separation transaction codes-required/conditional … · *1 this item is conditional for exempt...

' (

I (

3.200 (Rev. 11/04)

SEPARATION TRANSACTION CODES- REQUIRED/CONDITIONAL INDEX

(See PAM page 2.209.1 for inactive/redefined transaction codes)

CODE

Resignations

·so1

S02 *

S03 *

S04 *

sos 1 -

2-

3-

4-5-

S20 **

S21 *

IITI E/DESCRIPTION

Voluntary From any appointment. Also includes voluntary resignation while on leave of absence· and separation of permanent intermittent employee who did not report to work after being requested to report three times or was in non-pay status for one year.

Layoff Situation or In Lieu of Involuntary Transfer

In Lieu of Military Leave

Failure to Meet Conditions of Employment

For employee moving to, from or between exempt positions when lump sum vacation is to be paid. For current PERS member moving to an exempt position covered under a different retirement system. · For employee being appointed or employed by the Legislature (House or Legislative Committee). For employee accepting CSU exempt appointment Do not use for employee accepting employment with California Conservation Corps.

Voluntary under Unfavorable Circumstances- Pursuant to a stipulated agreement resulting from an appeals process. This code should be used .on4!: in those cases where the employee has entered into a stipulated agreement (approved by the State Personnel Board) with the appointing powerto voluntarily resign "with fault".

AWOL- Automatic resignation as a result of an absence without approved leave for five consecutive working days.

Termination Without Fault S30 Layoff Situation (Reduction in Force)

*For separation of Civil Service employee only.

**For actions occurring after 02/02/89.

PAGE

3.204

3.206

3.208

3.210

3.212

3.214

3.216

3.218

3.201 (Rev. 11/05)

SEPARATION TRANSACTION CODES- REOlJIRED/CONDITIQNAl INDEX (Cont.)

S31

S32

TITI E/DESCRIPTION

1 - No Layoff Situation Includes termination of TAU, L I, Emergency, Exempt and Retired Annuitant appointments, or for CEA who does not wish to exercise right of return.

*** 2- Termination From Immediate Pay Appointment

* Medical Reasons

S33 * Displacement When employee is separated because another employee exercised his/her right of return. Becomes effective after reemployment list eligibility expires (after 5 years).

* For separation of Civil Service employee only. *** Formerly "One Document Method" Appointment.

Termination With Fault (No Layoff Situation) S40 Includes termination of TAU, L I, Emergency,

CEA, Exempt and Retired Annuitant appointments.

S41 * Dismissal

L eave of Absence S49 Non-industrial Disability Insurance Leave

S50 Regular or State Disability Insurance Leave

S51 Military- Short Term

S52 Military - Long Term

S53 Military- Emergency

S54 Temporary -30 days or less under DPA Regulation 599.781 (Only when effective immediately after an S49 Transaction.)

PAGE

3.220

3.221.1

3.222

3.224

3.226

3.228

3.230

3.232

3.234

3.236

3.238

3.240

S55 *Special - 3.242 Technical Cooperation Program, Peace Corps, VISTA (Per G.C. 19991.2); Veterans Education (Per G.C. 19991.9); Civilian War Work, U.S. Merchant Marine, Full Time Duty with American Red Cross, Military Substitution Service (Per G. C. 19991.8 ).

S56 *Special - · Job Incurred Injury or Illness

3.244

--· .. (

! '

3.202 (Rev. 11/04)

SEPARATION TRANSACTION CODES- REOlJIRED/CONDITIONAL INDEX (Cont.)

TITLE/DESCRIPTION

Temporarily Off Payroll

857 1 - Pending Investigation of Injury or Illness. 2- Involuntary Leave Pending Disability Retirement

*For separation of Civil SeNice employee only. 3.203 (Rev. 02/92)

Retirement

S70 SeNice- Voluntary or Compulsory

S71 Disability

Other

S80 * Termination-Illegal Appointment (Per G.C. 19257 or G.C. 19257.5 -Initiated by Personnel Operations only.)

S85 * Adverse Suspension

S90 * Rejection During Probationary Period

S95 Death

S99 Cancellation of Appointment

* For separation of civil service employee only.

3.246

3.248

3.250

3.252

3.254

3.256

3.258

3.260

1

7

3.204 (Rev. 05/88)

S01 RESIGNATION WITHOUT FAULT VOLUNTARY

-·-0

NJEJC't 1 t.HT QASS I I I

*1 Items 725 - 740 cannot have an entry when reporting separation of exempt employee.

*2 Optional when reporting separation of exempt employee.

*3 Required when employee's work schedule i s other than normal (i.e. , 4-10-40 or l/2 Time = 8 hours a day for 2 weeks per month) .

REQUIRED (MUST be completed)

CONDITIONAL (MUST be completed when required by ITEM DEFINITION)

e ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid transaction)

. -·-.

(Rev. 09/03)

LINES 8-9 ITEMS:

857 -Emergency Qualifying Time

869* - Reemployment List Eligibility Date

3.205

957 - Other Eligibility Substantiation

958- Separation TitTle To Be Paid Substantiation

871 - Right of Return Designation

872- Salary ln.c.r.ease Certification

960- Corrected Transaction Identifier

962* - Separation Pay At Al.ternate Salary Rate

8.77* - Lump Sum Payment Deferral I 999- Deduction Information

952** - Case No. and Date of Action

* Refer to PAM Section 5.76 for documentation instructions.

** Items 869, 952 and 962 cannot have an entry when reporting separation for an exempt employee . .

LINE 10 .REMARKS AND BACKUP INFORMATION:

Refer to PAM pages 2.201 -2.205 for specific substantiation required on:

1 - Certain deductions or payments to be made from employee's final pay. (See PAM page 2.151.)

2 - S01 resignation while on leave of absence.

(/) m -o )> ;::o )>

=! 0 z -;

~ z (/) )> ("")

=! 0 z ("")

0 0 m (/) 0 ~

S02

-·-0




C:\WPSl\OOCS\PAM\3.200/9

3.206 (Rev. 11/96)

RESIGNATION WITHOUT FAULT

LAYOFF SITUATION OR IN LIEU OF

INVOLUNTARY TRANSFER

/

i (

3.200 (Rev. 11/04)

SEPARATION TRANSACTION CODES- REOlJIRED/CONDITIONAL INDEX

(See PAM page 2.209.1 for inactive/redefined transaction codes)

CODE

Resignations

S01

S02 *

S03 *

S04 *

S05 1 -

2-

3-

4-5-

S20 **

S21 *

TITI EIDESCRIPTION

Voluntary From any appointment. Also includes voluntary resignation while on leave of absence· and separation of permanent intermittent employee who did not report to work after being requested to report three times or was in non-pay status for one year.

Layoff Situation or In Lieu of Involuntary Transfer

In Lieu of Military Leave

Failure to Meet Conditions of Employment

For employee moving to, from or between exempt positions when lump sum vacation is to be paid. For current PERS member moving to an exempt position covered under a different retirement system. For employee being appointed or employed by the Legislature (House or Legislative Committee). For employee accepting CSU exempt appointment. Do not use for employee accepting employment with California Conservation Corps.

Voluntary under Unfavorable Circumstances- Pursuant to a stipulated agreement resulting from an appeals process. This code should be used ~ in those cases where the employee has entered into a stipulated agreement (approved by the State Personnel Board) with the appointing power·to voluntarily resign "with fault".

AWOL- Automatic resignation as a result of an absence without approved leave for five consecutive working days.

Termination Without Fault S30 Layoff Situation (Reduction in Force)

* For separation of Civil Service employee only.

** For actions occurring after 02/02/89.

PAGE

3.204

3.206

3.208

3.210

3.212

3.214

3.216

3.218

3.201 (Rev. 11/05)

SEPARATION TRANSACTION CODES- REOlliRED/CONDITIQNAl INDEX (Cont.)

S31

TIT! E/OESCRIPTION

1 - No Layoff Situation Includes termination of TAU, L I, Emergency, Exempt and Retired Annuitant appointments, or for CEA who does not wish to exercise right of return.

*** 2- Termination From Immediate Pay Appointment

S32 * Medical Reasons

S33 * Displacement When employee is separated because another employee exercised his/her right of return. Becomes effective after reemployment list eligibility expires (after 5 years).

* For separation of Civil Service employee only. *** Formerly "One Document Method" Appointment.

Termination With Fault (No Layoff Situation) S40 Includes termination of I AU, L I. Emergency,

CEA, Exempt and Retired Annuitant appointments.

S41 * Dismissal

I eave of Absence S49 Non-industrial Disability Insurance Leave

S50 Regular or State Disability Insurance Leave

S51 Military- Short Term

S52 Military- Long Term

S53 Military - Emergency

S54 Temporary-30 days or less under DPA Regulation 599.781 (Only when effective immediately after an S49 Transaction.)

PAGE

3.220

3.221 .1

3.222

3.224

3.226

3.228

3.230

3.232

3.234

3.236

3.238

3.240

S55 *Special - 3.242 Technical Cooperation Program, Peace Corps, VISTA (Per G.C. 19991.2); Veterans Education (Per G.C. 19991.9); Civilian War Work, U.S. Merchant Marine, Full Time Duty with American Red Cross, Military Substitution Service (Per G. C. 19991.8 ).

S56 *Special - · Job Incurred Injury or Illness

3.244

. ~-....

{

(

3.202 (Rev. 11/04)

SEPARATION TRANSACTION CODES- REOlJ!RED/CONDITIONAL INDEX (Cont.)

TITLE/DESCRIPTION

Temporarily Off Payroll

S57 1 - Pending Investigation of Injury or Illness. 2 - Involuntary Leave Pending Disability Retirement

*For separation of Civil Service employee only. 3.203 (Rev. 02/92)

Retirement

S70 Service- Voluntary or Compulsory

S71 Disability

Other

S80 * Termination-Illegal Appointment (Per G.C. 19257 or G.C. 19257.5- Initiated by Personnel Operations only.)

S85 * Adverse Suspension

S90 * Rejection During Probationary Period

S95 Death . S99 -Cancellation of Appointment

* For separation of civil service employee only. .

3.246

3.248

3.250

3.252

3.254

3.256

3.258

3.260

1

5

7

3.204 (Rev. 05/88)

S01 RESIGNATION WITHOUT FAULT VOLUNTARY

I FAST HME NQ I I I I

*l Items 725 - 740 cannot have an entry when reporting separation of exempt employee.

*2 Optional when reporting separation of exempt employee.

*3 Required when employee's work schedule is other than normal {i.e., 4-10- 40 or l/2 Time= 8 hours a day for 2 weeks per month).

·=REQUIRED

0 (MUST .be completed)



(Rev. 09/03)

LINES 8-9 ITEMS:

857 -Emergency Qualifying Time


3.205


958 - Separation Time To Be Paid Substantiation

871 - Right of Return Designation

872- Salary lncr,ease Certification


962* - Separation Pay At Al~ernate Salary Rate

8.77* - Lump Sum Payment Deferral I 999- Deduction Information

952** - Case No. and Date of Action


** Items 869, 952 and 962 cannot have an entry when reporting separation for an exempt employee. . .

LINE 10 REMARKS AND BACKUP INFORMATION:

Refer to PAM pages 2.201-2.205 for specific substantiation required on:


2 - S01 resignation while on leave of absence.

(f)

m '"U )> ;:u )>

:::l 0 z -1

~ z (f) )> ('") -1 6 z ('")

0 0 m (f) 0 _,..

S02

-·-0



ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid transaction)

C:\WPSJ\OOCS\PAM\3.200/9

3 .206 (Rev. 11/96)


LAYOFF SITUATION OR IN LIEU OF

INVOLUNTARY TRANSFER

3.207

(Rev. 09/03)

LINES .8-9 . ITEMS:



872 - Salary Increase Certification

877* - Lump Sum Payment Deferral

960 - Corrected Transaction Identifier

962* - Separation Pay At Alternate Salary Rate

952 - Case No. and Date of Action 999 - Deduction Information

*Refer to PAM Section 5.76 for documentation instructions

LINE 10· REMARKS AND BACKUP INFORMATION:

Refer to PAM pages 2.201 - 2.205 for specific substantiation requin;d on:


.. .

(/)

m . "U

)> :::0 )>

::! 0 z ~ :::0 )> z (/) )> ()

::! 0 z ()

o-0 m (/) 0 N

1

3

6

7

S03

-·- REQUIRED (MUST be completed)

CONDITIONAL

3.208

t fiA:ST HNt.tE AHJ tr.CXLE NllAI. I I I I I

0 (MUST be completed when required by ITEM DEFINITION)


(Rev. 02/ 95)

RESIGNATION WITHOUT FAULT IN LIEU OF MILITARY LEAVE

/ \

3.209 (Rev. 09/03)

LINES 8-9 ITEMS:

872- Salary Increase Certification 960- Corrected Transaction Identifier 877*- Lump Sum Payment Deferral 1962*- Separation Pay At Alternate Salary

Rate

952- Case No. and Date of Action 999- Deduction Information 958 - Separation Time To Be Paid

Substantiation

* Refer to PAM section 5.76 for documentation instructions


Refer to PAM pages 2.201 - 2.205 ·for specific substantiation required on:

1 -Certain deductions or payments to .be mad~ from employee's final pay. (See PAM page 2.151.)

2- S03

(/) m "U )> ;:u )> :j 0 z ~

~ z (/) )> ()

:j 0 z ()

0 0 m (/) 0 w

-·--0

S04




3.210 (Rev. 02/95)


FAILURE TO MEET CONDffiONS

OF EMPLOYMENT

(

3.211

(Rev. 09/03)

LINES 8-9 ITEMS:

872- Salary Increase Certification 960 - Corrected Transaction Identifier

877* - Lump Sum Payment Deferral 962 - Separation Pay At Alternate Salary Rate

·' 952- Case No. and Date of Action 999- Deduction Information

958- Separation Time To Be Paid Substantiafion

* Refer to Section 5.76 for documentation instructions.

LINE 10 ·REMARKS AND BACKUP INFORMATION:

Refer to PAM pag~s 2.201 - 2.205 for Sl?ecific substantiation required on:

1 - Certain deductions or payments to be made. from employee's final pay. ·· (See PAM page 2. 151.)

2- S04

U> m " )> :::0

·)> ~

0 z · ~

~ z U> )> () :j 0 z () 0 0 m U> 0 ~

sos 3. 212 (Rev. 02/95)

RESIGNATION WITHOUT FAULT 1) Use for e~~~ployee moving to exempt position or from exempt position to

civil service and lump sum vacation . is to be pald*l (this occurs when vacation accrual ra te Is higher In losing position than In gaining posi tion) ; or

2) Use for current PERS Member 1110vlng to exeiiiPt posl tlon covered under a. different r et1retnent systenl; or · .

J) Use for employee being appointed or employed by the Legislature (House or legislative Committees). These Legislative employees are not paid under the Uniform State Payroll System; or

4) Use for employee accepting a CSU Exempt Appointment; or 5) DO !lOT USE for employee accepting employment with Ca l ifornia CAnservation

CArPs. (CCC) (Use other appropriate separHion code).

*1 When no lump sum vacation is to be paid, see page 5.40 .

-·-0


CONDITIONAL .(MUST be completed when required by ITEM DEFINITION)

e ONE OR MORE REQUIRED (ONE or MORE of these items on th is chart MUST be completed for a valid transaction)

3.213

(Rev. 09/03)

LINES 8-9 ITEMS:

871 -Right of Return Designation (REQUIRED)

872- Salary Increase Certification

877* - Lump Sun Payment Deferral

952 - Case No. and Date of Action

958- Separation Time To Be Paid Substantiation


962* - Separation Pay At Alternate Salary . Rate.

999 - Deduction Information


LINE 1.0 REMARKS AND BACKUP INFORMATION:

. Ref~r to PAM pages 2.201 -2.205 for specific substantiation required on:

1 -Certain deductions or payments to be made from employee's final pay. (See PAM page 2.151.)

(/)

m -u )> ;u )>

:::l 0 z -4 ;:o )> z (/) )> () -4 0 z ()

0 0 m (/j 0 c.n

1

3. 214

S20 (Rev. 02/95)

VOLUNTARY RESIGNATION UNDER UNFAVORABLE CIRCUMSTMCES PURSUANT TO A STIPULA1ED AGRffi'ENT FR(J1 AN .APPEflLS PROCESS*

Use only when the employee has entered into a ·stipulated..--___,..----==~~--.. agreement (approved by the State Personnel Board) with the appointing power to voluntarily resign "with fault" .•.•

t fRST ~ IH> ...:n.E. N'TW.. I I I I

~~----~~--~~~~mM~~~~~--~~~==~~~~~~

2~~~~~~~~~~~~~~~~~~~~ 3jTO:~~~,~~~~

6

*For actions occuring after 02/02/89 .

·= REQUIRED (MUST .be completed)

0 CONDITIONAL (MUST be completed when required by ITEM DEFINITION)

ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid transaction) 0332cl5

/ i

3.215 (Rev. 09/03)

LINES 8-9 ITEMS:

857 - Emergency Qualify Time 960 - Corrected Transaction Identifier

877* - Lump Sum Payment Deferral 962 - . Separation Pay At Alternate Salary Rate

952- Case No. and Date of Action 999- Deduction Information


* Refer to PAM section 5. 76 for documentation instructions.

LINE REMARKS AND BACKUP INFORMATION:

Refer to PAM pages 2.201 - 2.205 for specific substantiation required on:


2-:- S20 for civil ser.vice employee.

(./) m ""C )>

?; -i 0 z -i

~ z en )> 0 -i 5 z 0 0 0 m en "' 0

-·-0

S21

REQUIRED (MUST .be completed)


e ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed. 1or a 'talid transaction)

3.216 (Rev. 02/95)

AW(l_ - AUTQ'I1ATIC RESIGNATION fJS A RESULT a= f1N ABSENCE HITHbUT PPPROVED LEAVE FOR FIVE CONSECUTIVE WORKING DAYS

0332cl 7

3.217

(Rev. 09/03)

LINES 8-9 ITEMS:

877*- Lump Sum Payment Deferral 1960- Corrected Transaction Identifier

952 - Case No. and Date of Action 962 - Separation Pay At Alternate Salary Rate

958- Separation Time To Be Paid 999- Deduction Information Substantiation


LINE 1 0 REMARKS AND BACKUP INFORMATION:


1 - Certain deductions or payments to be made from employee's final pay. . (See PAM page 2.151.)

2- S21

en m -o )>

~ ~ 0 z -+ :::0 )> z en )> () -f 0 z (')

0 0 m en N _..

1

5

6

7

3.218 (Rev. 11/96)

S30 TERMINATION WITHOUT FAULT

LAYOFF SITUATION

(REDUCTION IN FORCE)

*1 Items 725 & 730 are required for civil service only.

-·--0




C:\WPSJ\DDCS\PAM\3.200/21

\

.(

(Rev. 09/03)

LINES 8-9 ...

ITEMS:

869 - Reemployment List Eligibility 960 - Corrected Transaction Identifier Date

3.219

872 - Salary Increase Certification 962 - Separation Pay At Alternate Salary Rate

877*- Lump Sum Payment Deferral 1999- Deduction Information




LINE 10 REMARKS AND BACKUP INFORMATION.:



en m ~ ;;u }> ~

0 z ~

~ z en }> () ~

0 z () 0 0 m en w 0

S31

·= REQUI~ED 0

(MUST be completed)



3.220 (Rev. 05/04)

TERMINATION WITHOUT FAULT NO LAYOFF SITUATION

I I

(

(

3.221 {Rev. 09/03)

LINES 8-9 ITEMS:

857 - Emergency Qualifying Time 960 - Corrected Transaction Identifier

872- Salary Increase Certification 962- Separation Pay At Alternate Salary Rate

877* - Lump Sum Payment Deferral I 999 - Deduction Information




LINE .10 REMARKS AND BACKUP INFORMATION:


1 - Certain deductions or payments to be made from· employee's .final pay. (See PAM page 2.151 .)

(/) m ""0 ):> ;o ):> -{

0 z -{

~ z (/) ):> ()

=! 0 z () 0 0 m (/) w .....

1

5

6

7

S31

E~O'r(E lAST ftUJoE

3. 221. l

I FflS1' HAM£ loHJ t.CXl.£ H fW. I I I

(Rev. 02/ 95)

TERMINATION viiTHOUT FAULT FROM

IMMEDIATE PAY APPOINTMENT

""'"'"" ........

*l The effective date must be the date shown in Item 416 on the .. Immediate Pay Appointment... . ·

*2 Entry in Item 606 must be "NON" .

·= REQUIRED (MUST be compl~ted) ,


e ONE OR MORE REQUIRED (ONE or MORE of these items on th is chart MUST be completed for a valid tr?nsaction)

UNES 8 -9 ITEMS:

857 - Emergency Qualifying Ti me 960 - Corrected Transaction

Identifier

0332c23

1

2

3

4

5

6

7

3.222

S32

fiOCi" sto.mv- • , • ....._OY(f WiT """" :·---"""'-·NIW.

(Rev. 02/95)

TERMINATION WITHOUT FAULT MEDICAL REASONS

... sto.,ea~A

... CXJCU,.oiiEN'T"A(X:(~ .........

0

0 ..,.,. ........... OE•• C8 CO<#(rV ..... "'"'

"""' c COO(

()

,_.,;; ITO: I ..oE><CT I OHT ' cv.ss 1 .._

' ' I ' . : :1~ ' ' I I

1 ... ... 1.,, ,,. : 120 I ;, ,,,. I ,,.

: "" ' ,,. 1, ..

'"' '" fJ' ... CfN£ DOTE 1oH> HW0S I'""'"~ HSfOAT ........... ..1__, ,_...,.

lro I TR-..cfOOH """" N> I 'I) 1 ... 1 D I Hl I 0 I 00. " . ..,, 0

0 0 ' I I I ' lll :

' ! 1'1 <21 ' ' I I I ' I ""' I''" ..,.,oo, I••• I,., ~ I I ' I I I

r-~~~ ~':y ~~ ,..._..,DOH""""'' PI.US ,...._, ~OUN~ -.-:!:'.""'' ... = .. -~~ r;; ~~ ·- ' ,,,,...

t •~~yt lro

. ~ .. ' ... 1Uf .. ......., ' '

I"" "" ,,.

'"' I 1>:10 "" l:w I,.. "' » 1,.. ~

n.o[ ...... ~....., ...,.

......,..,..,HT ''"""''""' wn • ('if~,

MOD ~-~~ :' '""'::'~" ~~-lro "''' ' >QI'S IXliX I Et<»<i 04TI CX'lCi( I f O"W o ""' I ' I ' ' ' , ... ... .,, ... I ,,,. I •,. [ • lO_ I

~ ' ' L- · ~· 1 ..... , ... I~' = ".:= ,.~~ ~~~. " "" o~ .. 0..~

,...,_, ....,. ......... ..,.., ::~o.~~~

lro I~ . :: ~ . DO . .., ,.-.. •O.Dot- ' 1

tllf'(Tt) (). o.-.l't .., l ifo ,,. I"" 1 .. I <J 1 ... , ... '"" ,., i >oc i ,.,

=~~ ... """" ' ' . f O il( -..I ... WI

l-o·~_o_p .=.. '""' ' SU.O TOO( PAD .......... """""" ·;:: __ ....,

,. ...... <>- I •PP . ..,. . ·~.":':"'...::~

-- - -~- - - --:-- - Q'Q' ' ., • ..,.-.(T .-· ··- "'~ : ~ _Q._ '"" 1- -- - - -- 0 l SI I I i C<Xll

lro --- _, __ -•- -::..-· O [ O jO 0 0 ~ 0 --- ---1-- - -- ' --- ' ' ~~~o: o:o r----~---- -:--- 0

looro..;..,....; o.o•• OlO OA I : o<VOS : ..,,_ ' '

'"" ,., ~ ... I "" "'' : ~· : -c•· ••• I -~ OAS I t<:IUI'S I -<)1 .. lox 1•>: ...,. ... ... o• .. "' ""' .,.,,..!UHf OATH""' o ~· sto:,.~·

8t~ .. :...~:;.::.· . = 7.::--;'S:

~~~~ ::.~-d~~ lro: ""' I ...o.,AS I ., "' ;: ==;= =~;p?==j===j=== == = == ========== ==~: 0 ~ ,.,0 ·o · 0 ~ 0 ~0 ' ' 1:-J ~ . .-~ ~~~ ' ' I ~;,.-.~~-""'"~ ''!.'t-...,-'- m.!-,, -- -- -- - ----- ----- -~- "' ~'~

- REQUIRED - (MUST be completed}

0 CONDITIONAL (MUST be completed when required by ITEM DEFINITION}

e ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid transaction}

033?r?4

3.223 (Rev. 09/03)

LINES 8-9 ITEMS:

869- Reemployment List Eligibility 960- Corrected Transaction Identifier Date

872- Salary Increase Certification 962- Separation Pay At Alternate Salary Rate




* Refer to PAM Section 5. 76 for documentation instructions.



1 - Certain deducti0ns or payments to be made 'from emplbyee's final pay. (See PAM page 2.151 .)

2- S32

(/J · m

'"0 )>

~ -l 0 z -l

~ z (/J )> () -l 0 z ()

0 0 m (/J w N

S33

=REQUIRED (MUST be completed)

Q CONDITIONAL (MUST be completed when required by ITEM DEFINITION)


3.224 (Rev. 02/95)

TERMINATION WITHOUT FAULT DISPLACEMENT

i

'I

3.225 (Rev. 09/03)

LINES 8-9 ITEMS:

869 - Reemployment List Eligibility Date


877* - Lump Sum Payment Deferral

952- Case No. and Date of Action



962- Separation Pay At Alternate Salary Rate



LINE 1·0 REMARKS AND BACKUP INFORMATION:


1 - Certain deductions or payments to be made from employee's final pay. (See PAM page 2.151 .)

en m -u )> :::0 )> -f 0 z -f :::0 )> z en )> () -f 0 z () 0 0 m en w w

1

4

5

6

7

S40

·=.REQUIRED (MUST be completed)

3.226

I FRST NAME I'HJ ...:XX.£ NT'W. I I I I I

.0 . CONDITIONAL . . (MUST be completed when required by ITEM DEFINITION)


(Rev. 02/95)

TERMINATION WITH FAULT NO LAYOFF SITUATION

(

3.227 (Rev. 09/03)

LINES 8-9 ITEMS:

857- Emergency Qualifying Time 960- Corrected Transaction Identifier








2- S40

(/) m "'0 )> ::0· )>

:::! 0 z -f ::0 )> z (/) )> ()

:::! 0 z ()

0 0 m (/) ~ 0

S41

3.228 (Rev. 02/95)

I lAST HM.IE. 1-KJ t.CXI..L N fW.. I

TE~ATION

DISMISSAL *1

....... I OCJOf

C8 0

NJE.tCT I lHf I Q..ASS I I I I 1 TO:

I

i

3

4

5

6

7

... 110 •,u ,,. '•u 11-n "' ( HtCIIYE OA.I£ NO~

Ill I

1""- 0AS(

TO: ... ACCOU<I

COOE

TO: ... .. _.. ""' ,.,..,.,._ '"" TO:

..,

---0

-I 1£~

liS • L40S

llll :w C(FU. •

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0.4 . .. .' ..... 7',0 ... :'40 c.-T .. "'4:10.RS -~·

I I : : -M-0---tl -0--- ~~-o-- 0 :1 0 1: 0 0 ----..1---- -'---- ----~-----:- --- 0 I I I f o: 0 I I I I t I I I I I

60S ,,.,.,yy 60tl OAS I tCJI.RS I foCTH tor 0.4S t t<l.AS I lOTH 6 f1 UO 045 I tON t t()fM 61'$ 0oU I t0.RS I tCTH 1J0 .,. 1.,. ... rtl(~Of'\.ll{~f - ~ "" """ ),, ..

1 :' (." ~ .. ~.~ ,, 1-t.. :O:

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. *1 See Section 5 for information on documenting Decision of SPB After Appeal.

An employee employed in more than one position must be separated from all positions using the S41 transaction. Appointing powers should coordinate the processing of separations from all positions.



ONE OR MORE REQUIRED (ONE or MORE of these items on this ch art MUST be completed for a valid transaction}

.(

3.229 (Rev. 09/03)

LINES 8-9 ITEMS:

874- Punitive Action and Rejection 960- Corrected Transaction Identifier Substantiation (REQUIRED)

877*- Lump Sum Payment Deferral 962- Separation Pay At Alternate Salary Rate

952- Case No. and Date of Action 999- Deduction Information


* 'Refer to PAM Section 5.76 for documentation instructions.


Refer to PAM pages2.201 - 2.205 for sp~cific substantiation required on: .

1 - Certain deductions or payments to be made from employee's final_ pay. (See PAM page 2.151.)

2 - Adverse Actions

• '

en m "0 )>

~ -1 0 z -1

~ z en )> ()

::! 0 z () 0 . 0

· m en ~ .....

1

7

S49

3 .230 (Rev. 11/97)

LEAVE OF ABSENCE

NONINDUSTRIAL DISABILITY

INSURANCE LEAVE

t Ht5J ........ N<J loEQ.f HliAL I I I I I

*1 First day on NDI benefits (date approved on DE 8500A by EDD). If employee is on payroll for a portion of the day due to sick leave, vacation, holiday or CTO credits, enter the number of hours on the payroll. If employee was off the payroll for the entire day, enter 11BOB11

•

*2 Do not complete if employee is paid by positive attendance (roll codes 3-8). *3 This item is required if employee is participating in the Annual Leave Program.

-·-0




.J

\

·l

fFtm 3.231 (Rev. 05/93)

LINES 8 . • 9 ITEMS:

892

952

Last Day on Pay Status (REQUIRED) Case No. and Date of Action

960

999

Corrected Transaction Identifier Deduction Information

LINE 10 REMARKS AND BACKUP INF0RMATION~


· 1 - Certain deductions or payments to be made from employee's final pay. (See PAM page 2.151.)

C:\ WPS I \DOCS'\PAM\0332C/33

(/)

trl "0

~ ....... 0 z -l

~ (/)

> () -l ....... 0 z ()

0 tJ trl (/) ~ \0

sso

Fflm 3.232 (Rev. 11/05)

LEAVE OF ABSENCE REGULAR OR

STATE DISABILITY INSURANCE

*1 This item is conditional for exempt employees.

-·-0

*2 For consecutive S50 transactions refer to PAM pages 2.35 and 2.86.



ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed

dJ'j 2cfM transaction)

I .

3.233 (Rev. 11/05)

LINES 8 -·g ITEMS:

952 Case No. and Date of Action 960 Corrected Transaction 958 Separation Time To Be Paid Identifier

I Substantiation

Deduction Information 999

(I) tr1 '"0

~ >--< 0 z >---1

~ (I)

>-(") ..., >--<

/ 1 0. REMARKS AND BACKUP INFORMATION: . LINE

0 z (")

0 tJ t:rl Refer to PAM pages 2.201 - 2.205 for specific substantiation required on: (/)

(See (J1

0 1 - Certain deductions or payments to be made from employee's final pay. PAM page 2.151.)

2- S50

.(

C:\WPSl\OOCS\PAM\0332C/3S

3.234

(-.A..O'r'f.ft.AST ~ I ~ HAM£ »D ...CO..f NTW. I

(Rev. 05/88)

LEAVE OF ABSENCE MILITARY - SHORT TERM *i

1~----~~~==~!~~~~~~~~~~~k_~~ 2

3

4

5

6

7

-·--

*1 Refer to PTM Section 480.


Q · CONDITIONAL (MUST be completed when required by ITEM DEFINITION)


' '/

(

3.235 (Rev. 08/ 96)

LINES 8 -9 ITEMS:

865

871

952 958

Military Substantiation (REQUIRED) Right of Return Designation (REQUIRED FOR CIVIL SERVICE EMPLOYEE ONLY) Case No. and Date of Action Separation Time To Be Paid Substantiation

960

962

964 999

Corrected Transaction Identifier Separation Pay At Alternate Salary Rare Military Service Dates Deduction Information

LINE 10 REMARKS AND BACKUP·INFORMATION:

Refer to PAM pages 2 .201 - 2.205 for specific substantiation required on:

1 - Certain deductions or payments to be made from employee's final pay. (See PAM page 2 .151.)

2 - S51 granted for civil service employee.

(/) [T] "'0

~ ..., ..... 0 z ...,

~ (/)

:> ("') ......:j ..... 0 z (;

c 0 [T;

v: Ul ......

3.236 (Rev. 05/88)

S52 LEAVE OF ABSENCE MILITARY

1 TO: ' ' I

II()Sit()o. ....... fll

_..,. 1"" 1 cuss

2

3

7

... _, .. l..u: ...

TO: , • .....,.~100 '""" ,,, ,,, 0

TO: lP\.1.6~·

"'

I .... , .... ,, ........

••r , ,., I ~ft•oili"'l U~AIO.

OAT£ I t«J1,1U

' ' . ...

...,_., II SU""""'OA!. ........,. 8(f'EI't iS

d u o: ...

l'lt H" . rn

0 , .. (JMAJ()Io. 041: Of. P\.IJS ,S.AtNh

~Rs.Mr

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l""'fo:'

i•'lf-

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.,.

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"''

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f.t<JNG OAf(

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601

--

-----------~-----~--- _o_+o-~o o -~~ ___ L ___ L__ : : -----------~-----~- - - --- - ~- ---+--- 0 ~·~Oj 0 j0 0 1 0 1 0 6C) ....., "'"' I 606 O&s • -<lV"S • oe-• .. 60' o•s ' ~ ~ I'()'" ••) ' ?O C'• ! 1 ~~ ~ ..cr" •n o•s ~ --o..AS ' fo()'t ..

*1 Refer to PTM Section 485 .


0 CONDITIONAL (MUST be completed when requ ired by ITEM DEFINITION)

ONE OR MORE REQUIRED (ONE or MORE of these items on this ·chart MUST be completed for a valid transaction)

LONG TER~1

1 ....... I . I

I ~

:,~ t7.1

., 1 ... 1 I I

' ' I I

,.. COtl£1'-~·

0 I

' ·~· '

.... 0 0

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0

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"ffi:St •f~ OfO '..,.... 0 ' I

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.• !_m "" "'

. .. ·-;-·.· ·=l~:: ::: ••• --~ ~· '>

(

3.237 (Rev. 09/03)

LINES 8-9 ITEMS:

865 - Military Substantiation 960 - Corrected Transaction Identifier (REQUIRED)






Refer to PAM pages 2·.201 - 2.205 for specific substantiation required on:

1 - Certain deductions or payments to be made from employee's final -pay. (See PAM page 2.151 .)


U> m "'C )>

~ :j 0 z -i ::tJ )> z U> )> (') :j 0 z (') 0 0 m U> 01 N

853

-·-0


CONDITIONAL .(MUST be completed when required by ITEM DEFINITION)


3.238 (Rev. 02/95)

LEAVE OF ABSENCE MILITARY - EMERGENCY

0332c40

(

3.239 (Rev. 08/96)

LINES 8 -9 ITEMS:

865

871

952

Military Substantiation (REQUIRED) Right of Return Designation (REQUIRED for Civil Service Employee Only) Case No. and Date of Action

95~

960

962

999

Separation Time To Be Paid Substantiation Corrected Transaction Identifier Separation Pay At Alternate Salary Rate Deduction Information





c r ~

~

~ c -~ -( .. -.. c t: .. c. ... .. ( .. .. s ~

( ( c

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1

2

3

4

5

6

7

3.240

S54 (Rev. 05/88)

LEAVE OF ABSENCE TEMPORARY 30 DAYS OR LESS UNDER DPA REGULATION 599.781

... S(CUE..cf ~P _Q__OI_Q__

., ()()C.ur.I(NTII'ACICEs.s..c; 0 ~·

,~~~·· E~OYULAST ~ 1 fii:ST 1oCNoE N<J UCO..f NT....._ ~l'CIJ'of~A I ~··I "" ~" Bf:tTH QAT( -I COOf 0 c.oa: .....

I AO(h(:Y t .... , I a. ... I,.._

TO: I I I

:1n ,.,.. tlf

I I I I 120 ~ ~~· I

'r I:JO '" I« ~~~-"'' ... , 11'

I ff.-ECTM eMit »<() K:)...A$ f w:\.On.ENT lCST~Y ~ 1.61~~

_.fr .. 1-1 "' . .., . 0 I><> I 0 I 00 I

0 ' OCI I 0 TO:

.......... 0100 COOl I 0 0 » c ! I • • I

»1 ;

I I ( I ; 101': I • • . . I ' ! t • I I t ,., 11;;, .....,_,(D_ .... '" ,-~·--.. . ........ ... 6AS€Q()llo4 ~'r f'\.1.6 s.A.l.AA"t OF~~~! ~t .... -· '":r~ :;';, 5P!p~ """" P A"' ~l TH:M t•~~':.T'( ... .... o .....,.

I ' TO: _TOT..._~ ' ' '

"" "' "" ,.,, ' ,., ....., .. ,. ... = ,.., ,., ,.,..

"'-' ""' l~8A5oi.

I ,..,

I . ""' APf>ONTUE.Hl E~T()r.; "'"' . I .. ~ ~ PRQS.f,T()N.t.AY P£AC'C ~N"PAAI.VAI. '"' I

.,_ ~~1( (li::Vt&U1 T•

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""" ' """'' EKWT SlAT 000£ I EfoC».G DAn CCXl( I I()AI.j' I """ TO: I I I I . I ' I

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~· '"' ,,. "" .I I!'

ACCOJ.;: -~TY SVN'"'OAS ~ ~~ (Xf.t.Pl OA1 .. """" ""oc... . Ff'<oG,fRPRN: PROF£~ t.CffoiSt

I~~"~' COOl - et~fiTS AUTHCWlY = · Q.f.......c:.t. ........,.,., 0 0

,,.. I [ Xf"'IIRATOH: 0411 C0CX I

TO: I

: ....CnJfO. Clo'rt I

"" , .. ! ... "" .. ,..., '" ... "' ""' ,,. ..., I ,.,I

"''""' P A <t "1:RQO 1 ..... To,) 8.e PAD C'-tW I ft.€ TO 8l Pu;} lOLLI ... 1..~ SI..N TO 8( P..r..Q ~..~~t:•rA .. ~\ ,..,... ....... ,.... So(PAA.\h...., (llPHA 10.. ~o.(O fo4Ao#'ojlf~

'"" _o_~_a_~o-...... o "-" ~~~ftrW.. 01:0

5(P/oA.f., 0 I

0 I I I ' PA.~NT - I ,._ .,.,..

' """" 0 ,.,. -------__ _ _ .J __ _ _ _._ ___

ISO ' I I ' COOf ' I

' I I --- --L----~--- ' I I ' TO: I I ' I I ' •·o·m·~. v OEO --·-----

____ _. ____ ....1... ___ ----..J-----L--- 0 lVI I ' ' ' . *2

I

0 1 ... ~--.

' I I I ' I I ' . ' I " I I I '

I I .. , 606 OAS · ' ~S • rOT., fi07 DA5 I tO..RS ~ rO~ '" tl'O 043 I tO..I"S 1

.-()T .. USOAS 1 ~Sf "''" OlO ..,, !.,. .. , ... .QI .I..I,. SU. t $.lJf'VC(

;: .. =1=~j~~J~~~~~~~~===========E Sr,fAV(;.E " "' FE~~g_'Z:sw' ':: ~~~ """" TO:

'-'OS I~SI AS 0'

0 ,p 10 1 0 I I o I

71!1 ~·'1"'1' i,. . ., 1 ....

,., _nt ... *l Use only .to place employee on temporary 1 eave effective iml)lediately after

an 549 Transaction. (See PAM pages . 3. 136 or 5.30 for documenting temporary 1 eaves for other reasons . )

*2 Separation expiration date cannot exceed 30 calendar days from effective date in Item 210 .

- REQUIRED - (MUST be completed)


e ONE OR MORE REQUIRED (ONE or MORE of these items on this. chart MUST be ·completed 0332c42 for a valid transaction)

3.241 (Rev. 05/93)

LINES 8 -9 ITEMS:

958

960

Separation Time To Be Paid Substantiation Corrected Transaction Identifier

962

999

Separation Pay At Alternate Salary Rate Deductioninfonnation


Refer to PAM pages 2.201 - 2.205 for specific· substantiation r·equired on:

1 - Cenain deductions or payments to be made from employee's fmal pay. (See PAM page 2.151'.)

C:\WP~ I 'J)(Y'._S .PAM'.0332C/<3

c, r. ) ,... ... .... -c ...:

c: ~ ...: (, .... .... (

c :;: (

c c r: (,

t. . -

3.242

S55

I ,~ ~~=-----·. r-.-=~ ~- -~"........t~JH.:.C:O... ! W:....._

ITO., I .,. ... 1

(Rev. 05/88)

LEAVE OF ABSENCE *

SPECIAL

I ~~--· Itt- 1.~~ C.QOl _..,.! _. C1As: ·-. ' '

~ r. ,., . 1::-:' !t:-:o ,1•

- -.ea-.- ~_Q__

·~ ~"""""',_, 0 .........

~~,,~ ,-~~ -..... ....

'--~ I I I ('I( ; :-to.o, .:,.0.~ ..-(. >0J1t:: to#'\.:O .,.,._ ... - oes·:;,.· ... -..liP.~ ¥1~..-....c:-., ·• .., ' .. '.., . .. ,..,, .. "". 2 jTo:l;:--· ~~. 0 ,,,, · 0 1 .. : l l l! · I,.. : t . .., ' . ' .. "

3j [iTo:::::. ,......,:-, ~~ .,__,,,.. .......... .,.... ........ "'~ ... ""....:::..: ,-;;.~ ....... 'I~..:.:;; , I ;..~ I ~.- , .. ~ I I .. ~ .. ,...:.:,,6- ;.:.,

,.. ,.. • ,_. ! ,. u - ~ ,.,. ,.. ,., I,.. I,._. I,.,

! I "7;;:; . 5 ITO:!

I 1 ...

I l::!.· ,,., . ._~l 'u · .,••><:"· i6' ~o •o ~ ~: ~' ·--:··•,•..._j ,,.. ":- ''""' ,~ :To:~,-- ---_ - - ; -----'---- -~---~- --- :-- --;- .. , 0 ,.': .. +--+-- ! ! 61 i ,-------i--- ---:-----:----r-----:-----:---- o .. : : : . : ~ . I I I I I I

I .. - f .:-:- -.. .,.. : " >· . ..ol! . ooe;· .. I c:· o-J • o<:U'l" I -<"- t·~ U'! 00..: I tOJII(! I toC- .,., ()A.! I ~ t oC~ &X

'"

* PER G.C. 19991.2 - Technical Cooperation Program, Peace Corps, Vista PER G.C. 19991.9- Veterans Education

Jat: · , --.:.. -...cs· ., ........ 0(;

I no

PER G.C. 19991.8- Civilian War Work, U. S. Merchant Marine, Full Time Duty With American Red Cross, Military Subsitution Service

--0



ONE OR MORE REQUIRED (ONE or MORE of these items on this chan MUST be completed for a valid transaction)

0332c44

3.243 (Rev. 05/93)

UNES 8 -9 ITEMS:

866 Leave of Absence 960 Corrected Transaction Substantiation, Special Identifier

952 Case No. and Date of Action 962 Separation Pay At Alternate 958 Separation Time To Be Paid Salary Rate

Substantiation 999 - Deductioninfonnation

(J tJ ., ~ .... .. c .. .c .. ~ "' c. .., .. c .. .. (


.. .. ( ( t t Refer to PAM pages 2.201 - 2.205 for specific substantiation required on: c

(See (. (. 1 - Certain deductions or payments to be made from employee's final pay.

PAM page 2.151.)

2- 555

C:\WP5l\DOCS'.PAM\0332C/~5

-·-0

556

PAM 3.244 (Rev. 05111)

LEAVE OF ABSENCE *1

SPECIAL - ~DB INCURRED

IN~URY OR ILLNESS

CPER G .C. 18881 .4J

OR PER LC 4656 (CJ ( 1 J or (2J

*1 Exempt employees are not eligible for this type of leave,

REQUIRED (MUST .be .completed)

CONDITIONAL (MUST be compieted when required by ITEM DEFINITION)


(

(

3.245 (Rev. 09/03)

LINES 8-9 ITEMS:

866 - Leave of Absence 960 - Corrected Transaction Identifier Substantiation (REQUIRED)

877*- Lump Sum Payment Deferral 962- Separation Pay At Alternate Salary Rate

952- Case No. and Date of Action · 999- Deduction Information


* · Refer to PAM Section 5.76 for documentation instructions.

LINE 1 0 REMARKS AND BACKUP I'NFORM~TION: Refer to PAM pages 2.201 - 2.205 for specific substantiation required on:

1 - Certain deductions or payments to be. made from employee's final pay. (See PAM p~ge 2.151.)

2- S56

(/) m "'0 )>

~ -f 5 z -f :::0 )> z (/) )> 0 -f 5 z 0 0 0 m (/) 01 0)

PAM 3.246 (Rev. 05/02)

S57 1. TEMPORARILY OFF PAYROLL PENDING

INVESTlGATION OF INJURY OR ILLNESS* 1 OR

* 1

*2

0

2 . INVOLUNTARY LEAVE PENDING DISABILITY RETIREMENT

DO NOT USE for Agricultural Associations or California Conservation Corps. (CCC) employees.

Item 645- Separation Expiration Date, cannot exceed one year from effective date in Item 210 (or cannot ~xceed appointment expiration date of a temporary employee).



ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid transaction) ·

C:\WOR097\PAM\3.200/48

PAM 3.247 (Rev. 05/02)

LINES 8-9 ITEMS:




962 - Separation Pay At Alternate Salary Rate


LINE 10 REMARKS AND BACKUP INFO'RMATION:


1 -Certain deductions or.. payments-to be made, from employee's final pay: (See PAM page 2.151.}

(/') m · "'0 )> ::0 )> :1 ·o . z -I ::0 )> z (/') )> 0 ::! 0 z 0 0 0 m (J) 01 '-I

3.248 (Rev. 11/96)

570 RETIREMENT •2

SERVICE -VOLUNTARY OR

COMPULSORY

- "'"""""'.._ ~_Q 0 10 ooc::u...£Wf f"AACE$$N) 0 .........

1 S0C::W. $£.Q..ATY • (WI\OT£t \.AS.f NNooE I f AST H.M.o€ AH:l ..en.( H I""- P'OSTOof .......e£A IV'1 "" C<JU<JY OATH 041t

1 .-P.;i~r. I talE ., COO< I AOE...Ct t IHT I CIA$$ I,.,..._

TO: I I I I

:z~ I I I I 1

111 120 I 111 I 'on .,. ,. llO I» IM 110 m 1 ..

tHt.;:r~"¥t OAl~ loH) I'O..AS Elooofl\.On.EHT HSTOA,. AE.~S ES1~C~

= . TO:

................ ~ ~~1 *1 0 0

Nl I ., I Nl I D I N) I ., I"" I

0 I >0 I ., I I I I I I

Ul :

I I " I "' I I I I I I I I ,.,.

"" .-. ..... "('f '" "'I I I I I I I I 2

1- -~;---~· ......,., ... QA.5EoON~r .... ........ ~Js~~~ NH'4'EA$AA"f' 4.l lf......,TE PAYl'().J. ..... """"' wwo PAY lf "' u~!)~·~~~ ... Hl£0 """ ANa STATUS oFF ... .

~~;~ ... :.+.":.: I I TO: ' I

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310 "' )20 I= I llO ..... . '1"'1' '" ... ,.,

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f £>0'( UST 01\ ,._, """"" talE

TO: OATf I ..,.... UNT~fAT talE I [..oN:) 04' ( COO( I f OAtof I ....

I I I I I I I I 4 ... ... ... ... I

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~· '"' . .. ~I .=:;. """""'"' ~~= ':.~

f;ll£w:>f OAIH ..,.. "'"""" FN!E.~T ~5.SO-W. LC£HSE .oa~O..u.A't

"""" Bf.N(~"tlS ~Tt<:RfY onz:t .. O.EAAAHC< H.I.AT OAf( ...... I {XPi\ATO,. Od( COCf I TO: D D I I

I I li'ri'(.T010.. O,..t( ,.. '"' " ,. ,.,. m .., _f'O_ ,.,

'" .... ..., ' .... I

5 ... ...,..

" " ' I'(AICX) Ia..€ 10 8f PAD INEWI Tt.€ 10 8t PAC fo..Di ... l i.M' SI,.W TO 8( PI>IJ lu.# SI.N (I. TRot. 1-().AS , ..... ............ SLPAAA-10. U~t()tol F'lf.f.O.........,I~

""' _Q_j_Q_LQ o.a.EO b4 f'A$T1~0(0

Sof"AA.t. · ' I I I I I PAY'4;HT ..... I ....... ... .. I H()UU

0 '"" -------____ .l ____ _ t,.. _ _ _

0 IS! I I I I COCf ' I

I I -----1.-----'--- 0 lol 0 I I TO: ' I I ' I ' I I 0 o: 0

I ~J'lc..Y ct0 ------- ----.J-----L - ----~-----'---- 0 rvo: o:o I I ' I I I I I

' I I I I ' I I

6 I I)J ~t.III.IIYT 606 O.S 1 Kk.AS ' ;.oy~ to1 OA.S I tO.A$ I t()TH ... 120 O.U I ~S I tOTH &~ DA.s'~s ' .., ... .,., ..,, 1.,. ... I ...

tAl s.A E """"-I I --'-- -o-!.;;_~:;::-:_1~·~·-:-~~-----------~

S(A\ICE Pli.'f • AEE~On.EHl ~ AEl"""'-OY .. ...,., USI Cl"" UST[lG

TO: """ I ><lUIS I .. "' 0 .. ~· . "

,.,0 I o: 0

2J _ _ , ___ , __ _ l"f'l __ _, ___ J _ _ ___ _ _ _ ______ ______ ~ .. ·""';.,. I ..

I ~~~n--'-rn --,.y __ !.t!'! -- .. L m .1 n ------------------ ~~ "i ..... . yy I no ' '" ,.,. ,., "' .. : . 1).. ;·.'ft

7

*1 If NDI benefits should be paid for the day of separation, the effective date of the S70 Transaction should be changed to the next day "BOB". IN ALL OTHER CASES the S70 Transaction must be effective at the close of business and there should be no entry in "HOURS".

*2 S70 Transaction occurring after an S30, S32, or S33 Transaction is not required to be reported.



e ONE OR MORE · REQUIRED {ONE or MORE of these items on this chart MUST be completed for a valid transaction)

(

lf l

3.249 (Rev. 09/03)

LINES 8-9 ITEMS:

872- Salary Increase Certification 958- Separation Time To Be Paid Substantiation

877*- Lump Sum Payment Deferral 1960- Corrected Transaction Identifier

888- Sick Leave At Retirement 962- Separation Pay At Alternate Salary (REQUIRED) Rate



LINE 1:·0· REMARKS AND BACKUP INFORMATION:


· ··1 -Certain deductions or payments to be made from employee's final pay. · . (S.ee PAM page 2.151.)

(/)

m "'0 ~

~ ~

0 z ~ ::u ~ z (/)

~ () :j 0 z ()

0 0 m (/) "'-l 0

3.250 (Rev. 11/96)

871 RETIREMENT

DISABILITY *I

*1 S71 Transaction occurring after an S30, S32 or S33 Transaction is not required to be reported.

*2 If NDI benefits should be paid for the day of separation, the effective date of the S71 Transaction should be changed to the next day "BOB". IN ALL OTHER CASES the S71 Transaction must be effective at the close of business and there should be no entry in Item 210 - "HOURS".

*3 Employee is entitled to lump sum sick leave payment if S71 Transaction is due to a WCTD/IDL injury/illness (G.C. 19991.4) and there is a sick leave balance.

-·- REQUIRED {MUST be completed)



C:\WPSI\DOCS\PAM\3.200/54

I

(

(

3.251 (Rev. 09/03)

LINES 8-9 ITEMS: .


877*- Lump Sum Payment Deferral

888 - Sick Leave At Retirement (REQUIRED)







LINE 1 0 REMARKS AND BACKUP INFORMATION: .

. . Refer to PAM pages 2.201 - 2.205-for specific substantiation required on:


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3.252 (Rev. 11/96)

sao OTHER SEPARATION *1

TERMINATION- ILLEGAL APPOINTMENT

(PER G.C. 19257 OR G.C. 19257.5)

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0 ION ------- ----..J-----L--- 0 lSI I I I I COllE I I - I I ---- -.1..----~--- I I I I TO: I I I I I I I I I I I.Om<.Y OEO ------- ----~-----'---- -----'-----'---- 0 (Yo: o: o :o:o 0 o:o I - I I I

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*1 This transaction is initiated by Personnel Operations after notification by SPB. The appointing power will be contacted for any additional information necessary to complete this transaction.

- REQUIRED ·- (MUST be completed)

0 CONDITIONAL (MUST be completed when required by ITEM DEFINITlON)


C:\WPS 1\DOCS\PAM\3.200/ 56

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3.253 (Rev. 09/03)

LINES 8-9 ITEMS:


877*- Lump Sum Payment Deferral








1 - Certain deductions or payments to be made from employee's final pay. (See PAM page 2.151 .)

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S85 3.254 (Rev. 11/96)

OTHER SEPARATION

ADVERSE SUSPENSION

I ~T ~ N-0 I.CX1.f. NTW. I I I I I

See PAM Section 5 for infonnation on documenting Decision of SPB After Appeal.

*1 Effective Date is considered "BOB" unless 'Hours" are completed. "COB" must be entered when employee is suspended at close of business.

--0


CONDITIONAL (MUST be ·completed when required by ITEM DEFINITION)


C:\WPSl\DOCS\PAM\3.200158

I

\

3.255 (Rev. 08/ 96)

LINES 8 -9 ITEMS:

874 - Adverse Action and Rejection Substantiation (REQUIRED)

952 Case No. and Date of Action 958 Separation Time .To Be Paid

· Substantiation

960

962

999

Corrected Transaction Identifier Separation Pay At Alternate Salary Rate Deductioninfonnation

UNE 10 REMARKS AND BACKUP INFORMATION: .

Refer to PAM pages 2.201 . -· 2.205 for specific substantiation required on:


2 - Adverse Actions

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3.256 (Rev. 11/96)

S90 OTHER SEPARATION

REJECTION DURlNG

PROBATION PERlOD *1

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*1 See PAM Section 5 for information on documenting Decision of SPB After Appeal.




C:\WPSI\DOCS\PAM\3.200/60

'·

l

3.257 (Rev. 09/03)

LINES 8-9 ITEMS:

871 - Right of Return Designation 958- Separation Time To Be Paid Substantiation

872- Salary Increase Certification 960- Corrected Transaction Identifier

874- Adverse Action and Rejection 962- Separation Pay At Alternate Salary Substantiation (REQUIRED) Rate






1 - Certain deductions or payments to be made·fr.om employee's final r.?<iy. (See PAM page 2.151.)

2 - Rejection during probation .. (S9.0). ·

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1

4

5

6

7

S95 3.258

I f'ASY H.AW1E NC)

I I I I I

(Rev. 08/98)

OTHER SEPARATION DEATH ·1, •z

·1 For an employee employed in more than one position, appointing power(s) should coordinate the processing of separations from all positions.

·2 Refer to PAM pages 5.102, 6.1, 6.8, 6.11, 8.8 and 10.16.1 for special instructions.

·= .REQUIRED (MUST be completed)


e ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed

. for a valid traf)saction)

C:IWP51\00CS\PAM13.200/62

~~"'-,

i

PAM 3.259 (Rev. 09/03)

LINES 8-9 ITEMS:

872 - Salary Increase Certification

877* Lump Sum Payment Deferral

880- Time of Death (REQUIRED)

958 - Separation Time to Be. Paid Substantiation



999- Deduction Information

-·

* Refer to Pam Section 5. 76 or documentation instructions.

LINE 1·0 REMARKS AND BACKUP INFORMATION:


1 -Certain deduction·s or payments to be made from employee's final pay. (See PAM page 2.151.)

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3.260 (Rev. 08/05)

599 CANCELLATION OF APPOINTMENT*1

...

I f"RST ..W.C »C t.ClO..£ NTW. I



ONE OR MORE

REQUIRED

I I I I

(ONE or MORE or these items

on this chart MUST be

completed for a valid

transaction)

*1 . The S99 Transaction is used to cancel an employees ONLY..appointment to the data base or .atl.LY appointment to an additional position when:

a. the employee did not report to work; or b. the employee was erroneously appointed.

NOTE: S99 is nat used for an incorrect effective date (Refer to PAM 10.14-10.14.1 for voiding only appointment in history because effective date of appointment should be posted with an earlier or later effective date).

S99 is oat used when social security number is keyed incorrectly (Refer to Pam 3.104 and 10.9 when error is discovered on the social security

umber).

Refer to Section 9 when voiding an appointment for a Position that has

existing history on the database.

*2 This transaction must be effective the same date and hour(s) as the appointment being cancelled. If the-appointment effective date "Hours" box is

blank, "BOB" must be entered.

*3 Entry must be "NON".

3. 261 (Rev. 10/ 84)

LINES 8 -9 ITEMS:


UNE 10 REMARKS AND BACKUP INFORMATION:

Refer to PAM pages 2.201 - 2.205 for specific substantiation required on :

l - S99

0332c65

separation transaction codes-required/conditional … · *1 this item is conditional for exempt...

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