountyOh+'0 (4 P \ h t(ROCKLAND COUNTY DEPARTMENT OF PERSONNELOCKPreferred CustomerAref Normal.dotuRockland County2ckMicrosoft Word 9.0A@F#@Ź @Qxc@Qxc ՜.+,0  hp  Preferred CompanyTj  (ROCKLAND COUNTY DEPARTMENT OF PERSONNEL Title  !"#$%&'()*+,-./012346789:;<=>?ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_abcdefgijklmnorRoot Entry FRxctData 51Table@'?WordDocument-hSummaryInformation(`DocumentSummaryInformation8hCompObjjObjectPoolRxcRxc  FMicrosoft Word Document MSWordDocWord.Document.89q