"Acting Assignment Pay Request Form" - City and County of San Francisco, California

Acting Assignment Pay Request Form is a legal document that was released by the Department of Human Resources - City and County of San Francisco, California - a government authority operating within California. The form may be used strictly within City and County of San Francisco.

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City and County of San Francisco
ACTING ASSIGNMENT PAY REQUEST FORM
I.
E
I
MPLOYEE
NFORMATION
Name of Employee Assigned
Salary
(for period of assignment)
(Rate Change & eff. Date)
Bi-weekly
Hourly $
DSW ID#
Employee Organization/Union
Step
Salary Grade #
Current Job Code/Title
Current Funding
Job Code
Pos. No.
Dept
Program
Sub Fund
Project
Grant
Other
II.
A
I
SSIGNMENT
NFORMATION (Position to which employee will be assigned)
I
?
Explain:
Date Extension Begins
Date Extension Ends
S THIS AN EXTENSION
Yes
Job Code/Title of Temporary Assignment
Date Assignment
Adjusted Salary
(Rate Change & eff. Date)
Begins
Bi-weekly
Hourly $
Vice Name
Date Assignment
Step
Employee No.
Ends
Salary Grade #
Reason for Assignment
Eff. Date Acting Pay
Description of Duties: (DO NOT ATTACH JOB CLASS SPECIFICATION)
Dept
Program
Sub Fund
Project
Grant
Other
F
I
UNDING
DENTIFICATION

Budgeted
Non-Budgeted*
*Explain
III.
APPROVAL
Certifies Assignment meets conditions of applicable MOU provisions and validates description of duties statement.
Signature of Appointing Officer or Designee
Title
Date
DEPARTMENT: Retain copy of this form. It may be submitted to support claims of qualifying experience for DHR examinations.
Corrections to Form By:  Controller’ Budget Office
Date: _____
City and County of San Francisco
ACTING ASSIGNMENT PAY REQUEST FORM
I.
E
I
MPLOYEE
NFORMATION
Name of Employee Assigned
Salary
(for period of assignment)
(Rate Change & eff. Date)
Bi-weekly
Hourly $
DSW ID#
Employee Organization/Union
Step
Salary Grade #
Current Job Code/Title
Current Funding
Job Code
Pos. No.
Dept
Program
Sub Fund
Project
Grant
Other
II.
A
I
SSIGNMENT
NFORMATION (Position to which employee will be assigned)
I
?
Explain:
Date Extension Begins
Date Extension Ends
S THIS AN EXTENSION
Yes
Job Code/Title of Temporary Assignment
Date Assignment
Adjusted Salary
(Rate Change & eff. Date)
Begins
Bi-weekly
Hourly $
Vice Name
Date Assignment
Step
Employee No.
Ends
Salary Grade #
Reason for Assignment
Eff. Date Acting Pay
Description of Duties: (DO NOT ATTACH JOB CLASS SPECIFICATION)
Dept
Program
Sub Fund
Project
Grant
Other
F
I
UNDING
DENTIFICATION

Budgeted
Non-Budgeted*
*Explain
III.
APPROVAL
Certifies Assignment meets conditions of applicable MOU provisions and validates description of duties statement.
Signature of Appointing Officer or Designee
Title
Date
DEPARTMENT: Retain copy of this form. It may be submitted to support claims of qualifying experience for DHR examinations.
Corrections to Form By:  Controller’ Budget Office
Date: _____