ARIZONA DEPARTMENT OF PUBLIC SAFETY Close

PERSONNEL/POSITION ACTION REQUEST DATE

See G. O. 2.3.100, Recruitment Incentive Program; G. O. 2.4.100, Non-Exempt Employee Time
Accounting; G. O. 2.5.10, Processing Personnel and Position Changes; G. O. 2.5.20, Assignment 10/04/2007
INDEX CODE
Transfer and Promotion of Personnel; G. O. 2.5.70, Processing Terminating Employee; G. O.
3.4.70, Industrial Injury Compensation; G. O. 5.1.90, Department Owned Housing; G. O. 7.2.50, 21000
Residence Relocation.
REQUEST - CHECK APPROPRIATE BOX(S)
PERSONNEL ACTION POSITION ACTION

A 1. FILL VACANCY 7. LEAVE OF ABSENCE

With Pay B 1. ESTABLISH (New) 5. FUNDING RESOURCE
A. Appropriation F. RMIN
2. NEW HIRE Without Pay 2. REALLOCATE LIMITED TERM G. GOHS
3. REEMPLOYMENT FMLA
Industrial B. Federal H. State/Local
3. TRANSFER
4. RECLASSIFICATION 8. SPECIAL ACTION (Complete I below) C. POTF/ALEOAC I. RICO
D. LEMSC J. Other
5. TRANSFER/ASSIGNMENT 9. SEPARATION 4. DELETE
E. MCSAP
6. TEMPORARY ASSIGNMENT 10. RETIREMENT
HUMAN RESOURCES USE ONLY
EMPLOYEE / POSITION INFORMATION
PROPOSED ENTRY SDA
C NAME: FIRST M.I. LAST I. D. NUMBER SALARY $
MIDPOINT FIXED PAY
Daniel T Scott 6 2 8 6 PROPOSED
HOURLY $ MAXIMUM STEP

D EFFECTIVE DATE (IF TEMPORARY, INCLUDE FROM AND TO DATES)

E REPORT TO: (RANK, LAST NAME, FIRST INITIAL) I.D. NO. SUPERVISOR
CHANGE?
October 20, 2007 Sgt Swanty, B. 4733 YES NO

G
1. LOCATION CODE
F 1. LOCATION CODE COUNTY COUNTY

23090200 Cochise 21030600 Navajo

F 2. CLASSIFICATION / RANK 3. CLASS NO. T 2. CLASSIFICATION / RANK 3. CLASS NO.
R Officer O
1200 Officer 1200
O 4. POSITION NUMBER 5. CALL SIGN DESIGNATOR 4. POSITION NUMBER 5. CALL SIGN DESIGNATOR
M OVERFILL
775 925 1901 UNDERFILL 365
SUPPLEMENTAL INFORMATION
H TRANSFER/
ASSIGNMENT
1. MOVING EXPENSES
YES NO
2. PER DIEM EXPENSES
YES (Explain below) NO
3. STATE HOUSING
MOVING IN MOVING OUT
4. ADJUST UNIFORM TO:
ALLOWANCE $
> UNIT NO. UNIT NO.

I SPECIAL
ACTION
1. SHIFT DIFFERENTIAL 2. REMOTE DUTY 3. OTHER PAY OPTIONS (Specify in item "J" below)

> START STOP CONTINUE START STOP CONTINUE START STOP CONTINUE

J REMARKS
RESIGNATION / RETIREMENT LETTER ATTACHED
RECRUITMENT
INCENTIVE?
YES NO

K OTHER

AUTHORIZATION SIGNATURES
L INITIATOR (COMMANDER / MANAGER) DATE
P COMPTROLLER DATE

X X
M DIVISION CHIEF (NEW) DATE
Q LEMSC DATE

X X
N DIVISION CHIEF (CURRENT) DATE
R HUMAN RESOURCES DATE

X X
O POSITION CONTROL DATE
S DIRECTOR DATE

X X
HUMAN RESOURCES USE ONLY
SELECTION DISABLED / VIETNAM INFO. OVERTIME STATUS EXEMPT
NEW HIRE TRANSFER PROMOTION DISABLED VIETNAM APPOINTED NON-EXEMPT
REEMPLOYMENT LIMITED TERM DEMOTION RETIREMENT MARTIAL STATUS COUNTY
PROVISIONAL PART-TIME REALLOCATION
INTERN/RESERVE INTERMITTENT LATERAL CIVILIAN SWORN MARRIED SINGLE
APPLICANT ETHNIC ORIGIN HRIS APPLICANT NO.
NATIVE ALASKAN PACIFIC
WHITE BLACK HISPANIC ASIAN AMERICAN NATIVE ISLANDER
SOCIAL SECURITY NO. MALE DATE OF BIRTH PHONE NO. (Include Area Code) OTHER
FEMALE
RESIDENCE ADDRESS CITY STATE ZIP CODE

PREVIOUS STATE EMPLOYMENT AGENCY NAME HIRE / TERMINATION DATE I.D. NO. DATE
YES NO
DISTRIBUTION: ALL COPIES TO HUMAN RESOURCES (original plus three [3] copies) DPS 802-01881 (Page 1-F) Rev. 1-2007